How to Manage Incontinence after Prostate Surgery


What is Urinary incontinence?

Urinary incontinence is a medical condition in which an individual is unable to control urination, leading to a continuous dribble of urine. It is one of the major complications following radical prostatectomy, a surgery carried out to treat prostate cancer. With the advancement in robotic radical prostatectomy, the occurrence of urinary incontinence after prostate surgery is a temporary phenomenon in most patients. 70% to 80% recover within weeks of the surgery and over 97% are dry within 9 to 10 months. There are different types of urinary incontinence and different degrees of severity. Some men may experience a total leakage of urine, while others may just dribble urine while standing. Some might experience a loss of urine with a cough, sneeze, or laugh. This is called stress incontinence and is the most common type of urine leakage that men experience after prostate cancer treatment.

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Why Does Radical Prostatectomy Cause Incontinence?

Let us tell you a bit about how the bladder works so you can fully comprehend the reason behind incontinence: The bladder is a hollow organ shaped like a balloon. When the kidneys empty the urine into the bladder, it is stored inside there until you feel the urge to relieve yourself. When you urinate, the urine flows out of the bladder and leaves the body via a tube called the urethra. The muscles present in the wall of the bladder contract and force the urine out of the bladder. At the same time, muscles around the urethra relax to allow easy urine flow. The prostate gland is also present among these muscles around the urethra.

In males, there are two sphincters (control mechanisms). One of them has to be removed along with the prostate gland, during the surgery and hence, after a radical prostatectomy only one control mechanism is available. This results in a relatively weak bladder control. The removal of the prostate via radical prostatectomy can disrupt how the bladder holds urine. This often leads to urine leakage. Prostate removal can temporarily reduce the bladder's capacity and cause frequent spasms that cause urinary leakage in the initial postoperative period. A Radical prostatectomy can also damage the nerves that help control bladder function.


Managing Incontinence after Radical Prostatectomy

During your consultation, your urologist will explain everything you need to know about postoperative urinary leakage. You should satisfy your anxiety and should mentally prepare yourself to face this problem.

Here are 4 ways of managing incontinence after prostate surgery:

1. Supportive Care

Supportive care involves modifying behavior such as avoiding caffeine, alcohol, and spicy foods, drinking fewer liquids, and not drinking before bedtime. Men that have undergone radical prostatectomy are encouraged to urinate regularly and not wait until the last possible moment. Doctors might also advise some patients to lose weight as this can result in improved urinary control. You should not hesitate to use pads or special underwears available for this purpose. In no circumstances you should stop your physical activities or social commitments since physical exercise helps in quicker recovery.

2. Pelvic Floor Muscle Training

Many doctors also suggest behavioral techniques to train men to control their ability to hold their urine. They recommend Kegel exercises that stimulate the muscles that are squeezed when the patient tries to stop the urine. These exercises can be merged with different programs that will allow patients to train these muscles better.

3. Artificial Urinary Sphincter

Although rarely required, an Artificial Urinary Sphincter (AUS) is a very good option to be considered if there is no control over urine leakage after a year of radical prostatectomy. An Artificial Urinary Sphincter is a device that the patient himself controls. It is made of three parts: a pressure-regulating balloon, a pump, and a cuff that encloses the urethra and thwarts urine leakage. The use of an Artificial Urinary Sphincter may cure or greatly improve incontinence in the majority of patients.

4. Urethral Sling

A urethral sling can be used for some types of incontinence. It is a device that is suspended to compress the urethra. It is made from the patient's own tissue or a synthetic material and is used to create the urethral compression essential for bladder control.


Final Words

Going through prostate cancer and undergoing a radical prostatectomy can be a physically and emotionally trying time. Many men are unprepared for the extent to which they may experience urinary incontinence after prostate surgery. However, with the right determination and your urologist's advice, patients can definitely manage incontinence. It may take some time, but there is still hope.

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Disclaimer: This blog post is provided for informational purposes and is not intended to replace the guidance of your personal physician. Please consult a medical professional if you have any concerns after reading this or other blog posts on this website.