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LOWER URINARY TRACT PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
- Lower urinary tract problems
- Am I at higher risk of lower urinary tract problems?
- What are the symptoms and lower urinary tract problems?
- I am at higher risk of lower urinary tract problems. What tests should I have and when?
- What happens if I have lower urinary tract problems?
- What else can I do?
- Where can I find more information?
- Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Lower urinary tract problems” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Lower urinary tract problems
The lower urinary tract is made up of the bladder, urinary sphincter and the urethra and located in the lower abdomen.
The bladder stores urine, which is made by the kidneys. When full, the brain receives a signal that the bladder needs to be emptied. This is what causes the feeling that you need to wee/pee.
The urinary sphincter, which is located below the bladder, is a muscle that prevents urine from leaking from the bladder. When the bladder is ready to be emptied, the urinary sphincter relaxes and pee exits the bladder via a tube called the urethra.
Together, the bladder, urinary sphincter and urethra make up the lower urinary tract.
Sometimes problems can occur with the lower urinary tract. Lower urinary tract problems include:
- Hemorrhagic cystitis, where there is bleeding of the bladder.
- Bladder fibrosis, where the lining of the bladder gets scarred and stiff.
- Dysfunctional voiding, where the urinary sphincter does not relax while trying to pass urine. This makes it more difficult to empty the bladder.
- Vesicoureteral reflux, where urine flows back from the bladder to the kidneys.
- Nerve damage, which can cause urine to leak from the bladder.
- Hydronephrosis, where the tube between the kidneys and bladder (ureter) becomes blocked, making it difficult for urine to flow from the kidneys to the bladder.
There are a number of things anyone can do that may lower the risk of urinary tract problems, such as keeping hydrated.
Bladder fibrosis
Urinary tract
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Am I at higher risk of lower urinary tract problems?
Anyone, including people who have never had cancer treatment, may develop lower urinary tract problems. However, there are some cancer treatments that may increase the risk of having lower urinary tract problems later in life.
The following treatments can increase the risk of lower urinary tract problems:
- Chemotherapy drugs cyclophosphamide and ifosfamide. Any dose of these chemotherapy drugs can cause urinary tract problems.
- Radiotherapy to the bladder or an area that includes the bladder
- Surgery that involves removal of the bladder (cystectomy)
- Surgery that involves removal of the womb (hysterectomy)
- Surgery to the pelvis
- Surgery to the spinal cord
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience lower urinary tract problems, it does not always mean that this is caused by your cancer treatment. Lower urinary tract problems may have other causes.
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
Other causes
What are symptoms and signs of lower urinary tract problems?
There are symptoms and signs that can tell you if you might have lower urinary tract problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have lower urinary tract problems:
- Difficulty passing urine
- Pain or a burning feeling while passing urine
- Urine leaking from the bladder
- Passing urine more frequently than usual
- Blood in the urine
Very often these symptoms have another cause, such as urinary tract infections. If you recognise any of these symptoms or signs in yourself, please contact a general practitioner or follow-up care specialist.
Symptoms and signs
Pain
From a physical point of view, pain is a life-sustaining biological reaction to damaging influences – even if tissue damage has not yet occurred. Due to its function as a damage indicator or warning, pain is usually associated with negative feelings so that we pay sufficient attention to it and learn as quickly as possible when it is dangerous for us. How intensely we feel a pain stimulus, whether it causes us to feel fear and panic, depends not only on the pure nerve signal, but is an interplay of biological, psychological and social factors.
All pain whose duration exceeds the extent of an acute (recent) cause and lasts for an incomprehensibly long time is called chronic pain. Strong and prolonged pain stimuli can make the transmitting nerve cells of the spinal cord and brain more sensitive to subsequent pain stimuli. This means that even mild stimuli can be perceived as severe pain. Under certain circumstances, these nerve cells, which have become hypersensitive
I am at higher risk of lower urinary tract problems. What tests should I have and when?
If you are at higher risk of lower urinary tract problems, it is advised to:
- Discuss your medical history and whether you experience(d) any symptoms and signs of lower urinary tract problems with your general practitioner or follow-up care specialist at least every 5 years.
If you have had your bladder removed (cystectomy), or if part of your bowel was used to enlarge the bladder (enterocystoplasty), it is important for you to be followed up by a nephrologist (physician specialised in kidney diseases) or urologist (physician specialised in the urinary tract).
If you might have lower urinary tract problems, it may be necessary to confirm the diagnosis by doing a urine test.
What happens if I have lower urinary tract problems?
If you have lower urinary tract problems, your general practitioner or follow-up care specialist will probably refer you to a:
- Urologist (physician specialised in the urinary tract)
The urologist may discuss different treatment options with you.
What else can I do?
Knowing that you may be at increased risk of lower urinary tract problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
To lower your risk of lower urinary tract problems, it is very important to live a healthy lifestyle. In particular, it is important to keep hydrated. This means increasing your fluid intake if it is hot or if you are physically active. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing lower urinary tract problems and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about lower urinary tract problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- Together: Here you can find more information about bladder problems after childhood cancer treatment
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Lower urinary tract problems” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext