Do What You Can to Ease Treatment Side Effects and Symptoms of Bladder Cancer

You will most likely have physical concerns since your cancer may cause symptoms and you may have side effects from your treatment. In this article, you'll learn more about how to respond to some of the most common ones. Your reaction depends on the treatment you get. We've listed symptoms and side effects alphabetically so that you can easily find tips to ease the problems you are having:

Anemia (low red blood cell levels)

Chemotherapy and radiation therapy may damage blood-producing cells in the bone marrow. This can reduce levels of red blood cells. Red blood cells carry oxygen throughout the body. If your body doesn't have enough oxygen, you may feel fatigued.

Take these actions to feel better:

• Take short rests when you're tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of fluids. Dehydration can also lead to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people feel blue, anxious, or distressed after being told they have cancer. Taking these actions may ease your distress:

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

• Ask to see a counselor.

• If these feelings persist, ask your doctor about medications for depression and anxiety.

Bladder irritation

Most people with early-stage bladder cancer won't have any symptoms. But later-stage bladder cancer may cause a burning sensation when you urinate. Some of the treatments for bladder cancer may also cause bladder irritation. These treatments include radiation therapy, chemotherapy, and intravesical chemotherapy or immunotherapy, where the medication is put directly into your bladder. The irritation will usually ease about two weeks after treatment ends. You should call your doctor if you have this symptom.

These steps can also help relieve the discomfort:

• Drink plenty of water after chemotherapy or radiation. Water helps soothe damaged cells in the bladder. It also reduces the concentration of irritating drugs used in chemotherapy. Try to drink one to two quarts of water every day.

• Avoid coffee or other beverages with caffeine. Caffeine irritates the bladder.

• Avoid alcoholic beverages. Alcohol irritates the bladder.

• Urinate on a regular schedule to flush the bladder.

• Ask your doctor about drugs that may help. One drug called Mesnex (mesna) protects the lining of the bladder. The drug Pyridium (phenazopyridine) is a local painkiller that reduces burning during urination.

Bleeding

Chemotherapy and radiation therapy may reduce levels of platelets in the blood, resulting in a condition called thrombocytopenia. Platelets are cell-like structures in blood that allow the blood to clot. If your doctor or nurse tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to bruising or bleeding:

• Protect your skin from cuts and scrapes.

• Shave with an electric razor.

• Use a soft toothbrush to prevent bleeding gums.

• Take steps to prevent constipation, which can lead to hemorrhoids and anal or rectal bleeding.

• Call your doctor if you develop a rash, bleeding, or bruising.

Diarrhea

Both chemotherapy and radiation therapy can damage cells in the intestine. This can result in diarrhea. Diarrhea can sometimes cause dehydration. To prevent it, take these precautions:

• Avoid milk and milk products.

• Eat low-fiber foods, such as those in the BRAT diet (bananas, rice, applesauce, and toast).

• Increase your intake of fluids (such as water and broth) to prevent dehydration.

• Ask your doctor about medications that may help.

Fatigue

Fatigue is a common cancer symptom. It's also a common side effect from chemotherapy and radiation treatments and after surgery to remove your bladder. You may feel only slightly tired, or you may suffer from extreme fatigue. Take these actions to help increase your energy level:

• Take short rests when you feel tired. Avoid long naps during the day. These choices will help you sleep well at night.

• Add mild exercise, such as walking, to your daily routine. Exercise increases energy and helps prevent fatigue.

• Save your energy for important tasks. Ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• Eat nutritious meals. Many people lose their appetite during cancer treatments. A lack of nutrients can make you tired.

Hair loss (alopecia)

Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. If you are having radiation to your pelvis for bladder cancer, you may lose your pubic hair, but not the hair on your head. It will grow back. You may lose the hair on your head if you are getting systemic chemotherapy. Try these coping tips:

• Find out if your treatment may cause hair loss. If so, consider cutting your hair short before your chemotherapy starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Increased infections

Chemotherapy and radiation therapy may damage blood-producing cells in the bone marrow. This can reduce levels of white blood cells, causing a condition called neutropenia. Low levels of white blood cells make you vulnerable to infections. If your doctor or nurse tells you that your white blood cell count is low, take these actions to stay healthy:

• Avoid crowds or people with colds.

