Advanced prostate cancer can cause changes in your bladder and bowel. These changes can come from the cancer itself or from its treatments.

Many of these symptoms are manageable with diet and lifestyle changes. Often, they can improve over time. Open communication with your healthcare team can help you get the right guidance and support.

The prostate gland is part of the male reproductive system. It’s below the bladder and in front of the rectum. It also surrounds part of the urethra.

There are several types of advanced prostate cancer:

  • biochemical recurrence
  • castration-resistant prostate cancer (CRPC)
  • non-metastatic castration-resistant prostate cancer (nmCRPC)
  • metastatic prostate cancer
  • metastatic hormone-sensitive prostate cancer (mHSPC)
  • metastatic castration-resistant prostate cancer (mCRPC)

Advanced prostate cancer has spread beyond the prostate to areas such as the lymph nodes, bones, or organs.

Advanced prostate cancer can cause bladder and bowel symptoms. These might be from the cancer itself or from medicines to treat it.

Bladder symptoms are some of the more common signs of prostate cancer. They can include:

  • problems starting urination
  • weak flow or interrupted flow of urine
  • frequent urination
  • trouble emptying bladder
  • painful urination
  • burning sensation during urination
  • blood in the urine

Bladder symptoms might be from an enlarged prostate which is obstructing the bladder. Symptoms might occur before the diagnosis of prostate cancer.

Bowel symptoms are less common in prostate cancer. You might experience bowel changes if cancer has spread from your prostate to the bowel, but it’s rare for prostate cancer to spread to the gastrointestinal tract.

Some possible bowel symptoms are:

  • passing gas (flatulence)
  • diarrhea
  • constipation
  • inability to completely evacuate bowels
  • more frequent or more urgent bowel movements
  • pain in the rectal area or abdomen
  • bowel blockage
  • rectal bleeding

If prostate cancer has spread to the digestive tract, you might experience pain, bleeding, and constipation.

When you have cancer, your lifestyle can also change. This might also lead to bowel changes. You might have constipation if you are eating different foods, are less active, or drinking less fluids.

According to the American Cancer Society, advanced prostate cancer may be categorized as one of the following:

Stage 4A: Prostate cancer that has spread to nearby lymph nodes, but not to distant parts of the body.
Stage 4B: Prostate cancer that has spread to distant organs such as the bones when the cancer is found. Most stage 4B cancers can’t be cured, but they’re treatable.

Certain treatments for more advanced prostate cancer can cause bladder or bowel problems.

Radiation therapy

Some radiation treatments for advanced prostate cancer can cause bowel symptoms. Radiation therapy is directly targeted to the prostate, but because the rectum sits right behind it, the treatment can lead to bowel issues.

External beam radiation therapy (EBRT) and internal radiation (brachytherapy) might lead to rectal pain, diarrhea with or without bleeding, or burning. EBRT might also cause rectal leakage.

While it’s rare to experience severe bowel problems during radiation therapy, you may have softer stools and less often, diarrhea. Most symptoms clear up after a few weeks or up to 6 to 12 months after treatment ends.

Talk with your doctor about the type of radiation you’ll be given as older form of radiation therapy may increase these side effects.

Both the bladder and urethra will receive some radiation due to their proximity to the prostate. The bladder and urethra are pretty resistant to radiation therapy, though, and long-term urinary leakage is rare.

The bladder and urethra can become irritated during and after radiation therapy. You may feel a need to urinate more often and with more urgency. A few weeks after radiation therapy, you may also wake up more often at night to urinate (nocturia).


It’s very rare for bowel issues to arise after prostatectomy (removal of the prostate). But urinary dysfunction can come up.

During surgery, the bladder is pulled downward and connected to the urethra where the prostate once was. It’s possible that some urinary incontinence or leakage may happen if the sphincter at the base of your bladder is damaged during surgery.

That said, these symptoms will get better over time and with strengthening exercises such as pelvic floor muscle training. Urinary control typically comes back within 1 year.

The Prostate Cancer Foundation notes that it’s normal to experience some kind of urinary dysfunction following initial therapy for prostate cancer. If symptoms don’t improve or worsen, it’s important to talk with your healthcare team.

There are ways to manage bladder and bowel symptoms from advanced prostate cancer. The steps you can take depend on what’s causing the symptoms.

Sometimes bladder symptoms caused by the cancer get better after treatment. For example, surgery might help treat an enlarged prostate as well as the prostate cancer, thereby eliminating some urinary symptoms.

Some management strategies for bladder and bowel symptoms that happen after treatment or because of treatment include:

  • Kegel exercises: Exercises to strengthen your pelvic floor muscles can help with urinary incontinence or leakage. A small clinical trial published in 2021 of people undergoing radiotherapy for prostate cancer found Kegel exercises reduced the risk of urinary incontinence. People in the intervention group also had less diarrhea and constipation.
  • Laxatives: A doctor can prescribe laxatives or recommend over-the-counter options to help relieve constipation.
  • High fiber foods: Fruit and whole-grain breakfast cereals are examples of high fiber foods that can help with constipation.
  • Water: Drinking more water can help relieve dehydration that might result from diarrhea.
  • Movement: Gentle exercise can help relieve constipation.

You may choose to work with a dietician to find the best foods to support your bladder and bowel while you are managing advanced prostate cancer. Other professionals, such as a physiotherapist trained in cancer care, can help you choose an appropriate movement program.

If you are managing advanced prostate cancer, it’s important to feel comfortable discussing your bladder and bowel symptoms with a doctor. You’re not alone if this is not easy for you. Here are some ways to make the process easier:

  • Make a list of your symptoms before the appointment: You might find it easier to read the list or pass it to the healthcare professional.
  • Bring someone for support: A close friend, family member, or partner can help you to describe symptoms you experience.
  • Ask questions: Asking the doctor questions on your mind might make you feel more comfortable trusting them with your care.

Living with advanced prostate cancer can come with many challenges, but some might require immediate medical attention. Talk to members of your care team right away if you experience:

  • inability to urinate or trouble emptying your bladder
  • constipation for more than 4 days
  • excessive diarrhea
  • excessive rectal bleeding or blood in urine
  • erection lasting more than 4 hours
  • cold, bluish penis

During your prostate cancer treatment, it’s important to attend all of your appointments. You can also get help from others through support groups, community or religious organizations, friends, and family.

Managing bladder and bowel symptoms is an important part of advanced prostate cancer treatment. For many people, these symptoms do not last forever. Most people who have a radical prostatectomy no longer experience incontinence 1 year following the surgery.

You may experience bladder and bowel changes while managing advanced prostate cancer. Some of these symptoms improve over time, such as urinary incontinence after prostatectomy.

Communicating with a health care team can help you to get guidance on diet, lifestyle, medication, and exercises to relieve these symptoms.