Problems after prostate cancer treatment

Many men get urinary problems as a side effect of their treatment.

If you’re starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment you’re having, and on whether or not you had urinary problems before starting treatment.

If you’ve already had prostate cancer treatment and you’re getting urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes that can help manage or even stop these problems.

The prostate gland lies underneath the bladder and surrounds the urethra – which is the tube that carries urine from the bladder, through the penis and out of the body. So both the bladder and urethra can be damaged by treatments for prostate cancer, causing side effects.

Urinary symptoms can also be caused by prostate cancer itself, by other prostate problems, or by a urine infection.

Watch Paul's story for one man's experience of managing urinary problems after prostate cancer treatment:

Problems after surgery (radical prostatectomy)

Surgery can cause urinary problems, including:

Leaking urine

This is the most common urinary problem after surgery. When you wake up after surgery, you’ll have a thin tube called a catheter in your penis. This allows urine to drain out of the body. Most men can’t control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.

Your hospital may give you some absorbent incontinence pads to put in your underwear. But you might want to take some pads when you go to have your catheter removed. Close fitting underwear can help to keep the pads in place, and men often find loose trousers most comfortable.

Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. But some men leak urine for a year or more.

You might just leak a few drops when you exercise, cough or sneeze (stress incontinence). Or you might leak larger amounts. Some men also leak urine when they get an erection or during sex.

What can help with leaking urine?

Your treatment options will depend on how much urine you’re leaking, and how recently you had your prostate cancer treatment. Talk to your doctor or nurse about treatments and products that may be suitable for you.

Absorbent pads and pants

These can be worn inside your underwear, or instead of underwear. They soak up any leaks and are usually very discreet, so people won’t know you’re wearing them. Services vary from area to area, but your local NHS service may provide some pads for free. Talk to your doctor, nurse or continence advisor for more information.

Pelvic floor muscle exercises

These can strengthen the pelvic floor muscles, which help control when you urinate.

Read about pelvic floor muscle exercises.

Urinary sheaths (external catheters)

You might hear these called external catheters. These look like condoms with a tube attached to the end, which drains urine into a bag. The sheath fits tightly over the penis and you can strap the bag to your leg – under your clothes – and empty it as needed.

Artificial urinary sphincter

This involves surgery to fit a small device that consists of:

  • a fluid-filled cuff that fits around your urethra
  • a balloon in front of your bladder
  • a pump in your scrotum (the skin around your testicles). 

Artificial urinary sphincter 2014

The device lets you control when you urinate.

  • You squeeze the pump in your scrotum – this moves the fluid out of the cuff and into the balloon.
  • When the cuff is empty it stops pressing your urethra closed, letting urine pass through the urethra so that you can urinate.
  • After a few minutes, the fluid flows back into the cuff, pressing the urethra closed again.

One study found that over a quarter (27 per cent) of men with an artificial urinary sphincter no longer needed to use incontinence pads and over half (52 per cent) needed only one pad a day.

You’ll have an operation to fit the device. You will have a general anaesthetic, so you’ll be asleep and won’t feel anything.

Like all operations, there are risks in having an artificial urinary sphincter, such as infection or parts of the device breaking. Some men need another operation to fix problems. Around one in 10 men (10 per cent) may need their device taken out. Your doctor or nurse can tell you more about the possible risks.

If your hospital doesn’t do this type of surgery, your doctor may be able to refer you to one that does.

Internal male sling

This is a small piece of material that presses gently on your urethra to keep it closed and stop urine leaking. You’ll have an operation to fit the sling. It should be tight enough to stop urine leaking out, but loose enough to let you urinate when you want to.

Male sling 2014

You may be offered an internal sling if you leak a moderate amount of urine (if you use two to three pads a day) one year after your treatment for prostate cancer. Up to three quarters (75 per cent) of men with an internal sling no longer leak urine or need pads.

The sling may not work as well if you leak a lot of urine or have previously had radiotherapy.

You’ll have an operation to fit the internal sling. You will usually have a general anaesthetic so you’ll be asleep.

Like all treatments, there can be side effects.

  • You may get some pain in the first three months after the operation.
  • You might get an infection – about one in 10 men (12 per cent) may need their sling removed because of an infection.
  • A small number of men have problems urinating (urine retention) after their operation, but this is rare.

Your doctor or nurse can tell you more about the possible risks.

Adjustable balloons      

This involves surgery to place two small fluid-filled balloons around your urethra. The balloons press on the urethra to stop urine leaking out – but you should still be able to urinate when you want to.