• Wash your hands often throughout the day to kill germs.

• Call your doctor right away if you have signs of infection. These include a temperature of 100.5 degrees or higher, chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Insomnia (trouble sleeping)

It's natural for people undergoing cancer treatments to experience anxiety. Anxiety and stress are common reasons people have trouble sleeping. Trouble sleeping may be a side effect of chemotherapy or other drugs used during your treatment. Use these tips to improve your sleep:

• Go to bed at the same time every night.

• Use your bed only for sleeping, not for watching TV.

• If you don't fall asleep in 15 minutes, get up. Do something else for a while, then try to sleep again later.

• Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

• Don't eat, drink fluids, or exercise close to your bedtime.

• Avoid long naps during the day.

Loss of appetite

You need to eat well during cancer treatments to maintain your strength and lower your chance of infection. A diet high in calories and protein is important when you're being treated for cancer and following surgery to remove the bladder. However, chemotherapy can reduce your appetite. It may even change the way food tastes. Ask your doctor for a referral to a registered dietitian if you are having trouble maintaining your appetite. Also, try these tips to stimulate your desire to eat:

• If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue. Cancer treatments cause you to use more protein than usual.

• If you are underweight, eat high-calorie foods, if you can, to help you maintain your weight. High-calorie foods include margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, fruit juices, and other liquids, try these foods to increase fluids: gelatin, pudding, soups, Popsicles, and ice cream.

• Eat small meals throughout the day instead of three large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse. 

Memory or concentration problems ("chemo brain")

You may have mild problems with concentration and memory during and after chemotherapy. Symptoms can include trouble concentrating, short-term memory lapses, trouble multitasking, and trouble with remembering names. Fatigue can make the problem worse. Taking these actions may help:

• Make lists and write down important information.

• Organize your life by using calendars, pill dispensers, or alarm clocks.

• When you need to remember something important, put reminder notes where you'll see them, such as on the refrigerator door or bathroom mirror.

Be certain to alert your medical team if you have these symptoms, and ask what can be done to help improve cognitive health. Cognitive interventions may be especially important after treatment ends. 

Nausea or vomiting

Some people who have chemotherapy or radiation experience very little nausea. For others, nausea or vomiting is severe. To prevent and control nausea or vomiting, try these tips:

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. If one medicine doesn't work, call your doctor or nurse. There are other medicines that may be effective.

• Eat bland foods that are easy on the stomach, such as applesauce, bananas, rice, pudding, or crackers.

• Avoid foods that are fatty, fried, very sweet, or spicy.

• Eat cold foods or foods at room temperature. The smells from hot food may make nausea worse.

• Practice relaxation exercises, such as yoga or deep breathing. Relaxation exercises reduce anxiety, which can lessen nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists. The bands may reduce nausea in some people. They are available from most drugstores.

Pain

Pain is a common side effect of cancer treatments. For instance, you may have pain after surgery to remove your bladder. Pain can also be caused by the cancer itself. For example, the growth of the cancer may put pressure on nerves in the area of the bladder. Call your doctor right away if you're in severe pain. Medicines can be very effective at easing pain. Here are a few extra tips to ease the pain:

• Take your pain medications regularly. Don't wait for pain to become bad before taking them.

• Change your activity level. This may mean resting more. Or it could mean being more active than you currently are. Try both approaches to see if either helps.

• Distract yourself when the pain is bad. Listen to music, for example, or play computer games.

• Apply a heating pad to painful areas. Or use a cold pack. Both hot and cold treatments help some people.

• Try relaxation techniques, such as yoga or meditation. People experience more pain when they're anxious and stressed. Relaxation techniques can help you reduce stress as well as pain.

Sexual problems in men

If you've had a radical cystectomy to remove your bladder and also had your prostate gland removed, you will no longer be able to impregnate a woman. And, you may have problems getting and maintaining an erection, called erectile dysfunction. You may also have this problem if you've had radiation therapy. If you've had bladder reconstructive surgery, it may also damage the nerves that allow you to have an erection. Feelings of depression from having cancer or fatigue from other treatments can also have a negative impact on your sexual desires.

