Complications of bladder cancer

A diagnosisof bladder cancer, and some treatments for the condition, can have a significant impact on your life.

Emotional impact

The emotional impact of living with bladder cancer can be huge. Many people report experiencing a kind of "rollercoaster" effect. For example, you may feel down at receiving a diagnosis,up whenthe canceris removed, and down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger feelings of Depression . Signs that you may be depressed include:

• having continuous feelingsof sadnessor hopelessness
• no longer taking pleasure in the things you enjoy

Contact your GP for advice if you think you may be depressed. There's a range of relatively successful treatments for depression, including antidepressant medication andtherapies such as cognitive behavioural therapy (CBT) .

This is called urinary diversion.

There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.

Your multidisciplinary team (MDT) can provide information on the most suitable options for you.

Urostomy

A urostomy iscarried out during a radical cystectomy. A small section ofthe small bowel isremoved andconnected to your ureters (the two tubes that normally carry urine out of the kidneys).

The surgeonthen creates a small hole in the surface of your abdomen and the open end of the removed bowel is placed in this hole, creating an opening known as a stoma.

Aspecial waterproofbagis placed over the stoma to collect urine. Astoma nurse will teach you how to care for your stoma, and how and when to change the bag.

The Urostomy Association is a UK-based charitythat provides information and assistance to people who have recently had, or are about to have, a urostomy.

Continent urinary diversion

Continent urinary diversion is similar to a urostomy, butwithout an external bag. Instead, a section of your bowelis used to create a pouch inside your body that stores urine.

The ureters are connected to the pouch and the pouch is connected to an opening in the abdominal wall.A valve in the opening (stoma) prevents urine leaking out.

The pouch is emptied using athin, flexible tube(catheter). Most people need to empty their pouch about four or five times a day.

Bladder reconstruction

In some cases it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra (the tube that carries urine out of the body) at one end and your ureters at the other end. However, bladder reconstruction isn't suitable for everyone.

You'll be taught how to empty your neobladder by relaxing the muscles in your pelvis, whiletightening the muscles in your abdomen at the same time.

Your neobladder won't contain the same types of nerve endings as a real bladder, so you won't get the distinctive sensation that tells you to pass urine. Some people experience a feeling of fullness inside their abdomen, while others have reported they feel like they need to pass wind.

Because ofthe loss of normal nerve function, most people with a neobladder experience some episodes of urinary incontinence , which usually occurs during the night, while they're asleep.

You may find it useful to empty your neobladder at set times during the day, including before you go to bed, to help prevent incontinence.

Guy's and St Thomas' NHS Foundation Trust has more information and advice about treatments for bladder cancer .

Sexual problems

Erectile dysfunction

Contact yourMDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.

PDE5s are sometimes combined witha device called a vacuum pump, which consists of acylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood toflow into the penis. A rubber ring is then placed around the base of the penis, which allows an erection to be maintained for around 30 minutes.

Narrowing of the vagina

Both radiotherapy and cystectomy can cause a woman's vagina to become shortened and narrowed, which can make penetrative sex painful or difficult.

There are two main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to the area, which should help to increase moisture inside your vagina.

The second is to use vaginal dilators. These areplastic cone-shaped devices of various sizesthat are designed to gently stretchyour vagina and make it more supple.

It's usually recommended that youusedilatorsfor a 5 to10-minute period every day, starting with the dilator that fits in easiest first andgradually increasing the size, as your vagina stretches over the following weeks.

Many women find this an embarrassing issue to discuss, but the use of dilators is a well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide more information and advice.

You may find that themore often you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

The Macmillan Cancer Support website has some excellent information and a video about cancer and sexuality .