Complications

Some treatment for bladder cancer 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 "roller-coaster" effect.

For example, you may feel down at receiving a diagnosis, up when the cancer is 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 feelings of sadness or hopelessness
• no longer taking pleasure in the things you used to enjoy

Contact your GP for advice if you think you may be depressed. There's a range of treatments for depression, including antidepressants and therapies such as cognitive behavioural therapy (CBT).

Urinary diversion

If your bladder is removed, an alternative way of passing urine out of your body will be created during the operation. This is called urinary diversion.

There are various types of urinary diversion. You may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.

Your medical team can provide information on the most suitable options for you.

Urostomy

A urostomy is carried out during a radical cystectomy. A small section of the small bowel is removed and connected to your ureters (the two tubes that normally carry urine out of the kidneys).

The surgeon then 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.

A special waterproof bag is placed over the stoma to collect urine. A stoma nurse will teach you how to care for your stoma, and how and when to change the bag.

Continent urinary diversion

Continent urinary diversion is similar to a urostomy, but without an external bag. Instead, a section of your bowel is 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 a thin, flexible tube (catheter). Most people need to empty the pouch about 4 or 5 times a day.

Bladder reconstruction

Sometimes, it may be possible to create a new bladder, known as a neobladder.

This involves removing a section of your bowel to make 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, while tightening 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 of the loss of normal nerve function, most people with a neobladder experience some episodes of urinary incontinence, which usually happens 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.

Find out more:

• Guy's and St Thomas' NHS Foundation Trust: bladder patient leaflets
• Urostomy Association: advice and support on urinary diversion surgery

Sexual problems

Erectile dysfunction (impotence)

Contact your GP or cancer nurse 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 with a device called a vacuum pump, which consists of a cylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood to flow 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.

Read more about erectile dysfunction (impotence)

Narrowing of the vagina

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

There are 2 main treatment options available. 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 are plastic cone-shaped devices of various sizes that are designed to gently stretch your vagina and make it more supple.

It's usually recommended that you use dilators for 5 to 10 minutes every day, starting with the dilator that fits in easiest and gradually 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 give you more information and advice.

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

Find out more about sex and the side effects of cancer treatment from Macmillan Cancer Support.