Cancer treatment can affect bladder and bowel control in lots of different ways, and it can be one of the most distressing consequences and one that people with cancer (and sometimes health professionals) find difficult to talk about. Problems may start during treatment and not get better or may develop months (or years) after treatment (‘late effects’).

Cancer treatment can cause changes to the way the bladder and/or the bowel work. Surgery on the bladder and bowel area can cause direct effects on continence.

Interventions like surgery or radiotherapy to the pelvic area may weaken the pelvic floor muscles which help to keep the bladder and bowel closed and prevent leaks. This means that small amounts of urine can leak out from the bladder. Some people also experience bowel incontinence with leaks of faecal matter from the bowel. Leaks from the bladder or bowel are called incontinence.

Cancer treatments, including surgery, may affect the pelvic floor muscles which can sometimes lead to urinary or faecal incontinence, which is the involuntary loss of urine or faeces. There are two different types of urinary incontinence:

• Stress incontinence – leaking small amounts of urine when you laugh, sneeze or cough, or when exercising.
• Urge incontinence – leaking of urine due to an overactive bladder and struggling to ‘hold on’ when you get the urge to go. If you have an overactive bladder, you may find that you cannot always get to the toilet in time.

Urinary frequency (needing to go to the toilet more often) and/or urgency (powerful urge to go to the toilet and feeling like you cannot ‘hold on’) are also another common side effects of cancer treatment.

Other side effects may include change in bowel habits and pain in the pelvic area.

Multi-professional management of incontinence includes advice from clinical nurse specialists and allied health professionals such as specialist physiotherapists and therapeutic radiographers at a registered and enhanced level in a prehabilitation or rehabilitation setting. People experiencing significant problems should be referred to their nearest Women’s Health Physiotherapy teams (many of whom also treat men with continence problems) or alternatively, if available, specialist gynae-oncology physiotherapy services for pelvic floor re-training exercises and advice.