Problems after prostate cancer treatment

Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate (pee).

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 have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.

Depending on the type of problems you’re having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.

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 is to drain urine out of your body. You'll usually have a catheter for about seven to 10 days after surgery. 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 with you when you go to have your catheter removed. Close fitting underwear can help to keep the pads in place, and men often find loose, lightweight trousers most comfortable.

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.

Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. But other men leak urine for a year or more, and some men never fully recover, even if they have treatments to help with their incontinence.

 

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.

There are treatments and products available that can help:

  • absorbent pads and pants
  • pelvic floor muscle exercises
  • urinary sheaths
  • bed protectors and handheld urinals
  • penile clamps.

If you have sudden urges to urinate (urinary urgency) and sometimes leak urine before you get to the toilet (urge incontinence), you may be offered bladder retraining.

If you still leak urine six to 12 months after surgery and pelvic floor muscle exercises haven’t helped, there are treatments available that might help. These may include:

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 that 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.

Bed protectors and handheld urinals

Bed protectors are large pads that protect your sheets and mattress by soaking up any urine that you might leak. There are pads that you can wash and reuse, and others that you only use once before throwing them away

Handheld urinals are containers with a lid that can be used if you can’t reach the toilet in time or if there isn’t a toilet nearby. These might also be useful if you drive long distances and don’t have any toilet near you.

Penile clamps

A penile clamp fits onto the penis and squeezes it, closing the urethra so that no urine can leak out. You should only use a penile clamp during the day for short periods of time, and should open it at least every two hours to let your blood flow back into your penis.

Penile clamps can be uncomfortable to wear and aren’t commonly used in the UK. They aren’t usually recommended by health professionals, as they reduce the blood flow to the penis. This means it can be unsafe if a clamp is put on too tightly or for too long.

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.

Internal sling attached to bone

 

You may be able to have an internal sling if you still leak a moderate amount of urine (if you use two to three pads a day) one year after your treatment for prostate cancer

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 have 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 isn’t very common.

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

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

The cuff presses the urethra closed so that you don't leak urine. This means you can 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.

An artificial urinary sphincter is usually only suitable for men who still leak a lot of urine at least six months after their prostate cancer treatment.

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.

Adjustable balloons      

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

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. So 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. But you probably won't be able to have them if you've had radiotherapy.

There are risks in having these balloons. They include infection, or the balloons shrinking or moving, and you may need to have the balloons removed. Your doctor or nurse can tell you more about the possible risks.

Adjustable balloons aren’t very common in the UK. 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 called an anti-cholinergic 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 (urine retention). 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 is 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:

  • needing 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). This happens when the bladder muscles twitch and squeeze (spasm) without you controlling them. This pushes urine out before you're ready.

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

If you need to urinate more often than usual or sometimes leak before reaching the toilet, you could try a technique called bladder retraining. This can help you control when you urinate, and help you hold on for longer. Speak to your specialist continence nurse or physiotherapist for more information.

Medicines

Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks. If you can't have anto-cholinergics, you may be offered mirabegron (Betmiga®) tablets.

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 needle is placed under the skin just above your ankle. A low electrical current is passed through the needle 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. This may be more likely if you have an enlarged prostate. Radiotherapy, particularly brachytherapy, 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 about 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, and affect 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.

  • Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
  • Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
  • Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
  • If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
  • 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 our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
  • 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.

Your GP, specialist nurse or continence nurse can offer you practical and emotional support. You can also speak to our Specialist Nurses. It can sometimes help to talk to other men living with prostate cancer. We have a range of services that can help put you in touch with someone who’s been there and understands what you’re going through. Visit our Who can help page to find out more.

For more information look at our How to manage urinary problems guide.

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?

References

Updated: May 2017 | Due for Review: May 2019

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