Urinary Incontinence After Prostate Surgery: Everything You Need To Know
Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.
But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.
Table : Surgical Options For Incontinence After Radical Prostatectomy
If youve experienced persistent and bothersome urinary incontinence following radical prostatectomy, even after 6 to 12 months of trying conservative measures like Kegel exercises, it may be time to consider surgery. Current options and success rates are summarized below, based on a recent review article in Current Opinion in Urology . Be aware that many of the studies cited involved small numbers of men.
Type of procedure
Future Perspectives And Conclusions
Prostate cancer is one of the most problematic and frequently encountered malignancies in male patients. It often occurs when men are still in the active period of their lives. Consequently, there is a high demand for minimally invasive therapeutic approaches, susceptible of preserving urinary continence and sexual function. Unfortunately, stress urinary incontinence is a common adverse event in men with localized or locally advanced prostate cancer undergoing radical prostatectomy, but also secondary to radiotherapy and to cryosurgery .
Despite rehabilitative procedures such as pelvic floor muscle training, biofeedback, electrical stimulation, lifestyle changes, or a combination of these strategies, no fully efficient treatment alternative has yet been established for this pathology . On the other hand, it should be acknowledged that nursing care, including the understanding of the patients needs, education, and psychosocial support remain essential features while aiming to improve the quality of life of prostate cancer patients.
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Peer Review And Document Approval
An integral part of the guideline development process at the AUA is external peer review. The AUA conducted a thorough peer review process to ensure that the document was reviewed by experts in the treatment of IPT. In addition to reviewers from the AUA PGC, Science and Quality Council , and Board of Directors , the document was reviewed by representatives from AUA and SUFU as well as external content experts. Additionally, a call for reviewers was placed on the AUA website from January 14-28, 2019 to allow any additional interested parties to request a copy of the document for review. The guideline was also sent to the Urology Care Foundation to open the document further to the patient perspective. The draft guideline document was distributed to 49 external peer reviewers. All peer review comments were blinded and sent to the Panel for review. In total, 33 reviewers provided comments. At the end of the peer review process, a total of 476 comments were received. Following comment discussion, the Panel revised the draft as needed. Once finalized, the guideline was submitted for approval to the AUA PGC, SQC and BOD as well as the governing bodies of SUFU for final approval.
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What Causes Frequent Urination After Prostate Surgery
Q: Is frequent urination normal after a radical prostatectomy? A: Yes, but its usually only a matter of time before urination returns to normal. Bladder capacity is usually reduced somewhat by the surgery, but the main cause is that, after surgery the bladder wall is swollen and thickened and irritable.
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Managing Urinary Incontinence Due To Prostate Cancer
Recently there has been a lot of progress in dealing with urine leakage. There are many ways of managing the problem.
If urine leakage becomes a long term problem, discuss this with your doctor or nurse. They can help or can refer you to a specialist incontinence clinic. Staff there can help you with muscle exercises, bladder training and medicines.
Choosing An Incontinence Product
Choosing an incontinence product depends on the severity of your incontinence and your mobility. If you only have the occasional light leak, a low absorbency light product is ideal. Typically, small incontinence pads are the most ideal for light incontinence. For more moderate leaks, a larger pad or pant product is recommended. For heavy to severe incontinence, an all in one pad is ideal. However, it is very rare that people have heavy incontinence after Prostate Surgery.
If you have low mobility or are immobile, a pad is your better option. Pants are harder to put on and take off than simple pads, as they require a full product change.
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What If My Incontinence Persists
When bladder leaks persist more than a year, other treatments may be needed to improve the urinary control.
Though rarely needed, Dr. David Samadi and his team provide a range of treatment options for men experiencing long-term incontinence after prostate surgery.
A variety of surgical procedures can be used to restore urinary control should your symptoms last more than a year.
What Can Help With Leaking Urine
There are treatments and products available that can help, and there are things you can do to help yourself. Your treatment options will depend on how much urine youre leaking, and how recently you had your prostate cancer treatment.
Treatments and products available that can help include:
- absorbent pads and pants
- bed protectors and handheld urinals
If you have sudden urges to urinate and sometimes leak urine before you get to the toilet , you may be offered bladder retraining.
If you still leak urine six to twelve months after surgery and pelvic floor muscle exercises havent helped, there are treatments available that might help. These may include:
- an internal male sling
- adjustable balloons
Talk to your doctor or nurse about treatments and products that may be suitable for you.
