Incontinence after prostate surgery

Prostate surgery can bring about temporary urinary incontinence for many men. But don't worry, the good news is that these symptoms often improve over time. If you or someone you love has undergone prostate surgery and is struggling with bladder control, it's time to take action.

In this article, we’ve partnered with MoliCare to explore the reasons behind incontinence after prostate surgery, including benign prostate enlargement, prostate cancer, and weak pelvic floor muscles. We'll also share tips on how you can support your recovery, including hygienic measures and pelvic floor exercises.

Don't let incontinence hold you back any longer. Empower yourself with the knowledge you need to regain control of your bladder and improve your quality of life.

Urinary incontinence is a common side effect of prostate surgery, particularly among older men. But here's the good news: in many cases, incontinence after prostate surgery resolves on its own over time. Until then, there are products designed specifically to help you manage your symptoms and live life without limitations such as MoliCare mens incontinence pads.

Surgery may be necessary due to a benign or malignant enlargement of the prostate. We will consider both these types in this article.

If the prostate has to be removed surgically, parts of the urethra and its sphincter muscle are often also affected. The sphincter muscle at the outlet of the bladder is responsible for opening and closing the bladder. If the muscle is damaged, the function of the sphincter can be impaired.

However, whether the sphincter muscle is actually affected depends greatly on the age of the person and certain pre-existing conditions as well as the surgical technique and the size of the prostate.

If the muscle is damaged during surgery, then stress incontinence is often the result. ‘Stress’ in this case refers to the increase in pressure caused by sneezing, coughing, laughing or carrying heavy objects. This leads to an unwanted loss of urine. Stress incontinence is the most common form of urinary incontinence following prostate surgery but urge incontinence (also called overactive bladder) may also occur. Those affected report a constant urge to urinate even when the bladder is barely full.

Unfortunately, it is very difficult anatomically to not damage the urethra during prostate surgery because the prostate surrounds the upper part of the urethra and parts of the sphincter muscle. Fortunately, the outer sphincter is usually not affected and can be strengthened using targeted training. This helps to alleviate incontinence over time.

Along with prostatectomy, treatment with radiotherapy can also weaken the bladder muscles and lead to male urinary incontinence. 

An enlarged prostate often manifests as problems when urinating. The growth of the prostate constricts the urethra further and further, which can lead to overflow incontinence or urge incontinence.

This occurs with both benign and malignant enlargement.

While the prostate in young men is about the size of a walnut, over the course of a man’s life the number of prostate cells steadily increases. The prostate thus grows and as a result closes increasingly tighter around the urethra. This change has nothing to do with prostate cancer but can still affect continence. This is often associated with the following symptoms: 

• Frequent urge to go to the toilet, also at night
• Problems with starting to urinate
• A weak urine stream and a feeling that the bladder is never completely emptied
• Or even unwanted loss of urine

Treatment of benign enlargement of the prostate depends on the individual symptoms and the size of the prostate. Medications are an option as is prostate surgery. Your doctor will provide you with the necessary information.

The risk factors for benign enlargement of the prostate includes: 

• The use of hormones,
• Hereditary factors,
• An unhealthy diet,
• Smoking
• Alcohol consumption 

Prostate cancer is the most common type of cancer in men. According to the German Cancer Society3, every year 60,000 men develop this type of cancer. Prostate cancer occurs very rarely in younger men. The risk increases dramatically with age.

There are different methods to treat prostate cancer. One option is the surgical procedure radical prostatectomy (removal of the prostate). The chances of a recovery are good with this therapy if the cancer has not already spread. It is therefore the best treatment option for many patients, even if the consequence may be possible impairment of bladder function that can lead to urinary incontinence. However, it is only relatively rarely and only in severe cases that incontinence is permanent.

Immediately after surgical therapy almost every man has difficulty controlling his bladder. After about 3 months one in two men is still affected but the number drops again over the next few months. 18 months after radical prostatectomy (removal of the prostate), 4 to 21 in 100 men still report that they experience unwanted loss of urine, particularly in stress situations such as coughing, sneezing or laughing. In these cases the pressure in the abdominal cavity and thus on the bladder also increases. After 5 years about one-quarter of those affected still use incontinence aids such as pads or disposable pants. In about 7% of men the urinary incontinence is permanent.

Along with incontinence erectile dysfunction can also develop after prostate surgery. As with incontinence, the symptoms improve in many men after a few months, however.

Mild or moderate incontinence after prostate surgery can be remedied by slim incontinence pads, making life much more pleasant. The MoliCare® MEN products are especially slim and designed for the male anatomy, providing both protection and a secure feeling.

With more severe bladder weakness it is important that even larger volumes of urine are captured and do not leak out. The disposable MoliCare MEN PANTS have a soft, leak-proof inner cuff, are worn like normal underwear and offer additional leak protection.

Because a part of the sphincter muscle is usually retained after surgical removal of the prostate, this muscle can be specifically trained and take over from the removed muscle. The difficulty is that many people do not know exactly where this muscle is located and how it can be strengthened. It is therefore advisable, particularly at the start, to work together with a specially trained physiotherapist. Find out what you need to know while you’re in the hospital.

In principle, you can imagine the pelvic floor as a sheet of muscle that supports the organs in the abdominal cavity with openings for the urethra and bowel. The better trained this muscle is, the more pressure it can withstand, particularly if stress is placed on the bladder.

This helps to improve bladder control. Pelvic floor exercises are easy to learn and can also be easily integrated into everyday life. Improvements are usually seen after a few weeks so be patient and keep training. 

Pelvic floor training can also be supported by other measures. Modern biofeedback, electrostimulation or even surgical methods are options.

After prostate surgery, urinary incontinence can be a major problem. The prospect of living with urine loss can be depressing. But it doesn't have to be this way. While you certainly don't want to ignore the condition, simply accepting the fact that you'll have pelvic floor incontinence after prostate surgery is not healthy and not smart either. If your urologist has already given you exercises to improve the situation, there's no need to worry – you are on the right track!

Sources

1.       https://gesund.bund.de/prostatahyperplasie-gutartig#definition

2.       https://prostata-hilfe-deutschland.de/gutartige-prostatavergroesserung-bph/

3.       https://www.gesundheitsinformation.de/gutartige-prostatavergroesserung.html

4.       https://www.prostata-hilfe-deutschland.de/prostata-wissen/inkontinenz-prostatakrebs-behandlung