Palliative care can also help you manage the urinary, kidney, and bowel symptoms of advanced bladder cancer.
Urinary Issues
Bladder spasms and frequent urination can be among the most distressing symptoms of the disease. Chwistek says they can “disrupt sleep, limit activity, and profoundly affect dignity and quality of life.”
Your care team can offer you several treatment options, including:
- Medications to Calm Spasms Drugs such as oxybutynin are often used to relax the bladder, especially in older adults.
- Direct Bladder Treatments In some cases, medications placed directly into the bladder (called intravesical treatments) can help soothe irritation and ease discomfort.
- Frequent-Urination Management Timed bathroom trips, strategic fluid timing, and medication can help manage urinary problems caused by less room in the bladder. If the symptoms are caused by the tumor itself, palliative radiation to the bladder can sometimes reduce irritation, says Chwistek.
- Relief for Pain or Burning Burning or pain with urination may improve with urinary analgesics, such as phenazopyridine, anti-inflammatory medications, or (in select cases) low-dose tricyclic antidepressants that help quiet pain signals.
- Supportive Urologic Procedures Palliative care teams work closely with urologists when procedures are needed, such as suprapubic catheter placement or other interventions to manage bleeding or obstruction.
Kidney Health
Tumors can block urine flow, causing kidney swelling (hydronephrosis) and pain. To relieve pressure, urologists may opt for ureteral stents or nephrostomy tubes.
Palliative teams ensure these procedures align with your goals. “When kidney function declines significantly, we have honest conversations with patients about how it affects treatment options and overall prognosis, always in a supportive context focused on what we can do to maintain quality of life,” says Chwistek.
Bowel Health
Bowel changes are common due to treatments and pain medications. “For opioid-induced constipation specifically, we have newer medications called PAMORAs (peripherally acting micro-opioid receptor antagonists), such as methylnaltrexone and naloxegol, that block opioid effects in the gut without affecting pain control,” says Chwistek, who also recommends drinking plenty of fluids, staying active, and taking laxatives.
If diarrhea is frequent, tell your doctor right away. Immunotherapy can cause colitis, which sometimes requires steroid treatment, says Chwistek. In the meantime, try to stay hydrated; steer clear of caffeine, high-fat foods, and raw vegetables; and eat small, frequent meals.