Adjustable balloons

Each balloon contains fluid and is attached to a device called a ‘port’, which is placed in your scrotum. Your doctor can use these ports to make the balloons bigger or smaller at any time. For instance if you still leak urine after the balloons are fitted, your doctor can inject more fluid into them so that they get bigger and press more on the urethra. If you can’t urinate properly, your doctor can remove some fluid from the balloons so they press on the urethra less.

Balloons may be an option if you still leak urine more than six months after your prostate cancer treatment. Up to two thirds (67 per cent) of men with balloons no longer leak, or need just one pad a day.

There are risks in having these balloons. They include infection, or the balloons shrinking or moving. Up to three in every 10 men (30 per cent) may need to have their balloons taken out. Your doctor or nurse can tell you more about the possible risks.

Adjustable balloons aren’t used very often. If your hospital doesn’t do this type of surgery, your doctor may be able to refer you to one that does.

Medicines

If you continue to leak urine, or if other treatments aren’t suitable for you, you may be offered a medicine to help keep the urethra closed, or to calm your bladder down. This can help to reduce leakages. All drugs can cause side effects, so talk to your doctor or nurse about the possible side effects and how to manage them.

Difficulty urinating

Some men may find it difficult to urinate after surgery. This is caused by scarring, which can cause the urethra to become narrow. This isn’t very common after surgery.

Problems after radiotherapy

Both external beam radiotherapy (EBRT) and brachytherapy can cause urinary problems, including:

Some men may leak urine after radiotherapy, but this is less common. It may be more likely if you’ve previously had surgery for an enlarged prostate.

Radiation cystitis

Radiotherapy can irritate the lining of the bladder and the urethra – this is called radiation cystitis. Symptoms include:

  • a need to urinate more often, including at night
  • a burning feeling when you urinate
  • difficulty urinating
  • blood in the urine.

Symptoms can start within a few days of your first treatment. They usually begin to improve when your treatment ends. But some men get symptoms for several months. And some don’t get symptoms until months or even years after their final treatment.

Symptoms such as blood in the urine can be worrying, but this is quite a common symptom of radiation cystitis.

If you get symptoms of radiation cystitis, tell your doctor or nurse. They can check whether your symptoms are caused by your treatment or an infection.

What can help with radiation cystitis?

There are treatments that can help with radiation cystitis, as well as things you can do yourself.

Lifestyle changes

Drink plenty of fluids (1.5-2 litres, or 3-4 pints a day), but try to avoid fizzy drinks, drinks containing caffeine – such as tea, coffee and cola – and alcohol, as these can irritate the bladder.

Some men find that drinking cranberry juice helps. But you should avoid cranberry juice if you’re taking warfarin to thin your blood.

Bladder wash

This is a liquid medicine that coats and protects the lining of the bladder, making it less irritated. A small tube (catheter) is passed up your penis and fills your bladder with the liquid medicine. You then go to the toilet to empty your bladder.

Urinary frequency and urgency

Some men find they need to urinate more often after having radiotherapy (urinary frequency). You may also need to urinate more often at night (nocturia). If this happens, it might help to drink less in the two hours before you go to bed.

You might get sudden urges to urinate that are hard to ignore (urinary urgency). And a small number of men leak urine before they can reach the toilet (urge incontinence).

What can help with urinary frequency and urgency?

There are treatments that can help with urinary frequency and urgency, as well as things you can do yourself.

Bladder retraining

Over time, this can help you hold on for longer and control when you urinate. Speak to your specialist continence nurse or physiotherapist for more information.

Medicines

Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks.

Percutaneous posterior tibial nerve stimulation (PTNS)

This is quite a new treatment that may help some men to urinate and leak urine less often. A low electrical current is used to affect the nerves that control urination. This can help stop the bladder from emptying before it’s full.

Botulinum toxin (BOTOX®)

Injecting BOTOX® into the wall of the bladder can help stop the bladder squeezing out urine before it’s full. This is quite a new treatment for urinary frequency and urgency and it’s not available in all hospitals.

Difficulty urinating

Some men find it hard to empty their bladder properly after radiotherapy – this is called urine retention. Radiotherapy can cause the prostate to swell and block the urethra, leading to urine retention. It can also cause the urethra to become narrow – this is called a stricture.

Chronic urine retention

Some men can still urinate a little, but can’t empty their bladder fully – this is known as chronic urine retention. The first signs often include:

  • leaking urine at night
  • feeling that your abdomen (stomach area) is swollen
  • feeling that you’re not emptying your bladder fully
  • a weak flow when you urinate.

