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  • Looking after yourself after treatment for bladder cancer

    Contents

    Cancer can cause physical and emotional strain. It’s important to try to look after your well-being as much as possible.

    Nutrition

    Eating healthy food can help you cope with treatment and side effects. A dietitian can help you manage special dietary needs or eating problems, and choose the best foods for your situation.

    For more information about nutrition call Cancer Council 13 11 20 or you can download the booklet Nutrition and Cancer.

    Staying active

    Physical activity may help to reduce tiredness, improve circulation and elevate mood. The amount and type of exercise you do depends on what you are used to, how you feel, and your doctor’s advice.

    For more information about exercise call Cancer Council 13 11 20 or you can download the booklet Exercise for people living with cancer.

    Complementary therapies

    These therapies are used with conventional medical treatments. You may have therapies such as massage, relaxation and acupuncture to increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying as some may not be safe or evidence-based.

    Alternative therapies are used instead of conventional medical treatments. These therapies, such as coffee enemas and magnet therapy, can be harmful.

    For more information about complementary therapies call Cancer Council 13 11 20 or you can download the booklet Understanding Complementary Therapies.

    Relationship with others

    Having cancer can affect your relationships with family, friends and colleagues. This may be because cancer is stressful, tiring and upsetting, or as a result of more positive changes to your values, priorities or outlook on life.

    Give yourself time to adjust to what’s happening and do the same for others. People may deal with the cancer in different ways, for example by being overly positive, playing down fears or keeping a distance. It may be helpful to discuss your feelings with each other.

    Sexuality, intimacy and fertility

    Cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on treatment and side effects, your self-confidence, and whether you have a partner. Surgery and other treatments to the pelvic area can cause sexual changes. A person who has a urostomy bag may also feel embarrassed, which can affect their desire for sex (libido).

    Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship. If you are able to have sex, you may be advised to use certain types of contraception to protect your partner or avoid pregnancy for a certain period of time. Your doctor will talk to you about the precautions to take. They will also tell you if treatment will affect your fertility permanently or temporarily. If having children is important to you, talk to your doctor before starting treatment.

    Sexual changes for men

    Nerve damage from cystectomy – A cystectomy can often damage nerves to the penis, but the surgeon will try to prevent or minimise this. Nerve damage can make it difficult for a man to get an erection. Options for managing erections include:

    • prescribed oral medicines that increase blood flow to the penis
    • injections of medicine into the penis
    • vacuum devices that use suction to draw blood into the penis 
    • an implant called a penile prosthesis – under general anaesthetic, flexible rods or thin inflatable cylinders are inserted into the penis and a pump is positioned in the scrotum; the man can then turn on or squeeze the pump when an erection is desired.

    Fertility after cystectomy – If the surgeon has to remove other organs, such as the prostate and seminal vesicles, you will also experience an orgasm without semen (dry orgasm) and be unable to father children. You may find this upsetting and worry about the impact on your relationship. It may be helpful to talk about how you’re feeling with your partner, family or a counsellor.

    Changes after radiation therapy – Men who are treated with radiation therapy may also have poor erections, and ejaculation may be uncomfortable for some months after treatment.

    Sexual changes for women

    Vaginal changes after cystectomy – In some women, the vagina may be shortened or narrowed during a cystectomy. In addition, some nerves that keep the vagina moist can be affected, making the vagina dry. These changes can make penetrative sex difficult or uncomfortable at first. You can manage them by:

    • using a hormonal cream to keep your vagina moist
    • asking a physiotherapist how to use a vaginal dilator to help stretch the vagina
    • trying to have sex regularly and gently (when you feel ready) to gradually stretch the vagina.

    Arousal after cystectomy – A cystectomy can damage the nerves in the vagina or reduce the blood supply to the clitoris, which can affect sexual arousal and the ability to orgasm. Talk to your surgeon or nurse about ways to minimise potential side effects.

    Menopause after cystectomy – Some women may have their uterus and other reproductive organs removed during a radical cystectomy. If you have not yet gone through menopause, this will cause menopause and your periods will stop. As your body adjusts to changes in hormone levels, you may experience symptoms such as hot flushes and vaginal dryness. Your medical team can give you advice about managing these symptoms.

    Fertility after cystectomy – Menopause means that it will no longer be possible to conceive children. You may feel upset and worry about the impact on your relationship. Try talking about how you’re feeling with your partner, family or a counsellor.

    For more information on sexuality, intimacy and fertility call Cancer Council 13 11 20 or download the booklets Sexuality, Intimacy and Cancer, Fertility and Cancer and Emotions and Cancer.

    Life after treatment

    For most people, the cancer experience doesn’t end on the last day of treatment. Life after cancer treatment can present its own challenges. You may have mixed feelings when treatment ends, and worry if every ache and pain means the cancer is coming back.

    Some people say that they feel pressure to return to “normal life”, but they don’t want life to return to how it was before cancer. Take some time to adjust to the physical and emotional changes, and re-establish a new daily routine at your own pace. Cancer Council 13 11 20 can help you connect with other people who have had cancer, and provide you with information about the emotional and practical aspects of living well after cancer.

    Dealing with feelings of sadness

    If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.

    Talk to your GP as counselling or medication – even for a short time – may help. Some people are able to get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council SA has a free counselling service which offers you an opportunity to discuss your cancer experience and its impact on your life. Call Cancer Council 13 11 20 for more information.

    The organisation beyondblue has information about coping with depression and anxiety. Go to beyondblue or call 1300 224 636 to order a fact sheet. 

    Follow up appointments

    After your treatment, you will need regular check-ups to confirm that the cancer hasn’t come back. Your check-ups may include cystoscopies, CT scans, x-rays and other tests.

    For people who still have a bladder, follow-up cystoscopies are needed regularly because they are the best way to detect bladder cancer that has come back. The cystoscopy procedure may be done in hospital in the outpatient department under local anaesthetic or in an operating theatre under general anaesthetic.

    Depending on the type of bladder cancer you had, you will need a follow-up cystoscopy every 3–12 months. The follow-up cystoscopies may continue for several years or for the rest of your life, but will become less frequent over time. Between these follow-up appointments, let your doctor know immediately if you experience any health problems.

    What if bladder cancer returns?

    Sometimes bladder cancer does come back after treatment, which is known as a recurrence. If the cancer recurs, it can usually be removed while it is still in the early stages. This will require a separate cystoscopy under general anaesthetic. If this isn’t possible, your doctor may consider a removal of the bladder (cystectomy). Some people need other types of treatment, such as chemotherapy or radiation therapy.

    The type of treatment you have will depend on the stage and grade of the cancer and your preferences.

    Call Cancer Council 13 11 20 for more information.

    This website page was last reviewed and updated September 2019

    Information reviewed by: Phil Dundee, Urological Surgeon, Epworth Hospital, VIC; David Connah, Consumer; Dr Elizabeth Hovey, Senior Staff Specialist, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, and Conjoint Senior Lecturer, University of New South Wales, NSW; Colleen McDonald, Clinical Nurse Consultant Urology, Westmead Hospital, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia, WA; Kerry Santoro, Urology Nurse Consultant, Repatriation General Hospital, SA. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.

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