Absorbent pads and pants
These can be worn inside your underwear or instead of underwear to soak up any leaks. Some people find it helpful to wear close fitting underwear with pads. You may want to try female pads as your leaking improves, as these tend to be smaller and lighter and may fit better. Pads are usually very discreet, so people wont know youre wearing them. But you may feel more confident wearing dark trousers so it wont show as much if your pad does leak.
Pelvic floor muscle exercises
Read about pelvic floor muscle exercises.
Urinary sheaths
Bed protectors and handheld urinals
Penile clamps
Internal male sling
Like all treatments, there can be side effects.
Adjustable balloons
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The Long Wet Road Back To Normal
Incontinence after radical prostatectomy sucks. But for nearly all men, it goes away. For the very small percentage in whom it doesnt, there is help.
JP Mac is an Emmy award-winning animation writer who worked for Warner Bros. and Disney, and a novelist. He is also very funny.
So, when he wrote a short ebook about his experience with prostate cancer including his diagnosis in 2014 at age 61, the rush to find the right treatment and get it done before his health insurance was going to expire, his laparoscopic-robotic prostatectomy and the complications afterward, and his five-month battle to recover urinary continence after the surgery he could legitimately have written a soap opera, or maybe even a tear-jerker but he didnt.
Instead, his ebook has a title that sounds like 1950s pulp fiction: They Took My Prostate: Cancer, Loss, Hope. Its not Prostate Cancer Lite, and it doesnt minimize what he or anyone else has gone through to get back to normal after radical prostatectomy. Far from it in fact, his short, hopeful essay is a testament to what it takes to recover from this difficult but life-saving surgery: a balanced perspective, a good sense of humor, a great support system, and plain old hard work and persistence.
Heres a message you hardly ever hear about prostate cancer, or any illness, for that matter: Its okay to laugh! That doesnt mean its not scary, and that it doesnt wear you down, or that youre not afraid you wont ever get back to normal.
Incontinence After Prostatectomy: Coping With Incontinence After Prostate Cancer Surgery
Purpose/Objectives: To describe the nature of postprostatectomy urinary incontinence, determine how men manage postsurgery urinary incontinence, identify men’s perceptions of adequacy of preoperative counseling, and identify men’s expectations regarding the probability of postsurgery incontinence.
Design: Survey.
Setting: United States.
Sample: Members of US TOO International, who experienced urinary incontinence after surgery.
Methods: Copies of the survey were mailed to all chapters of US TOO International, a prostate cancer support group, for distribution to members. A letter of invitation also was posted on the US TOO International Web site and in the monthly newsletter. Men who desired to complete the survey called the researcher’s office, and a copy of the survey and a stamped return envelope was mailed to them. Surveys returned to the researchers from June 1998 to January 1999 were included in the analyses.
Main Research Variables: Urinary incontinence, management of urinary incontinence, and coping.
Implications for Nursing: As the number of men who undergo surgical treatment for prostate cancer increases, nurses need to be equipped with the necessary knowledge and information to answer preoperative concerns and provide effective strategies for managing postoperative urinary incontinence.
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Common Side Effects Of Prostate Cancer Surgery
Urinary Incontinence
Urinary Incontinence is a bothersome complication of radical prostatectomy surgery, and studies have shown that it is experienced in as many as 69%2 of post-prostatectomy patients, with up to 88% of patients still suffering up to 1 year later2.There are three types of male incontinence:
What To Expect From Your Doctor
Your doctor is likely to ask you a few questions, such as:
- When did you first begin experiencing symptoms, and how severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve or worsen your symptoms?
- How often do you need to urinate?
- When do you leak urine?
- Do you have trouble emptying your bladder?
- Have you noticed blood in your urine?
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How Can Radiation Therapy After Prostatectomy Affect Incontinence
Some men need radiation after a prostatectomy. This treats the “prostate bed” . Some normal tissue will receive a low dose of radiation, including the external urinary sphincter. The radiation may irritate the external sphincter, urethra, and bladder during radiation therapy and for a short time after. This can lead to worsening incontinence that often gets better in the weeks to months after radiation. Some men may have more incontinence in the months to years after radiation therapy due to the buildup of scar tissue. This can cause the external sphincter to not open and close as it should.
Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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How Is Urinary Incontinence After Prostate Surgery Treated
If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.
These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.
Male Incontinence After Prostate Surgery Or Radiation
Incontinence is one of the major complications after a prostate cancer treatment. The rates of incontinence after radical prostatectomy are estimated to be between 5% up to 35% and after radiation therapy between 5 to 10%.