Tell your doctor or nurse if you get any of these symptoms. Chronic urine retention is usually painless, but the pressure of the urine can cause the bladder muscles to slowly stretch and become weaker. This can cause urine to be left behind in the bladder when you urinate. You may be more likely to get urine infections, bladder stones, blood in your urine or kidney problems.

Treatments for chronic urine retention include:

  • a catheter to drain urine from the bladder
  • drugs (alpha blockers or 5-alpha-reductase inhibitors)
  • surgery to widen the urethra or the opening of the bladder.

Acute urine retention

This is when you suddenly and painfully can’t urinate – it needs treating straight away. If this happens, call your doctor or nurse, or go to your nearest accident and emergency (A&E) department. They may need to use a catheter to drain your bladder.

Problems after high intensity focused ultrasound (HIFU)

You’re more likely to get urinary problems after HIFU if you’ve already had other treatments for prostate cancer. Possible urinary problems include:

  • difficulty urinating
  • leaking urine
  • urine infections.

Difficulty urinating

HIFU usually causes the prostate to swell for a week or two, so you’ll have a catheter to drain urine from your bladder until the swelling has gone. HIFU can also cause the urethra to become narrow, making it difficult to empty your bladder (urine retention).

Leaking urine

HIFU can cause some men to leak urine when they cough, sneeze or exercise (stress incontinence). This may be more likely if you’ve already had radiotherapy. There are ways to manage leaking urine.

Urine infections

Some men get a urine infection after HIFU. If this happens, you’ll be given a course of antibiotics to clear the infection.

Read more anbout urine infections in our fact sheet, Urinary problems after prostate cancer treatment.

Problems after cryotherapy

You’re more likely to get urinary problems after cryotherapy if you’ve already had radiotherapy. Possible urinary problems include:

  • difficulty urinating
  • leaking urine

Difficulty urinating

Cryotherapy can cause the prostate to swell, making it difficult to urinate for a week or two. You’ll have a catheter to drain urine from your bladder until the swelling has gone. Cryotherapy may also cause the urethra or the opening of the bladder to become narrow, making it difficult to urinate (urine retention).

Leaking urine

A small number of men who have cryotherapy may leak urine. This is more likely if you’ve already had radiotherapy. There are ways to manage leaking urine.

How can I help myself?

Urinary problems can affect your self-esteem and independence, as well as your work, social and sex life.

Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.

  • Drink plenty of fluids – 1.5-2 litres (3-4 pints) a day. You may worry about drinking lots if you’re leaking urine, but it can help prevent bladder irritation and infection. If your urine is dark, this could be a sign that you need to drink more.
  • Cut down on fizzy drinks, alcohol and drinks that contain caffeine (tea, coffee and cola), as these can irritate the bladder.
  • Regular pelvic floor muscle exercises can help strengthen the muscles that control when you urinate, and help if you leak urine.
  • Eat plenty of fibre and drink plenty of fluids to avoid constipation (difficulty emptying your bowels), as this can put pressure on your pelvic floor muscles.
  • If you smoke, try to stop as this can cause coughing, which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking.
  • Try to maintain a healthy weight and level of fitness. Being overweight can put pressure on your bladder and pelvic floor muscles.
  • Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
  • Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they can’t find a toilet.
  • Get an ‘urgent’ toilet card to show to staff in shops, restaurants and other public places. They should let you use their toilets without asking awkward questions.
  • Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
  • If you often need to use the toilet at night, leave a light on in case you’re in a hurry, or keep a container near your bed.

Who else can help?

  • Your GP, specialist nurse or continence nurse can offer you practical and emotional support.
  • Our Specialist Nurses can answer your questions over the phone and go through ways of managing urinary problems with you. You can also speak to a specialist nurse online. They can arrange for you to get an ‘urgent’ toilet card to show to staff in shops, restaurants and other public places.
  • Our trained volunteers can speak to you about your worries and their experience of urinary problems.
  • You might have a local support group where you can meet other men with prostate cancer or urinary problems.
  • Our online community is a place for you to ask questions or share experiences.
  • There's a list of organisations that can offer information and support in our online fact sheet.

Questions to ask your doctor or nurse

  • Is the treatment I’m having for prostate cancer likely to cause any urinary problems?
  • What type of urinary problems might I get?
  • What should I do if I can’t urinate?
  • Will my urinary problems get better?
  • What treatments are available?
  • What are the risks and side effects of treatments for urinary problems?
  • What can I do to help myself?
  • Where can I get pads and other products?

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