The urinary tract is particularly sensitive in the cancer patient; problems such as burning during urination or a constant urge to urinate are fairly common. Symptoms of an infection include local discomfort, dark or strong-smelling urine, fever or chills, and low back pain.
If a bladder infection is present, encourage the patient to drink up to three quarts of fluid a day (especially water), avoiding coffee, tea, and other caffeine-containing products, as well as alcoholic beverages. Avoid foods that could be irritating to the bladder lining, such as alcohol, coffee, tea, and spicy foods. Vitamin C or large quantities of cranberry juice (up to three quarts) may help reduce infection by acidifying the urine.
Dehydration and kidney failure can result from hyperuricemia (excessive blood levels of uric acid), which is most common in cancer patients as a result of tumor lysis syndrome (TLS), an emergency that may follow some chemotherapies, especially for leukemia or lymphoma.
When chemotherapy results in especially rapid destruction of massive numbers of tumor cells, tumor lysis syndrome may occur due to the accumulation of toxic waste products. This is a potentially life-threatening medical emergency that must first be identified by the treatment team. In addition to medical management, the following dietary recommendations should be considered:
• Drink at least three quarts of fluid a day (especially water), but avoid tea and wine, as they are high in purines. These substances contribute to the formation of uric acid, which can overwhelm kidney function.
• Avoid lentils, dried beans, liver, sardines, or anchovies, which also contain higher amounts of purines and so can make the condition worse.
When incontinence (leakage) is a problem, sometimes a medication to increase the sensation of having to urinate (an anticholinergic drug) or a catheter may be used.
Urinary retention, an uncommon side effect of opioids and a few other drugs, is most common in elderly men. Tolerance to the drug often eventually develops. If it is not particularly uncomfortable or severe, it may be left untreated.
Occasionally the outflow of urine becomes completely blocked due to medications, swelling, or pressure from a tumor. This is usually accompanied by swelling of the lower abdomen, feelings of pressure, and discomfort. If simple measures to help the urine flow do not work, the doctor should be informed; if he is unavailable, the patient may need to go to an emergency room to have a catheter passed to empty the bladder. Usually bladder catheterization is not uncomfortable, especially for women.
A catheter is often left in place when patients chronically leak urine or are bedridden and do not have the strength to get to the bathroom. The use of a catheter may increase the risk of a bladder infection, but it can make life much easier for patients who are easily fatigued by frequent trips to the bathroom.
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