Urinary incontinence (urine leakage) after pelvic radiotherapy

Pelvic radiotherapy can cause long-term changes to the way the bladder works. You may leak small amounts of urine. This is called urine incontinence.

About urinary incontinence (urine leakage)

Urine leakage (urinary incontinence) can happen if the pelvic floor muscles and the valve that keeps the bladder closed are weakened.

There are different types of incontinence: 

  • Stress incontinence 
    You may leak small amounts of urine when you laugh, sneeze or cough, or when you are exercising.
  • Urge incontinence 
    If you have an overactive bladder, you may find that you cannot always get to the toilet in time. We have information on treating an overactive bladder that can help.

If you have problems with leaking urine, it can make the skin in that area sore. You can protect your skin by keeping it clean and dry. There are lots of products available to help you. Your specialist can give you more information.

Get a toilet card

Macmillan has a free toilet card you can use. It may help you access a toilet more quickly when you are out. You can use it in places such as shops and pubs. The card says you have a medical condition that means you need urgent access to a toilet.

Pelvic floor exercises

The most common treatment for urinary incontinence is to do exercises to strengthen the pelvic floor muscles. We have more information about doing these exercises.

It is best to ask your doctor to refer you to a continence adviser. They can teach you how to do the exercises correctly. The Bladder and Bowel Community can also give you details of your nearest adviser and can send you information about pelvic floor exercises.

Drugs to control your bladder

If pelvic floor exercises do not help, your doctor may suggest using drugs to help you control your bladder. Your doctor or continence adviser can tell you more about this.

Surgery

Occasionally, when other treatments have not helped, you may be offered an operation to improve incontinence. If this could help, your doctor will discuss it with you. You will be referred to a specialist surgeon for an assessment. You may need to have tests before any treatment.

Some types of surgery may only be available as part of a clinical trial. Your specialist can tell you more about this.

It is important that you understand everything about your operation. You should be given the chance to discuss the operation with your surgeon and ask questions. This might happen at the pre-assessment clinic. You will need to sign a consent form to say that you agree to the operation. No operation will be done without your consent.

Possible treatments include:

  • Tape or sling to support the urethra

    The surgeon inserts a tape or sling inside the body under the urethra to support it. This helps stop urine leaking when there is increased pressure on the bladder, for example when you cough or sneeze.
    A sling is usually made from tissue. It is often the tissue that covers your abdominal (tummy) muscles. Tape is made from a plastic mesh material. Mesh has been linked to serious complications in some people. Talk to your surgeon about this.

  • Bulking agents

    A doctor can inject these into the wall of your urethra. This helps keep it closed and makes it harder for urine to leak out. You may need several injections for them to work, and they become less effective over time.

  • Artificial urinary sphincter (AUS)

    This treatment is not often done. It may be suitable for some people who are leaking a lot of urine most of the time. The surgeon inserts a small cuff around the urethra. The cuff is attached to a pump that the surgeon places in the skin next to the vagina or around the testicles.
    When you want to pass urine, you deflate the cuff by squeezing the pump under the skin between your fingers. This takes pressure off the urethra, allowing it to open so you can pass urine. The cuff then automatically inflates again.

If bladder problems do not improve

If your bladder symptoms continue or do not improve after having these treatments, your specialist may talk to you about other possibilities. When symptoms are severe, an operation to remove the bladder may be an option, but this is very rare.

We have information about coping with bladder or bowel problems.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

About our information

  • References

    Below is a sample of the sources used in our pelvic radiotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Andreyev HJN, Muls AC, Norton C, et al. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology, 2015; 6, 53-72.

    Dilalla V, Chaput G, Williams T and Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Current Oncology, 2020; 27, 2, 107-112.

    The Royal College of Radiologists. Radiotherapy dose fractionation. Third edition. 2019. Available from: www.rcr.ac.uk/system/files/publication/field_publication_files/brfo193_radiotherapy_dose_fractionation_third-edition.pdf [accessed March 2021]. 


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.