Urinary problems in women

Some cancer treatments lower sex hormone levels in the body. The main female sex hormones are oestrogen and progesterone.

Low levels of these sex hormones can sometimes cause urinary problems in women, including urinary tract infections (UTIs) and leaking urine (incontinence).

The importance of oestrogen

An important function of oestrogen is to help keep the wall of the urethra elastic and the pelvic floor muscles healthy. The urethra is the tube that takes urine from the bladder to the outside of the body. The pelvic floor muscles surround the lower part of the bladder and urethra.

When the amount of oestrogen in the body drops, it can weaken the muscles and make the urethra less elastic. This can lead to incontinence or infection.

How common are urinary problems?

Not everyone who has low levels of sex hormones due to cancer treatment develops urinary problems. 

Some research studies suggest that almost 75 out of 100 menopausal women (75%) experience symptoms of incontinence. It also shows that it is the problem they are least likely to seek help for. The reason for this is often that women believed it was normal.

Urinary problems can be difficult to cope with. And it can have an impact on how you feel about yourself and your quality of life.

Speak to your GP or specialist nurse if you are having problems. They are used to talking about these issues and can help you.

UTIs

A urinary tract infection (UTI) is an infection of any part of the urinary system. It may affect the:

• kidneys

• the tubes that connect the kidneys with the bladder (ureters)

• bladder

• the tube that carries urine from the bladder out of your body (urethra)

Symptoms

Symptoms of a UTI include:

• a frequent and urgent need to pee

• pain or burning when peeing, often when the infection is in the bladder (cystitis)

• peeing more often than usual during the night

• pain in your tummy (abdomen), your back or sides

• blood in your pee

• pee that looks cloudy

• a high temperature, chills and feeling sick

• a very low temperature of below 36C

Reducing the risk of a urinary infection

• drink plenty of fluids (about 2 litres a day), particularly water

• avoid urine staying in your bladder for too long, pee as soon as you feel you need to

• empty your bladder soon after sexual activity

• wipe from the front to the back

• reduce vaginal dryness

Vaginal dryness can cause irritation in the area of the urethra. This can increase the risk of infection and pain when peeing. There are various ways of reducing vaginal dryness, including oestrogen vaginal creams or lubricants and moisturisers.

Leaking urine (incontinence)

Incontinence can be a symptom of low oestrogen levels. Other causes include:

• weight gain

• lifestyle changes

• diabetes

• UTIs (urinary tract infection)

Treatment

Treatments can include:

• bladder training

• pelvic floor exercises

• medicines

• vaginal oestrogen

Bladder training

Bladder training encourages your bladder to hold larger amounts of urine for longer periods of time. You keep a diary of when you go to the toilet and gradually increase the time between each visit.

Pelvic floor exercises

Doing pelvic floor exercises could help to reduce your incontinence. Strengthening and maintaining the pelvic floor muscles might also help with other symptoms, such as:

• pelvic pain
• pain during sex

Medicines

Your doctor might prescribe medication if they are likely to help your symptoms. For example, you might have medicine from a group of drugs called anticholinergics. They help:

• to relax the bladder muscle
• the bladder to hold more urine before you feel the need to go. This makes it easier to pass urine

Vaginal oestrogen

Research has found that using vaginal oestrogen can help to reduce incontinence and the need to pass urine often and urgently. You can either use a:

• cream

• gel

• vaginal ring - a small plastic ring that is placed inside the vagina and releases hormones

• pessary - a small pellet that you put inside your vagina, where it gradually dissolves

• tablet - a tablet that you put inside the vagina where it releases oestrogen

Your body will absorb some oestrogen, but the amounts are small. Current research shows that low dose vaginal oestrogen does not seem to increase the risk of breast cancer or a type of womb cancer called endometrial cancer.

Low dose vaginal oestrogen can be used by some people who have hormone dependant cancer, but your doctor will discuss the risk with you. If it is suitable for you, you usually have it under the supervision of your oncologist.

Talk to your GP or specialist nurse to see if this might be an option for you.

What else can help to reduce incontinence?

There are other things you can do that can help. This includes maintaining your weight and reducing the amount of caffeine you have.

Coping with urine problems

Urinary problems can be difficult to cope with. It's important to tell your doctor or nurse if you are having problems. They will have helped many people with these problems before and can recommend the best treatments for you.