Here are some ways you may cope better:

• Talk with your partner about changes in your desire to have sex.

• Explore new ways to share affection and intimacy.

• Discuss sexual problems with your doctor or with other members of your health care team. They may be able to refer you to a counselor who specializes in sexual problems or to a sexual rehabilitation program.

• Talk with your doctor about medical ways to restore erections. Your options may include medications such as Viagra, penile implants, injections, or vacuum devices.

• If childbearing is an issue, talk with your doctor about this before your treatment. There may be ways to store your sperm in a sperm bank.

Sexual problems in women

If you've had a radical cystectomy to remove your bladder and had your uterus, ovaries, and fallopian tubes removed, you will no longer be able to become pregnant. You may also have menopausal symptoms, such as hot flashes or vaginal dryness. Receiving radiation treatment may also cause vaginal dryness.

Here are some ways you may cope better if this is an issue for you:

• Talk with your partner about changes in your desire to have sex.

• Explore new ways to share affection and intimacy.

• Discuss sexual problems with your doctor or with other members of your health care team. They may be able to refer you to a counselor who specializes in sexual problems or to a sexual rehabilitation program.

• Discuss with your doctor ways to manage menopausal symptoms, such as using lubricants for vaginal dryness, doing mild exercise, and talking with an accredited psychotherapist about mood swings or signs of depression.

• Report any unusual bleeding to your doctor.

• Continue with regular pelvic exams.

Skin problems

Radiation treatments can damage skin cells and cause the skin to get dry, red, or irritated. Here are a few ways to protect your skin:

• Use sunscreen with a sun protection factor (SPF) of at least 15. It's especially important to use sunscreen between 10 a.m. and 3 p.m., when the sun is brightest.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use skin products, including lotions, soaps, deodorants, perfumes, or powders, for two hours after radiation treatments since your skin will be extra sensitive.

• Wear loose, soft clothing over the treated area.

• Try not to scratch, rub, or scrub skin over the area being treated.

• Avoid using skin bandages. If you need to bandage the area, use paper tape. Ask your nurse to help you place the dressings properly to avoid irritation.

• Don't apply heat or cold to the treated area, which can irritate the skin. Bathe only with lukewarm water.

• If you must shave the treated area, use an electric shaver rather than a blade. Don't use lotion before shaving because it can get in the skin through small cuts.

• Don't use hair removal products.

Urinary incontinence

Incontinence is the inability to control the flow of your urine. This may be caused from the tumor itself. Or it may be a side effect of radiation.

Not being able to control your urine can lead to anxiety, and loss of self-control or self-esteem. Take heart. There are treatments available. Start with these steps:

• Talk with your doctor about prescription drugs that may decrease urinary frequency.

• Talk with your partner about how you feel if your fear of incontinence is limiting your participation in sex or social activities.

• Keep track of your symptoms so that you can let your doctor know exactly what is happening. Record how many incontinence pads you use, what activities cause incontinence, how frequently you urinate, if you have frequency or urgency, how strong your force of urine stream is, if you feel that you are emptying your bladder well, and what types and how much fluid you are drinking.

• Make sure you urinate regularly — about every three hours.

• Avoid drinking caffeinated beverages because caffeine causes the kidneys to make more urine and irritates the bladder.

• It may help to avoid acidic foods, such as orange juice, and spicy foods because they may irritate the bladder.

• Talk with your doctor about how to do Kegel exercises to help with stress incontinence. These exercises strengthen the pelvic floor muscles. Here's how to identify these muscles. Try stopping your urine stream while you are urinating. The muscle you use is the one you want to strengthen. To perform Kegel exercises, simply repetitively contract and relax that muscle at least 20 times every day. These exercises are the most helpful when the catheter is removed after radical surgery. They are not as effective in men who have had radiation treatment.

• Talk with your doctor about your options for treatment. These may include medications, catheterization, and other options.

It's helpful to keep a log of your side effect symptoms — physical, cognitive, and emotional changes. A written list will make it easier for you to remember your questions at your appointments. It will also make it much easier for your medical team to identify appropriate treatments for your side effects. Bring a family member or close friend with you to doctor's appointments to help deal with the medical information and remember all your questions.