In advanced bladder cancer, the tumor’s abnormal cells grow out of control and metastasize beyond the bladder. Pain is common, so understanding what pain management options are available can help make you more comfortable.

It’s the fourth most common type of cancer among men. Around 62,420 males assigned at birth (MAAB) and 19,870 females assigned at birth (FAAB) are expected to be diagnosed with bladder cancer in 2023, according to the American Cancer Society.

Bladder cancer usually starts in the innermost lining of the bladder. It can grow into the deeper muscle layers of the bladder and eventually spread to nearby lymph nodes, surrounding tissues, or even distant sites.

This last type of growth is called metastasis. Metastatic bladder cancer is a more advanced disease and is classified as stage 4 bladder cancer.

Here’s what you need to know about pain management in advanced bladder cancer.

When it’s in its earliest stages, bladder cancer doesn’t usually cause much pain. Some people have no pain whatsoever, while others may experience pain or burning when they urinate. Blood in the urine, either microscopic or visible to the naked eye, is commonly the first sign of bladder cancer.

Sometimes, the disease itself isn’t the only source of pain in people with advanced bladder cancer. It can also be caused by treatment. Chemotherapy, a common treatment method for bladder cancer, can cause uncomfortable side effects, such as mouth sores.

Chemotherapy can also cause peripheral neuropathy, which may present as pain, numbness, tingling, or other sensations in the hands, arms, feet, or legs.

Surgery may be a part of treatment for bladder cancer. The pain associated with surgery depends on the operation.

As the cancer grows and spreads to other areas of the body or during treatment for bladder cancer, pain may become a bigger issue.

Depending on where the cancer metastasizes, you could experience pain in that area.

Pain in back

Bladder cancer can cause lower back pain when it reaches a more advanced form of the disease. The pain is typically only on one side of the back but can be centrally located.

Lower back pain might occur once the tumors increase in size or cancer cells start to spread to other parts of your body.

Urination pain

Bladder cancer can cause changes in urination. You might experience pain or a burning sensation when you urinate, and you may see blood in your urine.

You may also feel:

  • an urge to urinate more frequently than you used to
  • an urgent need to urinate even if your bladder isn’t full
  • an urge to urinate often throughout the night

Not being able to urinate can also be a sign of advanced bladder cancer.

Bone and muscle pain

Advanced bladder cancer can cause pain in your bones that can feel either dull or sharp.

In addition, it can sometimes cause pain in the hips and pelvis. This may occur if cancer spreads to an inner hip muscle called the iliopsoas and causes a condition known as malignant psoas syndrome.

While the outlook for this cancer-associated condition is poor, malignant psoas syndrome is very rare.

Pain during sex

Sex can become a painful experience while you undergo treatment for bladder cancer.

Radiation can irritate a man’s urethra, which can cause sharp pain during ejaculation. This pain usually stops when treatment is over.

Bladder cancer surgery can also affect a man’s ability to produce semen. This can lead to “dry orgasms,” where little or no semen comes out.

For FAABs who undergo removal of the urinary bladder, removal of the front part of the vagina is often included. As a result, sex can become less comfortable for some FAABs.

Pelvic radiation can cause scarring, which may narrow the vagina and lead to painful sex.

Some FAABs may also experience vaginal dryness during sex.

Pain is often part of the reality of living with bladder cancer and undergoing treatment for the disease. However, medication and complementary techniques can help you manage your pain and keep you more comfortable.

Here are some cancer pain management options to consider.

Over-the-counter (OTC) medication

You may be able to manage mild to moderate pain with OTC drugs. These medications include:

  • acetaminophen (Tylenol)
  • ibuprofen (Advil, Motrin)
  • aspirin

Even though you don’t need a prescription for OTC drugs, it’s still important to talk to your doctor before taking any medication. Some of these medications can:

  • cause side effects
  • cover up the signs of a possible infection
  • affect your cancer treatment

High doses of ibuprofen, for example, can affect kidney function. This can be a problem if your kidneys are affected by cancer or if you’re receiving chemotherapy, which can also alter kidney function.