Risk factors for incontinence after prostate cancer treatment include the patients age as well as prior urinary symptoms. Generally older patients tend to have a higher risk of incontinence than younger patients and patients who have had prior urinary symptoms are at higher risk for having incontinence also.
Probably the two most important factors are the extent of cancer and the experience of the surgeon doing the radical prostatectomy. More aggressive cancers often require a wider resection to be cancer free. The wider resection increases chances of damage to the urinary sphincter which in turn increases the chances of incontinence. Surgeon experience is critical as well with high-volume prostatectomy surgeons having better outcomes than low-volume prostatectomy surgeons. One of the best ways to minimize the chances of incontinence after your surgery is to pick the right surgeon before surgery.
Other tests that can be useful include cystoscopy and videourodynamics to evaluate sphincter and bladder function.
In patients who have a predominance of urge incontinence medical treatment such as overactive bladder medications or even Botox injected into the bladder can be useful.
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Biofeedback For Incontinence After Protatectomy
Biofeedback is a widely used technique that helps people understand how to control their body functions, including the urinary control. It has proved its efficiency in helping many men regain their urinary control.
Biofeedback therapy uses computer graphs and audios to make it easier for you to locate the muscles you a are working on. It is a teaching tool that instructes you how to strengthen your muscles.
Oab And Urgency Incontinence
In the context of management of post-rPR OAB syndrome, it is important to understand its underlying pathophysiological mechanism . Since OAB is multifactorial , the exact role of prostate surgery in the development of OAB is still under debate as, after rPR, there are several variables that could contribute to detrusor overactivity.
Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery . However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described.
It has been demonstrated that urethral afferents are activated by urethral perfusion and they could modulate the micturition reflex via pudendal and pelvic afferent and efferent signals, causing bladder contraction. This has been described as urethrovesical mechanism .
In a recent study, Mastukawa et al. identified that low maximum urethral closure pressure at baseline and its decrease postoperatively were strong predictors of de novo post-rPR OAB underlying the role of the intrinsic sphincter deficiency on the pathophysiology of OAB .
In contrast, detrusor underactivity may cause OAB syndrome as well, which seems contradictory at the first glance. Bladder underactivity may affect up to 40% of patients after radical prostatectomy mostly due to denervation .
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Re: Male Incontinence After Prostate Surgery
Thank you for this. I have forwarded it to him. However I was specifically after the best products to manage the incontinence. He has been to an NHS district nurse and specialist, but neither suggested changing product, and I think this is where he is struggling.
Thank you for your response- much appreciated.
Hi Koo
Welcome to the forum.
Sorry to hear about the problems your Dad is having, but delighted to hear that the surgery was a success – that is the best news isn’t it ?
A lot of the Guys that I know, swear by ‘TENA’ for Men Incontinence pads. they are widely available in most supermarkets, but Morrissons and Asda appear to have more offers on these products, more frequently than the other ones. Its a case of just looking around. They come in different absorbancies, so Dad will have to have a look and decide which is more suited for him.
The Guys have said they are more absobant than the ones supplied by the Ditrict Nurses, and not as bulky. However, the Tena pads you have to buy.
Has he been doing his KEGELS exercises ? These are really important, and the equivalent of ladies pelvic floor exercises. I know they are boring to do, but he must persevere with them, they will help him a lot.
Also, I would ask Dad if he is reducing his fluid intake after 7pm, and avoiding Tea and Coffee and other caffeine drinks/products. All this will help to reduce his nightly visits to the toilet.
Regards
Hi sorry about your problems .
Hi Koo
All the best
Bladder Neck Stenosis And Urethral Stricture
Removing your prostate naturally creates a gap between the urethra and the bladder. This is surgically repaired by re-joining the urethra to the bladder with stitches.
Sometimes surgery can cause scar tissue to form at the operation site and narrow the urethra. This can make it difficult to pass urine. This is called a urethral stricture. In this case, minor surgery can be performed to widen the urethra.
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Aua Nomenclature: Linking Statement Type To Evidence Strength
Where gaps in the evidence existed, the Panel provides guidance in the form of Clinical Principles or Expert Opinions with consensus achieved using a modified Delphi technique if differences of opinion emerged.2 A Clinical Principle is a statement about a component of clinical care that is widely agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members clinical training, experience, knowledge, and judgment for which there is no evidence.
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