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Bladder changes after pelvic radiotherapy

Bladder changes caused by pelvic radiation disease (PRD) can show as a variety of symptoms. These may be uncomfortable and inconvenient, or even painful and distressing. 

We hope the information on this page helps explain why you might have bladder symptoms and how to manage them. We are also here if you need some extra support or aren’t sure where to start.

Get support >

About bladder changes

Pelvic radiotherapy uses radiation to destroy cancer cells in that part of the body. It may also damage healthy cells and tissues in that area, which can include the bladder. 

Bladder changes are common after pelvic radiotherapy for any cancer . Research has suggested that about 2 in 10 (20%) cervical cancer patients have long-term bladder problems, with those who had some type of radiotherapy treatment being more affected.

Symptoms of bladder changes

The common symptoms of bladder changes after pelvic radiotherapy are:

  • needing to wee more often 
  • needing to wee more urgently or in a rush 
  • pain or a burning feeling when weeing 
  • leaking wee or having accidents where you cannot control your bladder 
  • blood in your urine
  • finding it difficult to wee
  • feeling the need to wee even when your bladder is empty
  • having a lot of gas or wind.

Medical treatments for bladder changes

Bladder problems can be inconvenient and you may feel embarrassed by them, particularly if they involve leaking or needing the toilet more often. 

If your symptoms are mild, you may be able to manage them with lifestyle changes and pelvic physiotherapy. However, if these options don’t work, there are medical treatments available.

Speaking with your healthcare professional 

It is important that your healthcare professional tries to diagnose the underlying cause of the bladder symptoms, rather than simply treating the symptom itself.

You can speak with:

  • your GP
  • your clinical nurse specialist (CNS)
  • your cancer doctor (consultant).

It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history.

You might be having this conversation years after you have finished your treatment, so it is a good idea to be clear about what is happening. You could:

  • tell them that these bladder changes started after pelvic radiotherapy treatment
  • tell them when the symptoms started
  • tell them how long the symptoms have lasted for
  • explain the impact the symptoms are having on your life – be prepared to give all the details. 

You may like to write down what you experience day-to-day or keep a diary of when the bladder changes flare up.

Read more about getting a diagnosis >

Possible underlying causes

Although bladder changes can present as a specific symptom – for example, pain when weeing – they may be happening because of a different condition caused by pelvic radiotherapy. It is important that this underlying cause is tested for. We spoke with experts who told us they sometimes see patients with PRD who have these conditions:

Pelvic radiotherapy can irritate the lining of the bladder and cause symptoms including needing to wee more often or urgently, pain and incontinence. This is called radiation cystitis. 

Radiation cystitis can be treated with medicines. It is best to talk to your GP or healthcare team if you have symptoms of radiation cystitis.

Possible treatments for symptoms 

As well as treating any underlying causes, it is also possible to treat the symptoms of bladder changes. 

Some of these treatment options may be prescribed by your GP or hospital healthcare team. For more severe or persistent problems, you should be referred to a urologist – a doctor who can diagnose and treat bladder problems. 

Possible treatments could include:

  • medications to relax the bladder – these can help to reduce how urgently and often you need to use the toilet
  • medications to help reduce bleeding
  • sealing off blood vessels with heat to stop bleeding – this is sometimes called cauterisation
  • in more severe cases, surgery may be an option to help prevent leaks.

Lifestyle changes for bladder changes

You can make some changes to your lifestyle to help reduce or manage bladder changes. A healthy lifestyle is also good for overall health and wellbeing. This includes:

  • eating a balanced diet
  • maintaining a healthy weight 
  • exercising regularly. 

There are also a number of bladder-specific exercises and lifestyle changes you can use to manage and alleviate some of your symptoms.

Diet

Although changes to your diet may seem more relevant if you have bowel symptoms, having a healthy diet and managing your weight can also help with bladder problems. Not being able or finding it hard to poo (constipation) and being overweight can put extra pressure on the bladder, which can make any symptoms worse.

Read about good bowel health after pelvic radiotherapy > 

You might be tempted to drink less than normal if you’re anxious about leaking or having an accident. But not drinking enough can make your bladder more sensitive, so it’s important to drink at least 1.5 to 2 litres (3 pints) each day. 

The Bladder & Bowel Community has a guide to the best types of drinks for a healthy bladder. These include: 

  • water
  • decaffeinated tea and coffee
  • diluted or non-acidic fruit juices. 

Unsweetened cranberry juice is sometimes recommended if you’re suffering from urinary tract infections.

