Follow-Up Care & Healthy Lifestyle
Whether you are still receiving treatment or have finished, you will be checked at regularly scheduled follow-up appointments to monitor for a possible recurrence or other health care issues. These appointments are important because finding any disease recurrence early is key to successful treatment. Along with running tests, your doctor will ask questions about any ongoing physical symptoms you may be having, especially those related to recurrence and continued side effects of treatment.
Your follow-up plan may include:
- An appointment schedule for ongoing monitoring. These appointments may include medical history, a physical exam, imaging procedures (such as X-rays and CT scans), a cystoscopy (if the bladder has not been removed), urine tests, blood work and other lab tests.
- Maintenance medications or therapies, including type, dosage, frequency and duration.
- Referral(s) for cancer rehabilitation, such as physical or occupational therapy, or assistance from a pelvic health specialist.
- Information about your risk of a recurrence, a second cancer, long-term treatment-related side effects and late effects, which are side effects that develop weeks, months or years after treatment ends.
- Recommended screening guidelines for other types of cancer.
Along with reporting physical symptoms, it is also important to discuss how you feel mentally and emotionally — or sooner if something changes. Specific information to discuss includes the following:
- New or ongoing physical symptoms that are not adequately relieved, including pain, gastrointestinal problems, nausea and vomiting, signs of infection and sexual health
- Cognitive (thinking-related) symptoms, such as difficulties with memory, concentration, processing information, word-finding or completing tasks
- Emotional issues, such as depression, anxiety, fear, anger, grief, hopelessness, emotional numbness, feeling overwhelmed or other concerns
- Visits to the emergency room, urgent care or other doctors, even if not cancer-related
Having a well-balanced lifestyle may help you tolerate treatment better, lower the risk of a recurrence or the risk of other chronic diseases, and help protect against secondary cancers. Following are suggestions for smart ways to approach key elements of your everyday life.
- Follow a nutritious, heart-healthy diet that includes a variety of fruits and vegetables, lean meat, low-fat dairy products and foods with plenty of fiber. Ask your doctor to recommend a registered dietician who can help you plan meals and make good food choices.
- Watch your weight. It may be difficult to maintain your appetite, which may lead to weight loss.
- Get regular exercise. Even walking 10 minutes a day can provide benefits.
- Stay hydrated. In general, drinking 8 to 10 glasses of fluid a day is recommended. Sometimes you may need more. Dehydration can worsen side effect symptoms.
- Avoid processed and red meats.
Difficulty with urination may occur after treatment for bladder cancer. Incontinence, or leakage of urine, can range from mild to severe. There are three types of incontinence:
- Stress incontinence happens when the muscle that squeezes the urethra to keep urine in the bladder is weak or damaged, or the nerves that help the muscle work have been damaged.
- Overflow incontinence occurs when the bladder does not empty well and the amount of urine made is more than the bladder can hold. Usually caused by a blockage or narrowing caused by scar tissue, overflow incontinence may happen when the bladder muscle cannot squeeze well enough to release all the urine.
- Urge incontinence is the most common type after radiation therapy. The symptoms are similar to that of an overactive bladder. The bladder muscle, irritated by the radiation, contracts too often, sometimes powerfully enough to force urine out with little warning.
Below are some options for managing incontinence.
- Pelvic floor exercises, commonly known as Kegels (pronounced KEE-gulz), can help reduce leakage from stress incontinence (see About Kegels below).
- Medications that will tighten or relax your muscles may be prescribed. These drugs can have side effects, so make sure to ask about them.
- For overflow incontinence caused by blockage of the urethra by scar tissue or by an enlarged prostate, a surgical procedure done through a scope can relieve the obstruction.
- In serious cases of stress incontinence, the surgeon may implant a sling to hold up the bladder or place an artificial urinary sphincter (device that constricts) around the urethra to prevent or reduce leakage.
- Empty your bladder on a regular schedule and before physical activities to help prevent leakage.
Other lifestyle changes may include:
- Avoiding lifting heavy objects
- Practicing lengthening the time between trips to the bathroom to train your bladder
- Eating a healthy diet
About Kegels: Exercises to help manage incontinence
Kegels are helpful before and after bladder cancer treatment. These exercises may not eliminate your bladder incontinence, but with consistent practice, you could see a marked improvement in just weeks. Do not practice them if you have a catheter in place.
To get started, try to perform these exercises while you are standing. If you are not able to stand, try sitting or choose a position that is comfortable for you.
- Tighten your pelvic floor muscles. Ensure you’re flexing the correct muscles (not your abdomen, thighs or buttocks). Tighten the muscles used to stop urinating mid-flow.
- Hold the contraction for 10 seconds, and then relax for 10 seconds. Avoid holding your breath. Instead, breathe freely during the exercises.
- Aim for at least six sets of 10 repetitions a day. As your muscles get stronger, increase your repetitions daily.