Bladder cancer is a disease in which abnormal cells in the bladder grow out of control, forming a tumor.

It’s the fourth most common type of cancer among men. Around 62,100 men and 19,300 women are expected to be diagnosed with bladder cancer in 2020, 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 classified as stage 4 cancer.

Pain is a common symptom people can experience as their bladder cancer progresses. Understanding what to expect over the course of the disease and what pain management options are available can help keep you more comfortable.

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.

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

  • in the pelvis
  • in the back
  • in bones
  • when having sex

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.

Early bladder cancer can be managed with a minimally invasive surgery, during which the tumor is scraped off the bladder wall from within.

More advanced bladder cancer may require surgery to remove the entire bladder. This operation is much longer and usually has a more painful recovery.

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 it 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.

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.

Advanced bladder cancer can sometimes cause pain in the hips and pelvis. This may occur if the 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 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
  • ibuprofen
  • 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 the cancer or if you’re receiving chemotherapy, which can also alter kidney function.

Prescription pain medication

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

  • codeine
  • hydrocodone
  • oxycodone

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.

Nerve pain agents

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

Gabapentinoids, specifically gabapentin and pregabalin, are medications that treat seizures and 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:

  • oxybutynin
  • mirabegron
  • tropsium

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 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:

  • acupuncture
  • art therapy
  • yoga
  • massage
  • hypnosis
  • biofeedback

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.

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

Radiation can irritate a man’s urethra, which can cause a 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 women 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 women.

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

Some women may also experience vaginal dryness during certain cancer therapies, which can make sex uncomfortable and painful without lubrication.

Even though changes may happen to your body during your bladder cancer treatment, sex can still be an enjoyable experience with some adjustments.

Keep the lines of communication open with your partner and explore alternative techniques to penetrative intercourse. Consider asking your oncology team about specific recommendations that may work best for you.

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.