Urinary and Bowel Symptoms from the Cancer
What causes it: A tumor in the prostate gland itself, especially if it grows large or extends beyond the prostate, can cause urinary symptoms. The prostate surrounds part of the urethra (the tube that carries urine out from the bladder). When a prostate tumor grows, it can press on the urethra or even start to invade the bladder or urethral wall. This can lead to blockage of urine flow. Also, if cancer spreads to lymph nodes in the pelvis, those enlarged nodes can press on the ureters (tubes from kidneys to bladder) or blood vessels, affecting urinary function indirectly. Common urinary issues include: difficulty starting urination, weak or slow stream, stopping and starting (hesitancy), not fully emptying the bladder, frequent urge to urinate, nighttime urination (nocturia), and sometimes blood in the urine.
These are similar to symptoms of benign prostate enlargement, but in advanced cancer they can be more pronounced. In severe cases, a complete blockage can occur, causing urinary retention (inability to urinate), which is painful and requires urgent medical attention. As for bowel symptoms, it’s rarer because the prostate is near the rectum but usually separated by a tissue layer. However, if a prostate tumor grows far back enough or if cancer invades the rectal wall (which is uncommon but possible in locally advanced cases), you could experience bowel problems like constipation, pain during bowel movements, or even bleeding from the rectum. More often, bowel symptoms are from treatments (like radiation) as discussed earlier, but the cancer itself usually has to be quite advanced locally to cause bowel issues. Metastatic cancer to abdominal lymph nodes could, in rare cases, contribute to bowel motility issues or obstruction, but this is not as common. So, in summary, urinary symptoms are a common direct effect of prostate cancer (the tumor pressing on or blocking the urinary tract), whereas bowel symptoms from the cancer are less common but can happen if there’s rectal involvement.
How it affects daily life: Urinary symptoms can be very bothersome. If you have to urinate every hour or constantly feel the urge, it disrupts your daily routine and sleep. Frequent urination and urgency might make you always be on the lookout for a restroom when you go anywhere. Nighttime urination (nocturia) means interrupted sleep – you might be waking up several times a night to pee, leading to fatigue during the day. Difficulty urinating or a weak stream can be frustrating; you spend a long time in the bathroom waiting for things to flow. Incomplete emptying can make you feel like you have to go again shortly after you just went. These issues can also be embarrassing – for instance, if you can’t hold urine, you might have leakage or occasional accidents, or you may have to rush out of meetings or social events to use the toilet. Blood in the urine (hematuria) can be frightening to see and messy if significant. If the tumor causes urinary retention (complete blockage), that’s acutely painful – your bladder stretches and it’s very uncomfortable; this typically requires a catheter to drain. Bowel symptoms, if present, might include constipation or a feeling of fullness in the rectum. You might need to strain more to have a bowel movement, or go more frequently if the rectum isn’t clearing well. Blood in stool or from the rectum can be alarming and can lead to anemia if it’s chronic. Even without rectal invasion, a large prostate can sometimes just create a sensation of pressure in the rectal area, making you feel the need to move your bowels more often. All of these urinary/bowel issues can reduce quality of life and can be a source of constant distraction and discomfort.
Ways to manage or reduce it: For urinary symptoms caused by the tumor, several approaches can help:
- Medications: Similar to BPH (benign enlarged prostate) treatment, doctors may prescribe alpha-blockers such as tamsulosin (Flomax) or alfuzosin. These relax the muscle in the prostate and bladder neck to improve urine flow, which can relieve symptoms of hesitancy and incomplete emptying. They work whether the enlargement is benign or malignant. 5-alpha-reductase inhibitors (like finasteride) that shrink the prostate are generally for benign growth and take months to work – in cancer, hormone therapy is more often used to shrink the prostate. If you’re not already on ADT and you have significant urinary issues from the tumor, starting hormone therapy can shrink the prostate tumor, often relieving urinary obstruction symptoms over weeks to a couple of months.
- Catheterization: If you have a lot of trouble urinating, a temporary measure is a urinary catheter. This can be an indwelling Foley catheter that stays in to continuously drain the bladder, or an intermittent self-catheterization where you learn to insert a catheter to empty your bladder a few times a day. These ensure the bladder empties and prevent retention. They are not ideal long-term solutions due to infection risk and inconvenience, but they can be a bridge while other treatments take effect.
- Surgery or procedures: In some cases, a TURP (transurethral resection of the prostate) can be done to carve out the inside of the prostate and relieve obstruction, even if cancer is present. This is mostly for symptom relief (known as “channel TURP”). It can dramatically improve urine flow and is considered if medications aren’t enough and life expectancy is such that invasive treatment is appropriate. Another scenario: if a tumor is blocking a ureter causing kidney issues, doctors can place a stent in the ureter or a nephrostomy tube to ensure urine drains from the kidney. This is more a complication management if needed.
- Radiation: If the primary tumor is causing severe local problems, sometimes radiation to the prostate is done even in advanced disease to reduce local tumor burden (this can also be considered as part of therapy to improve survival in some metastatic cases per newer studies). Radiation can shrink the tumor that’s pressing on the urethra, improving urinary function.
- Behavioral strategies: Avoiding fluids before bedtime can reduce nocturia. Limiting caffeine and alcohol (especially in evenings) can also help, as they stimulate urine production and bladder activity. Double-voiding (urinating, then waiting a moment and trying again) can help empty the bladder more fully. Taking your time and relaxing, perhaps sitting down to urinate, can sometimes help if you have trouble starting flow.
- Pelvic floor exercises: These are not just for incontinence; some evidence suggests they can help with urinary symptoms in men by better coordinating bladder and sphincter muscles, though their primary role is in strengthening control, not relieving blockage.
For bowel symptoms caused by the cancer:
- Diet and laxatives: If you’re dealing with constipation due to tumor pressure or related issues, a high-fiber diet and stool softeners or mild laxatives can keep things moving. Conversely, if you have a partial obstruction and fiber worsens pain, you might need a low-fiber diet; this can be tricky and requires a doctor’s input. Ensure you drink plenty of fluids.
- Radiation or surgery: If the cancer has actually invaded the rectum and is causing significant issues like obstruction or bleeding, treating that area via radiation or surgery might be considered. This is complex and would involve a multidisciplinary team (urologists and colorectal surgeons) because it’s an unusual situation. Sometimes a colostomy (bringing out part of the colon to bypass the rectum) might be needed if there’s a severe blockage or fistula (abnormal connection) between prostate and rectum. But these are rare scenarios.
- Management of hemorrhoids: Distinguish if bleeding is from hemorrhoids (common, especially if you strain a lot due to urinary issues) versus tumor. Treating hemorrhoids (softening stool, using creams, etc.) can alleviate some rectal discomfort or bleeding that might not actually be from the cancer.
- Consult gastroenterologist: If bowel symptoms are notable, seeing a GI specialist can help. They might do a scope to see what’s going on in the rectum and provide specific treatments.
Don’t be embarrassed to tell your doctor about urinary frequency, dribbling, or bowel changes. These are very common issues and doctors have heard it all. They will help differentiate if it’s treatment side effects or cancer itself and then tailor the approach.
Additionally, palliative care teams can assist with symptom management strategies for urinary and bowel issues too, ensuring you have the best quality of life. With the right combination of medication, possible procedures, and lifestyle tweaks, most men can find substantial relief from these pelvic symptoms of prostate cancer.