Ask the experts

Will bladder cancer cause urine leaks?

The most common symptom for bladder cancer is blood in the urine but, when the bladder gets irritated, it can lead to pain or, on a rare instance, some urgency to urinate that might lead to urinary leaking. Incontinence is the term used when your bladder causes urine leaks when it shouldn’t.

Bladder cancer and certain cancer treatments that are within the pelvis may cause urine leaking. For example, radiation used to treat prostate cancer in the pelvic area can irritate the bladder and might lead to leaking urine when you feel urgency. Some surgery in the pelvic area can cause the muscle that controls urine to weaken and can lead to incontinence.

Urinary leaking is not specific to bladder or pelvic cancers. There are many other causes of urinary leaking. Causes may include medicines that cause your body to make more urine leading to urgency and urge incontinence, bladder irritants like coffee or spicy foods and other conditions like disease that damages the nerves or diabetes.

If you feel like your bladder isn’t holding your urine well, there are treatments that may help. Talk to your doctor about what is best for you. Certain questions and tests can help your doctor learn more and provide the best treatment plan. Some treatments work better than others based on why leaking is happening. Some strategies include bladder training (going to the bathroom at specific times), physical therapy (Kegel exercises), medication, medical devices (like a pessary for women), surgery or using support devices.

Before using some of the more invasive treatments, lifestyle changes may help. The first step may be to limit what you drink and when. For example, coffee and alcohol can cause your body to make more urine. Or, you can avoid foods that may irritate the bladder. These could be dairy products, citrus or sugary things like soda or chocolate. As a quick-fix, you can wear an absorbent pad. Maintaining a healthy weight also helps.

Dr. Ali A. Dabaja is the Vice-Chair of Clinical Affairs, Director of Male Reproductive & Sexual Medicine and Associate Director of Urology Residency at the Vattikuti Urology Institute at Henry Ford Hospital. He is also the Clinical Associate Professor at the Wayne State School of Medicine. His clinical focus includes male infertility and sexual medicine.

How does sexual health and intimacy change with bladder cancer?

You likely ask your doctor lots of questions about how to save your life after getting a cancer diagnosis, but do you ask how to protect your sexual health? Too often, conversations about sex and sexual health are not talked about enough. Whether you need surgery or something else for bladder cancer, you should ask your doctor about your sexual health before treatment starts.

With the bladder located so close to reproductive organs, there are many ways treatment can make an impact. For example, if BCG is recommended for non-invasive bladder cancer, you’ll want to protect your partner from the live bacteria. It is key to stay clean and use a condom in this case. Or if you need surgery, there are nerve-sparing options that may help reduce sexual side effects. If you’re a woman, you should know that treatment can lead to menopause. The point is, ask questions about your sexual health in advance. This way you can take positive steps to protect your physical and mental health.

Beyond physical issues from treatment, many people lose the mood or self-confidence for sexual activity after dealing with cancer. Even so, it is still of great value to feel good about your body and feel close to someone you love. You can still explore ways to be intimate, like kissing, cuddling or massages. Stay open and share your feelings with your partner. If you need help, ask your urologist if their urologic practice has a sexual medicine specialist on hand. A specialist may be able to help your specific concerns and needs.

If you are concerned about your sexual health after a bladder cancer diagnosis, you are not alone. Start by asking your doctor questions and take one positive step at a time from there.

Dr. Landon Trost, a urologist at Brigham Young University, focuses on male infertility, vasectomy reversal and Peyronie’s disease.

Does having a urostomy bag affect quality of life?

For people with bladder cancer, your treatment may involve removing your bladder. Your surgeon will create a new way for your urine to leave your body. One option is for your surgeon to create a small, spout-like hole called a stoma in your abdomen. Your urine will pass out of your body through the stoma into a pouch called a urostomy bag. You will get instructions about how to empty and care for the pouch.

You should be able to wear your normal clothing with a urostomy bag. Some people buy different clothes or undergarments that can help hold the bag in place.

You can do many activities with a urostomy bag, including running, swimming, golfing and sexual activity. A special belt or binder may be used to hold your urostomy bag in place for running or swimming. If you lift weights, your doctor may suggest a device to support your abdomen.

Contact sports with a high risk of injury aren’t recommended for a person with a urostomy bag. Talk to your doctor before you start any new activity to see if it’s safe for you.

To reduce anxiety about having a urostomy in social situations, empty your pouch before activities.

Some people find it useful to join a support group for people with ostomies. People in the group can help answer questions and provide emotional support.

Dr. Kristen Scarpato, a urologic oncologist at Vanderbilt University Medical Center, focuses on genitourinary cancers including bladder and prostate cancer.  |  SPECIAL BLADDER CANCER EDITION  |  UROLOGYHEALTH extra