Managing incontinence after Prostate Surgery

Incontinence is experienced by many men following prostate surgery. Men often find this to be a stressful challenge to manage during the recovery process. It is important to get professional advice to help cope with incontinence after Prostate Surgery.

Why is it common to develop incontinence after Prostate Surgery?

The prostate gland is a male reproductive organ that sits at the base of the bladder. The thin tube urethra that carries urine and semen out of the penis runs through the center of the prostate gland. At the point where the bladder and urethra join, there is a ring of muscles known as the bladder neck sphincter, which opens and closes. The bladder neck sphincter is closed most of the time to prevent urine leaking out. However, when the brain sends a signal to the sphincter, it opens to allow urine to be passed. Another sphincter is part of another set of muscles below the prostate called the pelvic floor. These muscles are also involved in bladder control. If the bladder neck sphincter is damaged during prostate cancer surgery, this can lead to urinary incontinence. Temporary incontinence is the result of disruption or distress to the sphincter muscles that control the release of urine.

Although most reported statistics on the incidence of urinary incontinence following radical prostatectomy for Prostate Cancer indicate that the problem affects 2%–15%, this is likely understating the problem. A problem with identifying the number of men who suffer from incontinence is that relatively few studies have examined how long urinary incontinence persists and what proportion of men affected seek out interventions. It is common for men to be reluctant to mention the problem to their Doctors due to the taboo surrounding the topic of incontinence. It can be embarrassing and even shameful for some men to mention the problem to a Doctor and even others around them. A recent study published in the Journal of Clinical Oncology sent periodic surveys to 279 patients to proactively seek their responses both before and after treatment for prostate cancer. The results of the surveys concluded that at three months after surgery, 58% of men reported wearing an absorbent pad in the previous week. At 12 months after surgery, 35% reported using a pad in the previous week. The investigators also asked about urinary leakage, assuming some men were using absorbent pads as a protective measure but might not be leaking urine on a regular basis. The staff found that at three months after surgery, 24% of men reported leaking urine “a lot” in the previous week, and at 12 months, 11% were still experiencing the problem.

How long are you likely to be affected by incontinence?

It is estimated that the majority of men will begin to see an improvement one to six months after surgery. Other men leak urine for a year or more, while some men never fully recover. Larger studies, reported more recently, indicate that the problem of urinary incontinence often persists after surgery for prostate cancer. A study of the outcomes of 1,291 men who underwent radical prostatectomy, published in the Journal of the American Medical Association, found that 8.4% remained incontinent 18 months or longer after surgery. Another study published in the Journal of the National Cancer Institute questioned 901 men who were treated with surgery and found that 14% to 16% were incontinent five years after treatment. Finally, a recent analysis of 11,522 men who underwent radical prostatectomy found that 18% to 24% of men continued to experience incontinence more than one year after surgery.

How can you reduce the risk of becoming heavily incontinent after surgery?

Although it is common to develop incontinence after surgery, there are things you can do to treat or lessen the severity of your incontinence. Treatment options for incontinence post-surgery can depend on how much urine you’re leaking and how recently you had your prostate cancer treatment. There are a number of health professionals who can help you with incontinence following prostate surgery. Continence nurse advisors or urology nurses are there to provide you with advice about lifestyle tips such as changes to diet and exercises. If your incontinence persists beyond 12 months, talk to your urologist immediately, as there are a range of surgical alternatives to help you through the process. You can read our blog for guidance on how to talk to a Urologist about incontinence. Doctors and Urologists may also provide you with a variety of medications that can increase bladder capacity and decrease the frequency of urination. In the near future, newest medications will become available to help stop some other forms of urinary leakage. Physiotherapists also specialize in pelvic floor muscle exercises and can develop an individual program to suit your needs. Kegel exercises strengthen the muscles you squeeze when trying to stop urinating mid-stream. These exercises can be combined with biofeedback programs that help you train these muscles even better.

An artificial sphincter is a common treatment method that many men turn to after having Prostate Surgery. This patient-controlled device is made of three parts: a pump, a pressure-regulating balloon, and a cuff that encircles the urethra and prevents urine from leaking. The use of the artificial sphincter can cure or greatly improve more than 70% to 80% of the patients. Another popular surgery option is a Bulbourethral sling. A sling is a device used to suspend and compress the urethra. It is made from synthetic material or from the patient's own tissue and is used to create the urethral compression necessary to achieve bladder control.

Although Doctors can help you choose the most suitable treatment method, there are things you can be doing in the meantime to help your incontinence. This treatment includes behaviour modification, such as drinking fewer fluids, avoiding caffeine, alcohol or spicy foods and not drinking before bedtime. It is also recommended that you urinate regularly and do not wait until the last moment possible before doing so. In some people, losing weight may result in improved urinary control. Therefore, it is vital to look after your health and ensure you stay fit and active.

What should you ask your Doctor or Nurse if you are having Prostate Surgery?

Being proactive and ensuring you are aware of the potential side effects of having surgery is important in maintaining good health. You can prepare yourself for the highs and lows of prostate surgery by asking a Doctor or Nurse the following questions:

> Is the treatment I’m having for Prostate Cancer likely to cause any urinary problems?

> What type of urinary problems might I get after the Surgery?

> Will my urinary problems get better?

> What are the risks and side effects of treatments for urinary problems?

Although incontinence can be a stressful condition to manage, the majority of men who have treatment for prostate cancer eventually regain continence. If you do become incontinent, it is important to weigh all the risks and benefits of cancer treatment. It is vital to stay optimistic and ensure you are using the correct products and are educated on the topic.