Incontinence is the loss of normal control of the bowel or bladder. Incontinence can involve the involuntary voiding of urine (urinary incontinence) or of stool and gas (fecal or bowel incontinence). There are several types of urinary incontinence. Those most frequently seen as side effects of cancer include overflow incontinence, urge incontinence, and stress incontinence. In rare cases incontinence occurs as the result of cancer, but more commonly it is a side effect of treatment. Because the subjects of bowel and bladder control are perceived as socially unacceptable, those affected with incontinence often feel ashamed or embarrassed by the problem. Instead of seeking medical attention, these individuals try to hide the problem or manage it themselves. For this reason, incontinence is sometimes referred to as "the silent affliction." Impacts of incontinence include low self-esteem, social withdrawal and isolation, and depression. In most cases incontinence can be successfully treated, so affected individuals should discuss the problem with a doctor.
Incontinence can result from damage to the muscle, nerves, or the structure of the body parts involved in the control of voiding. Complex systems of hollow organs (such as the bladder) and tube-shaped structures (such as the rectum and urethra) work together to store and release waste. Special muscles, including sphincters, are especially important in maintaining the tight seals that hold in waste. When physical damage to muscle or organ structure occurs, the system can no longer maintain these tight seals, and waste can leak out.
Nerves carry messages between the brain and the bowel and bladder systems. Injury to these nerves, or the related part of the brain, interferes with the delivery of these messages, which can prevent the body from recognizing the signals telling it when to void. Without these signals and messages, an individual cannot coordinate the brain with the bowel and bladder systems, and incontinence results.
Several types of cancer and its treatments are associated with incontinence. Usually, it is the treatment of cancer that causes incontinence, rather than the cancer itself.
The treatment of prostate cancer is one of the most common causes of cancer-related urinary incontinence, largely because the prostate is located so closely to the nerves, muscles, and structures involved in urine control. Surgical removal of the prostate, or prostatectomy, carries the highest risk of urinary incontinence as a side effect; the risk from radiation therapy is somewhat lower. The incontinence (typically stress or urge incontinence) is often temporary, but in a small percentage of men it may be long lasting.
Prostate cancer itself seldom causes incontinence. However, this depends on the location and size of the cancer; a large cancerous prostate can interfere with the flow of urine and result in overflow incontinence.
Incontinence is only occasionally the direct result of bladder cancer, but it is a common side effect of some treatments. For early-stage cancer where treatment does not require the bladder to be removed, incontinence almost never occurs. But removal of the bladder and surrounding structures is often necessary to treat more advanced cancer. This requires creation of an artificial system for storing and releasing urine and carries a risk of long-term incontinence.
Colon cancer and rectal cancer
Muscles in the anal and rectal region largely control bowel evacuation, with the colon storing stool and gas. When these regions are removed or damaged during cancer treatment, or if injury to the related nerves occurs, fecal incontinence can result. Fecal incontinence is most commonly a side effect of surgery. Weakening of bowel muscles or damaging of nerves by radiation therapy can also cause incontinence, but this type is more likely to be mild and temporary, and will often improve as these areas heal. However, in some patients, radiation causes permanent and severe fecal incontinence.
Loss of voluntary bowel and bladder control is less commonly associated with other cancers of the genital and urinary systems, mainly as a side effect of treatment. Incontinence can also result from cancer or treatment damage in the brain and spinal cord. Other cancers indirectly cause incontinence; for example, constant coughing from lung cancer can lead to stress incontinence. Very rarely, incontinence can be a side effect of certain medications.
Treatments and complementary therapies
The method of treatment depends on the cause and type of incontinence. Surgical treatment is usually reserved for severe or long-lasting incontinence. An artificial pouch for storing urine or stool can be placed inside the body as a substitute for a removed bladder, colon, or rectum. Placement of an artificial sphincter successfully treats other cases. For mild or temporary incontinence, treatment may include medications, dietary changes, muscle-strengthening exercises, or behavioral training, such as establishing a time pattern for voiding. A small group of patients, however, requires a permanent colostomy or urostomy.
Electrical stimulation therapy, which targets involved muscles with low-current electricity, can be used to treat either urinary or fecal incontinence. Biofeedback uses electronic or mechanical devices to improve bladder or bowel control by teaching an individual how to recognize and respond to certain body signals.
Embarrassment may lead some people to manage the symptoms of incontinence themselves by wearing absorbent pads to prevent the soiling of their clothes. However, many treatments exist to successfully restore or improve control of bowel and bladder function, so individuals experiencing incontinence should speak to a doctor or nurse.
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Stefanie B. N. Dugan, M.S.
—Release of stool or gas from the bowel system.
—Slow leaking or dripping of urine from an overfilled bladder that may be unable to empty completely.
—A circular muscle that relaxes and tightens to control the storage and release of bodily waste.
—Involuntary loss of waste resulting from sudden pressure or force, such as by coughing, sneezing, laughing, or lifting an object.
—A tube-like structure allowing the passage of urine between the bladder and the outside of the body.
—Involuntary loss of waste after feeling a strong, sudden need to void, without enough time to get to a toilet.
—Release of urine from the bladder system.