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Pelvic floor (Kegel) exercises can strengthen the muscles that support the bladder or other organs in the abdomen (lower belly). Healthcare providers, such as pelvic floor physical therapists, trained in pelvic therapy can help you create a plan that works for you.

Pelvic floor physical therapists may use biofeedback for your treatment. This uses sensors placed near the anus to show on a screen which pelvic muscles are being exercised. Pelvic therapy done with biofeedback often works better than exercises alone.

You can ask your care team for a referral to a pelvic floor physical therapist. Or if you search for one yourself, check that they are trained in caring for people with cancer.

Contact your insurance to find out whether you need a referral to pelvic physical therapy to cover costs. Learn more about Managing Your Health Insurance and Medical Bills.

Bladder training creates a schedule of times to urinate. You also learn to use relaxation techniques in between to help with urges to pee in between scheduled times. Track your progress in a bladder diary. The time between peeing is made longer as you progress.

Medicines can be used to help relax overactive bladder muscles. If incontinence is related to menopause, topical estrogen can help some people.

Several medical devices can help manage bladder incontinence.

• An external catheter is worn outside the body near the urethra. It collects urine in a bag that can be emptied.
• An internal (or indwelling) catheter is inserted through the urethra and goes into the bladder. Urine flows out through the catheter into a bag that can be emptied. Internal catheters can increase the risk of infection.
• Pessaries can help with incontinence when? pelvic organs have dropped out of position (prolapsed). These devices are placed in the vagina to support the bladder and urethra.

Internal and external catheters do not treat the cause of incontinence. They only help manage it to prevent other problems.

Surgery might be an option if other methods haven’t helped or there is a blockage. The type of surgery for a blockage depends on the cause.

• Sling surgery places a piece of mesh or tissue between the vagina and urethra. This supports the bladder and urethra. In men, a male sling surgery can be done.
• Artificial urinary sphincter surgery places a device to keep the urethra closed. When you need to pee, you squeeze a pump that releases a cuff and opens the sphincter for a few minutes.

• Alcohol, tobacco, caffeine, and artificial sweeteners can irritate your bladder.
• Some medicines can make bladder incontinence worse. These include opioids, benzodiazepines, allergy medicines, antidepressants, diuretics, heart medicines, and muscle relaxants. Always talk to your doctor or cancer care team before making any changes to the medicines you take.

• Pushing or straining to urinate (pee) can make leaks worse.
• Constipation can make your bladder incontinence worse. Work with your cancer care team to manage it.

A bladder diary can help you and your care team see patterns, find what triggers leaks, and tell if a treatment is working. You can use this from the National Institute of Diabetes and Digestive and Kidney Diseases or another method to track:

• What and how much you drink
• When you urinate (pee) and how much
• When leaks happen and what you were doing
• Any other symptoms

Do not limit how much liquid you drink unless you have been told to do so by your doctor. This can lead to other problems like dehydration.

Incontinence products can help you cope with leaks, especially during daily activities or while you sleep. They are not treatments. Options include:

• Washable or disposable incontinence underwear
• Waterproof underwear
• Incontinence pads to place in your underwear
• Large disposable absorbent pads to place on the bed while you sleep
• Waterproof mattress covers
• External catheters to collect urine and drain into a container that can be emptied

Consider whether you want one-time use, disposable products or reusable, washable products. Disposable products might cost more over time. Ask if your insurance covers certain products. Most importantly, find a product that you feel most comfortable using.

Urine can irritate the skin. Change wet incontinence products right away. Ask your care team about creams and lotions to help prevent skin irritation and breakdown from urine. Take good care of your skin.