Prostate Cancer And Incontinence

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Urinary Incontinence After Prostate Surgery

Prostate surgery is a medical procedure that is often recommended for men who have prostate cancer or other prostate-related conditions. While it can be an effective treatment it can also cause unwanted side effects such as urinary incontinence. Managing Urinary Incontinence after prostate surgery can be distressing, and sometimes surprising for men and may affect their quality of life. But, with patience and treatment, many men will recover from incontinence due to prostate removal.

What Happens During Prostate Surgery?

Prostate surgery involves removing part or all of the prostate gland, depending on the severity of the condition. There are different types of surgery your doctor may choose to perform. These include:

Open prostatectomy (Radical prostatectomy). In this surgery, your doctor will make a cut in either the lower abdomen (retropubic approach), or in the skin between the anus and scrotum (perineal approach). A retropubic approach is used most often. Your surgeon will remove the prostate and place a catheter in the penis to allow urine to drain from the bladder. The catheter is a short-term treatment and is typically removed 1-2 weeks after surgery, allowing you to urinate on your own.1
Laparoscopic surgery. With laparoscopic surgery, your surgeon will make small incisions into the body and will use a camera, plus surgical instruments to remove the prostate. This procedure is less invasive than an open prostatectomy since the incisions are smaller and recovery is generally faster.1
Robot-assisted surgery. Similar to laparoscopic surgery, small incisions are made in the body. However, instead of the physician using surgical instruments to remove the prostate, they use a robotic system, which may be more precise.¹

Depending on the type of surgery performed, patients may be required to stay in the hospital for a few days to a week after the surgery. Most patients are recommended to limit activity for some time after the surgery until they fully recover.

Possible side effects of prostate surgery may include:

Pain
Bleeding
Infection
Erectile dysfunction
Bowel function
Urinary incontinence

Why Incontinence Can Happen After Prostate Surgery?

Urinary incontinence occurs when a person is unable to control their bladder, resulting in the involuntary loss of urine. Prostate surgery commonly causes urinary incontinence and can result from muscle damage caused by the surgery.

When the prostate is removed, it also removes one of the two valves (sphincters) responsible for controlling the flow of urine. Although one valve typically suffices, the remaining urinary sphincter may sustain damage, resulting in difficulty for the patient in controlling their urine. Additionally, the bladder muscles may be affected in some cases.

Several factors, including the patient’s age, the extent of the surgery, their general health, and the surgical technique used, determine the extent of damage to the urinary sphincter muscle and the bladder muscles. In many cases, incontinence after prostate surgery may resolve on its own, while in others, it may necessitate medical intervention.

Men who experience urinary incontinence after prostate removal may observe one of several different types of incontinence:

Stress Urinary Incontinence. Urine leakage when stress is placed on the bladder or sphincter (think coughing, laughing, sneezing or exercising).
Overflow Incontinence. This happens when men cannot completely empty their bladder, and is typically caused by a blockage of the bladder outlet due to scar tissue.
Urge incontinence. This type of incontinence happens when a man feels a sudden need to urinate.

Learn More About Urinary Incontinence After Prostate Surgery In This Video

How Common Is Urinary Incontinence After Prostate Surgery?

According to the Cleveland Clinic, around 6-8% of men experience long-term incontinence after prostate surgery. However, the incidence of incontinence may vary depending on several factors such as age, overall health, and the type of surgical technique used.

How Long Can Men Expect Incontinence to Last After Surgery?

The duration of incontinence after prostate surgery can vary from patient to patient. Some men may experience incontinence for a few weeks, while others may have it for several months. In most cases, incontinence gradually improves over time. However, in some cases, it may persist for longer periods.

The type of urinary incontinence also affects the duration of incontinence. Stress incontinence, which happens when urine leaks due to physical activity, is more likely to improve faster than urge incontinence, which happens when there is a sudden, strong urge to urinate. However, with proper medical care and the right treatments, most men can regain their bladder control over time.

Ways to Treat Incontinence After Prostate Surgery

Luckily, there are many ways to treat and manage incontinence as a result of prostate surgery, and many men find that they regain control with in a few months. Read below to learn some of the treatment options available.

Non-Surgical Treatments

Absorbent products. Even when incontinence doesn’t last long, it’s important that men have some options for how they’ll stay dry while they recover. There are many types of absorbent products to choose from. Think about your lifestyle and find a product that works with it, and fits you well.
Many men find comfort in using reusable absorbent products for incontinence since it typically fits and feels like their normal underwear. It can be a small step in helping men feel normal again after surgery, despite the leaks. There are also many brands, like Confitex, that have products specifically made for men.
Pelvic Floor Exercises. Pelvic floor exercises, also known as Kegels, help to strengthen the muscles that support the bladder and the urethra. Kegel exercises, which involve contracting and relaxing the muscles in the pelvic floor, can be particularly effective in improving bladder control.
Biofeedback. During biofeedback, sensors are placed on the patient’s body to monitor the muscle activity in the pelvic floor. The patient can then learn to control their muscles using visual and auditory cues, which can help improve bladder control over time.
Medication. Medications such as alpha-blockers and antimuscarinics may also be used to treat incontinence after prostate surgery. Alpha-blockers help to relax the muscles in the prostate and the bladder neck, which can improve urine flow and reduce leakage. Antimuscarinics help to reduce the urge to urinate, which can be helpful in treating urge incontinence.

Surgery

For some men, surgery may be necessary to treat incontinence after prostate surgery. Surgery can involve the implantation of an artificial urinary sphincter, which is a device that helps to control the flow of urine from the bladder. The artificial sphincter is placed around the urethra, and it can be controlled using a small pump that is placed under the skin. When the pump is activated, it closes the sphincter, which helps to prevent urine leakage. The artificial sphincter is a highly effective treatment for incontinence, and it can significantly improve a patient’s quality of life.

Other surgical options include the placement of a urethral sling, which provides support to the urethra, or the use of a bulking agent, which is injected into the tissue surrounding the urethra to help close it. These procedures are typically less invasive than the implantation of an artificial sphincter, but they may not be as effective in treating incontinence.

Be Patient And Don’t Lose Hope

One of the most important things to remember if you’re experiencing bladder leaks after prostate surgery is to be patient. Most men recover from incontinence with time and behavioral changes, like Kegel exercises or biofeedback can also make a big difference. It may also help to talk with others who know what you’re going through during this time. NAFC’s message boards offer a safe place to discuss your condition and is an encouraging environment with lots of people who have been where you are. (Join the message boards – free and anonymous – here.)

Incontinence after prostate surgery is a common side effect, but it can be managed effectively with the right medical care and treatment. If you’re experiencing incontinence after prostate surgery talk to your doctor to determine the best course of action. With proper medical care, most men can regain their bladder control and resume their normal activities. It is important to remember that incontinence after prostate surgery is usually a temporary condition, and it should not prevent men from seeking treatment for their prostate-related conditions.

References

https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html

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