Read the Bladder & Bowel Community’s guide > 

Exercise

Doing regular exercise is important for a healthy lifestyle, but bladder changes may mean you need to think more carefully about the type of exercise that’s right for you. 

Pelvic floor exercises are designed to strengthen the muscles supporting your bladder. This helps to improve bladder control and alleviate incontinence. 

If you’re not sure how to do pelvic floor exercises, you can ask to be referred to a pelvic physiotherapist or women’s health physio. They can guide you through the correct technique as well as recommending any tools, such as Kegel eggs or weights, to help strengthen these vital muscles.

Read about pelvic floor exercises on the NHS website > 

Stress incontinence is when physical activity or a movement, such as sneezing, puts pressure on your bladder and causes wee to leak. This can be a symptom of bladder changes. 

If you have stress incontinence, it is a good idea to avoid high-impact exercises, such as running. Instead, you could try exercises that have a lower impact, including:

  • walking 
  • swimming
  • yoga 
  • Pilates.

You can also add pelvic floor exercises to activities like yoga and Pilates, so they can have extra benefit.  

Practical management of bladder changes

While lifestyle changes and medical treatments can help to improve your symptoms, we know that bladder changes can be really difficult to manage. This is especially true when you are away from home. Not having easy access to a toilet can be a huge source of anxiety when you have bladder changes. It’s always worth checking where the nearest toilets are when you’re out, to reassure yourself and avoid any accidents.

The impact of COVID-19

Accessing public toilets may be more difficult at the moment, as local restrictions are put into place due to the COVID-19 pandemic. The website Lockdown Loo has a list that shows public toilets around the UK that are currently open.

Visit the Lockdown Loo website > 

Disabled toilets and emergency access

As some shops, restaurants and leisure venues reopen after COVID-19 restrictions are lifted, it’s worth remembering that many of these will have customer toilets available. 

There are a number of toilet cards you can apply for. The cards discreetly explain that you have a medical condition that means you need to use the toilet urgently. You can order a free toilet card from:

You can also buy a Radar Key from Disability Rights UK. This master key is part of the National Key Scheme (NKS). It gives you access to more than 9,000 locked disabled toilets around the country, including in shopping centres, department stores, pubs and cafes.

Buy a Radar Key > 

Changing Places also have a list of accessible toilets and rooms that can be used if you need a more private space. Some of them are free to access and some of them need a Radar Key. You can search for your nearest Changing Places toilet to find out more about it.

See the Changing Places toilet map >

Emergency bag

It is a good idea to prepare and carry an emergency bag, in case of any accidents. You could include:

  • a spare pair of underwear
  • a change of clothes
  • a waterproof bag that you can seal
  • wet wipes
  • hand sanitiser 
  • a pack of tissues
  • any toiletries you might want for a quick freshen up. 

You could leave the emergency bag in the boot of your car, in the bottom of your usual bag, or near the front door, so you remember to take it with you. 

You may not ever need the emergency bag, but knowing that you are prepared may ease any anxiety and help you to feel calmer about going out.

Getting support with bladder changes

We understand that bladder changes can impact the practical side of your day-to-day life, as well as your emotional wellbeing and confidence. It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but it’s important that you get support based on your individual situation.

If you are not sure where to turn, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.

Check our Helpline opening hours > 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum > 

If you have general questions about PRD, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service >

Useful organisations

Bladder & Bowel Community 

A UK-based network providing information and support for bladder and bowel problems. Offers a free ‘Just Can’t Wait’ toilet card.

www.bladderandbowel.org

Bladder Health UK

Offers information and support for anyone living with bladder problems, including a confidential advice line and local support groups.

www.bladderhealthuk.org 

Pelvic Radiation Disease Association (PRDA)

A UK charity providing information about PRD. Has an online community as well as hosting national and local events for people with PRD.

www.prda.org.uk

Action Radiotherapy

A UK charity dedicated to improving radiotherapy treatments. Provides information about radiotherapy, including side effects.

www.actionradiotherapy.org 

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • Liberman, D. et al (2014). Urinary adverse effects of pelvic radiotherapy. Translational Andrology and Urology. 3;2. pp.186-195.
  • Pfaendler, K. et al (2015). Cervical Cancer Survivorship: Long-term Quality of Life and Social Support. Clinical Therapeutics. 37;1. pp.39-48.
  • Pascoe, C. et al (2018). Current management of radiation cystitis: a review and practical guide to clinical management. BJU International. 123. pp.585-594.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected].

Read more about how we research and write our information >

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Date last updated: 
29 Oct 2020
Date due for review: 
29 Oct 2022
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