Urinary problems during and after prostate cancer treatment

Learn how to deal with leaks and other urinary issues that can occur after prostate cancer treatment. They are especially common after surgery and radiation therapy.

It’s common to experience urinary issues when you’re going through certain prostate cancer treatments. Leaking urine (pee) and trouble controlling your flow—also called ‘incontinence’—are both signs of urinary problems.

    Other issues can be:

  • Needing to urinate more often or urgently.

  • Pain when you urinate or blood in your urine.

  • Difficulty getting your flow going when you urinate.

What causes urinary problems with prostate cancer treatment?

Much of it has to do with the location of the prostate. Because the prostate sits underneath the bladder, it’s right next to where urine is held and near the muscles that control the opening and closing of the bladder. So any prostate cancer treatment that damages the muscles or nerves in this area—like surgery—is likely to cause some urinary issues. Treatments that cause the prostate to swell—like radiation therapy, HIFU or cryotherapy—are also likely to cause some problems with peeing.

The challenges will be different based on the treatment you’ve had but most issues are treatable and will improve over time. Make sure to talk to your doctor or care team, as they’ll know what’s normal and where you may need more support.

If you’ve already had treatment or want to know more about related urinary problems, check below to see what’s typical.

Urinary problems after surgery for prostate cancer (radical prostatectomy)

Surgery to treat prostate cancer (known as a radical prostatectomy) involves removing the entire prostate. Because of its location close to bladder and surrounding the urethra (where urine flows through) removing the prostate can damage the muscles and nerves that control when you urinate.

This can result in stress incontinence—when some activities like sneezing, coughing, laughing, lifting, physical activity, or changing your posture may cause you to leak a few drops of urine.

    You might also experience:

  • Uncontrollable leaking.

  • Sudden urges to urinate.

  • Dribbling urine.

  • Difficulty knowing what products can help (and where to get them).

  • Uncertainty about whether you can do anything, like special exercises, to regain some control.

In general, some men may also experience changes with their bladder because of extra weight they’re carrying and getting older.

How common are urinary issues after surgery?

Most men who’ve had surgery to treat their prostate cancer experience some level of urinary problems. The actual challenges may be different for each man, but most issues are treatable and get better over time.

Soon after surgery, you’ll have a thin tube called a catheter to help pass urine. Once that’s removed, you’ll have some leaking, but this is usually temporary and can be managed with pads. Many men have heavier leakage right after surgery and need to use a pad, but that improves over time.

Recovery times, and how long you may need a pad will be different for each man. Some men—around 10 to 30%—may still require a pad to control leaks 12 months after surgery.

Exercising while managing urinary problems

After treatment, you may need to adjust your exercise routine. Talk to your doctor about your current level of physical fitness and what changes you might need to make. High impact exercise can increase leaks. If your routine includes heavy strength training (using weights), your doctor or an exercise physiologist may advise you to reduce your weights.

Urinary problems after radiation therapy (radiotherapy)

During radiation therapy, the lining of your bladder and the urethra (the tube that men urinate and ejaculate through) can be irritated, which can cause some urinary problems. This is known as radiation cystitis. Radiation therapy also causes your prostate to swell, which can make it difficult to urinate—it can be harder to start, it may burn a little or you may not feel like you’re emptying your bladder.

    After radiation therapy, you can experience:

  • Needing to urinate urgently.

  • Needing to urinate more often.

  • Needing to go to the bathroom several times during the night.

  • Pain or burning sensations when you urinate.

  • Difficulty urinating (weak flow or getting your flow started).

  • Leaking or dribbling and not being able to control your urine (incontinence).

  • Blood in your urine.

If you experience any of these problems, tell your doctor or nurse so they can help figure out why it's happening and how to help.

How common are urinary problems after radiation therapy?

Many individuals who have radiation therapy to treat prostate cancer will experience some level of urinary problems and this is totally normal.

  • About 1 out of 3 men report experiencing some kind of urinary issue during radiation therapy. Most often, these issues are short term and will resolve over time.

  • About 1 out of 5 men experience urinary obstructive symptoms, which are typically slow or difficult urination.

If you’re older and having radiation therapy, the urge to urinate can get worse and sometimes lead to leakage (called ‘urge incontinence’). It’s unlikely, however, that you’ll totally lose urine control when you cough, laugh, or lift something heavy (stress incontinence) if you’ve only had radiation therapy.

How long do urinary problems after radiation therapy last?

Symptoms usually start shortly after your first treatment (within a few days to a couple of weeks) and will start to improve after your final treatment ends. This is different from man to man though. For some men, urinary problems can last for several months and in others, they may never go away.

For a few men, urinary incontinence (loss of urine control, leaking or dribbling) can appear for the first time months or years after treatment ends. If this happens, there is support for you—speak to your doctor or nurse to get help.

There are several things you can do to help reclaim control of your flow. These include lifestyle changes such as eating healthy, exercising, and cutting back on alcohol, as well as talking to your doctor about various treatment options like bladder training, surgery or even Botox. Learn more about how you can tackle urinary problems after radiation therapy.

Urinary problems after other prostate cancer treatments

After HIFU, some men experience leakage, although this is rare (1 in 100 men).

Because HIFU causes your prostate to swell, it might be hard to urinate immediately after treatment, so you’ll be given a catheter. You might experience some leakage right after your catheter is taken out but this should be temporary.

Cryotherapy can cause the prostate to swell, which leads to urinary problems. You’ll be sent home with a catheter after getting treated to help the urine drain well. You might have some leakage right after your catheter is taken out but this should be temporary. You might also see some blood in your urine but this should clear up on its own.

Hormone therapy alone does not cause urinary problems. But often, men will have hormone therapy in combination with another treatment (like radiation therapy), which can cause urinary problems. Speak to your doctor or care team if you are experiencing urinary problems.

Chemotherapy treatment itself is not a common cause of urinary problems. Please speak to your doctor if you are experiencing urinary symptoms.

If you're experiencing urinary problems, speak to your doctor. This might be a sign that the cancer is growing—but isn’t always the case. It may be a result of aging.

With age, your prostate gland may continue to grow and become enlarged. This is also known as ‘benign prostatic hyperplasia’ or BPH. Talk to your urologist to understand more about BPH and see if there are medications or treatments to help you urinate more easily.

While on watchful waiting, you might experience some urinary problems, like needing to urinate more often. This might be a sign that the cancer is growing—but isn’t always the case. It may be due to getting older. Talk to your doctor to understand more about managing these issues and what is causing them.

With age, your prostate gland may continue to grow and become enlarged. This is also known as ‘benign prostatic hyperplasia’ or BPH. As a result, you might experience a weak flow of urine. If this happens, you need to let your urologist know to see if there are medications or treatments to help you urinate more easily.

Side effects vary based on the type of immunotherapy. It is a newer treatment for prostate cancer, so how well it works and its side effects are still being understood.

Taking charge of urinary problems after prostate cancer treatment

Reclaiming control of problems and feeling more confident are both possible, with a bit of patience. While it may take some time, being persistent about recovery can bring results. Learn more about pelvic floor (kegel) exercises, specialized underwear for leaks, and lifestyle changes. You'll find there are several things you can do at home or on the go. Additionally, it's important to check in with your doctor or care team for their recommended tips, and guidance on local resources.

Keep your doctor informed about issues you’re experiencing as they will be able to suggest treatment options appropriate for you. If these issues continue long term, make sure your doctor or incontinence nurse knows—they’ve seen it all and will have support for you.