In addition, be careful to check that you’re taking a medication that contains more than one kind of OTC analgesic, which can cause you to take too much if you also take an individual medication dose.

Taking aspirin or ibuprofen can also cause stomach bleeding in some cases, and there’s a greater chance of this if you combined the two drugs.

Prescription pain medication

Your doctor may prescribe a stronger medication, like opioids if you’re experiencing moderate to severe pain from cancer. Examples of these drugs include:

  • codeine
  • hydrocodone (Hysingla ER)
  • oxycodone (OxyContin, Oxaydo, Roxicodone, Roxybond)

Opioids can cause constipation and potentially delay recovery after surgery, so they may not always be appropriate for every person with bladder cancer.

Some of these medications can also cause physical dependence and addiction over time. Talk to your doctor to determine whether prescription medication should be part of your bladder cancer pain management plan.

Anticonvulsants

If you have a nerve injury from cancer treatment, your doctor may recommend antiseizure medications to help reduce tingling and burning sensations.

Gabapentinoids, specifically gabapentin (Neurontin), and pregabalin (Lyrica, Lyrica CR), are medications that treat seizures, but they can also target nerve pain.

They’re becoming increasingly popular alternatives to opioids and may be useful for treating neuropathy that results from chemotherapy or tumor growth.

Bladder spasm medications

A bladder spasm occurs when muscles in the bladder contract and cause a sudden intense urge to urinate. Bladder control medications, called antispasmodics, work by blocking spasms in the bladder.

Antispasmodics are commonly prescribed to people with bladder cancer. They include:

They can help calm the constant sensation to urinate and relieve pressure in the pelvis.

Antidepressants

While antidepressants are primarily used to treat depression, some can also be used to manage tingling and burning pain.

This type of pain can often be caused by nerve damage from certain cancer treatments, such as surgery, chemotherapy, and radiation.

Relaxation techniques

Slow, rhythmic breathing and visual concentration on an object are common relaxation techniques that people with cancer can use to reduce pain. They help get rid of muscle tension and soothe the mind.

Distraction

Giving your mind something else to focus on besides the pain can help keep you more comfortable. Watching TV, reading a book, doing crafts, and listening to music may help distract your mind from the pain.

Meditation

Similar to relaxation techniques and distraction, meditation can take your mind off the pain and quiet your thoughts.

Some research shows that meditation can ease pain and reduce anxiety and depression among people with cancer, according to the American Cancer Society.

Other complementary pain management techniques

There are a range of other complementary and alternative pain management techniques that may be worth exploring. These include:

Biofeedback is a technique that uses machines to help you learn about and control some of your involuntary body functions. Led by a licensed technician, biofeedback may help you relax and cope with pain in your body.

Many of these integrative methods haven’t been tested in scientific studies on people with bladder cancer. But they’re regarded as ways to improve your quality of life when you have a disease.

Talk to your healthcare team to determine which ones might be best for your situation.

While bladder cancer and treatment of the disease can cause pain, there are ways to manage it.

Talk to your doctor if you’re experiencing any discomfort over the course of your disease or if you notice any new or increasingly severe pains. Your oncology team can suggest a palliative care or pain specialist to help make you more comfortable.

It’s never too early or too late to reach out for help with your pain.

Does pain come and go with bladder cancer?

Whether or not you feel pain, where you feel it, and how often you feel it depends on the stage of your cancer and whether it has metastasized. It is possible for the pain to come ad go.

What are the signs that bladder cancer is getting worse?

Signs that your bladder cancer is becoming more severe or has metastasized include bone pain, stomach pain, back pain, fatigue, or unexplained weight loss.

What is the number one symptom of bladder cancer?

A common sign, and often the first symptom, of bladder cancer is blood in urine, also called hematuria.

Bladder cancer begins within the deepest part of the bladder. As it expands, it can move to muscles, bones, and other organs or parts of the body.

This is known as metastatic bladder cancer, a more serious form of the disease classified as stage 4.

Pain often comes with this condition, so understanding what pain management treatments are available can help increase your comfort level while you’re undergoing treatment.