Preserving Pelvic Comfort With Advanced Bladder Cancer: Practical Solutions

But you can work with your care team to find ways to manage your symptoms and stay more comfortable.

“A multidisciplinary approach involving medical oncology, urology, radiation oncology, palliative care, pain specialists, and interventional radiology often provide the best symptom control while helping patients maintain the highest possible quality of life,” says Fernando Maciel Barbosa, MD, a medical oncologist with University of Iowa Health Care in Iowa City.

Blood in the Urine

“It can occur because the tumor is fragile and contains many abnormal blood vessels that can easily bleed,” says Dr. Barbosa. “In some cases, urinary tract infections, prior radiation, or certain cancer treatments may also contribute to bleeding.”

Adam Ramin, MD, a urology cancer surgeon in Los Angeles, emphasizes that you should not ignore blood in your urine. “For people already diagnosed with advanced bladder cancer, new or worsening bleeding should be taken seriously,” he says. “It may mean the tumor is actively bleeding, and prompt medical attention is important.”

Supportive Care

Treatment depends on various factors, including how severe the bleeding is and how healthy you are overall.

“If the cancer is still considered operable, some patients may be candidates for a radical cystectomy — a surgery to remove the bladder and create a new way for urine to leave the body,” says Dr. Ramin. “This is typically done as part of cancer treatment, not just to control bleeding.”

If you aren’t a good candidate for surgery, he says the following options can help manage bleeding:

• Bladder Irrigation The bladder is flushed with sterile liquid through a catheter to prevent and remove blood clots.
• Endoscopic Procedures A urologist can remove or cauterize (a special burning procedure) bleeding portions of the tumor using instruments passed through the urethra.
• Angioembolization An interventional radiologist performs a procedure to block the blood vessels feeding the tumor.
• Systemic Therapies Chemotherapy, immunotherapy, or targeted medications may reduce bleeding over time by treating the cancer. “Systemic treatments, including newer therapies such as enfortumab vedotin, pembrolizumab, and other biomarker-directed treatments, can significantly shrink bladder tumors and help control cancer-related symptoms such as pain, bleeding, and urinary obstruction,” says Rohan Garje, MD, the chief of genitourinary medical oncology at Baptist Health Herbert Wertheim Cancer Institute in Miami.
• Radiation Therapy The tumor is exposed to controlled doses of energy particles. “When bleeding is coming from the tumor itself, a short course of palliative radiation can often shrink the tumor and control the bleeding without requiring major surgery,” says Amar Rewari, MD, the chief of radiation oncology at Luminis Health in Annapolis, Maryland.

Urinary Frequency and Urgency

These happen for several reasons. The tumor can irritate the bladder lining, as well as take up space in the bladder. That reduces both its ability and capacity to hold urine. The tumor may also interfere with normal muscle function or cause spasms. And irritated nerves can signal your brain that your bladder is full even when it isn’t.

Supportive Care

The first step to managing frequency and urgency is to discuss the issue with your healthcare team. Effective treatment requires identifying the underlying cause, such as tumor irritation, medication side effects, radiation, or changes after surgery. Treatment may involve medication and lifestyle modifications, as well as bladder control techniques.

Bladder training involves creating a schedule of times to urinate, such as every two hours. You’ll also learn relaxation techniques to help you control urges to urinate in between.

• Limit or avoid alcohol, caffeinated drinks, and artificial sweeteners.
• If you smoke, consider quitting.
• Keep a bladder, food, and fluid diary to help identify patterns or triggers.
• Practice pelvic floor exercises to strengthen the muscles that support the bladder.
• Ask your doctor whether medications you take for other reasons may be contributing.
• Drink less fluid (if your doctor advises).

Urinary Obstruction

It is not unusual for the normal flow of urine to become blocked when you have metastatic bladder cancer.

“The tumor may block the bladder outlet, making it difficult to empty the bladder, or it may compress or invade one or both ureters — the tubes that carry urine from the kidneys to the bladder,” says Barbosa.

This can lead to urine backing up into the kidneys, impaired kidney function, pain, recurrent urinary tract infections, and difficulty receiving certain cancer treatments, he says.

Supportive Care

There are several effective ways to restore urine flow, protect kidney function, and prevent complications.

“A urinary catheter can drain the bladder when the obstruction is lower down, while a ureteral stent can be placed internally to keep urine flowing from the kidney past an obstruction,” says Dr. Rewari. “If a stent cannot be placed or does not adequately relieve the blockage, a nephrostomy tube can drain urine directly from the kidney into an external collection bag.”

For longer-term management, Dr. Garje says a suprapubic catheter may be an option. This is a tube that’s placed in your bladder through a small incision in the stomach to drain urine into a bag.

“Relieving the blockage can help improve kidney function and reduce the risk of infection,” he says. “However, these devices can themselves become a source of infection. Careful hygiene and regular device exchanges are therefore essential when they are needed for an extended period.”

Pelvic Pain

“Pain is one of the more common symptoms as bladder cancer progresses,” says Seth A. Cohen, MD, a urogynecologist and urologic surgeon at City of Hope Orange in County, California. “It may develop when the cancer grows into nearby tissues, affects surrounding nerves, or spreads to other areas, such as the bones.”

But he says it’s not something you simply have to live with. “Patients should let their physicians know about new or worsening pain as soon as it develops, since treating symptoms early often gives us more options to bring them under control,” Dr. Cohen says.

Supportive Care

Treatment strategies depend on what’s causing the pain.

• If caused by urinary blockage, relieving the obstruction with stents or nephrostomy tubes can help.
• If the cancer has spread to bones, radiation therapy can reduce pain and inflammation.
• Palliative radiation therapy can also shrink a painful tumor.
• Surgery may be considered to remove affected organs in some people.
• Pain management may also include prescription medications, nerve blocks, or spinal injections.

“A personalized, team-based approach helps ensure patients are as comfortable as possible while also addressing the underlying cause of pain,” Ramin says.