Different Types Of Urinary Incontinence
There are several different types of urinary incontinence, but the most common in men who have had prostate surgery is called stress incontinence. When you cough or sneeze, or pick up something heavy, the muscles in your abdomen put extra pressure on your bladder and urine may leak out.
You may have just a few dribbles of urine, a medium amount, or even a heavy loss of urine. You may find that you have a higher degree of incontinence right after surgery, and that it gets better with time. If you continue to have issues, though, there are treatments.
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 patient’s needs, education, and psychosocial support remain essential features while aiming to improve the quality of life of prostate cancer patients.
Questions To Ask Your Doctor Or Nurse
- Is the treatment Im having for prostate cancer likely to cause any urinary problems?
- What type of urinary problems might I get?
- What should I do if I cant urinate?
- Will my urinary problems get better?
- What treatments are available?
- What are the risks and side effects of treatments for urinary problems?
- What can I do to help myself?
- Where can I get pads and other products?
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How Long Does It Take To Overcome Incontinence After Undergoing Prostate Cancer Surgery
A study showed that 88% of post-prostatectomy patients suffering from stress incontinence were still suffering up to 1-year later1.
However, as Post Prostate Cancer Surgery patients will experience different degrees of side effects, so do they recover from these side effects at variable rates. In most cases, the recovery time for Urinary Incontinence Post Prostate cancer surgery ranges from 6-12months in most cases2, with continence improving progressively up until 2 years post-surgery2.
General Fitness/ Core 15% Of The Solution
I saw a dramatic decrease in incontinence through running/jogging downhill WITHOUT reducing any weight. Therefore I do not believe that strengthening kegels or reducing weight have anywhere close to the curative effect of jogging downhill.
DO THE STANDING BIKE
One month after having the robotic prostate removal I started a standing 20 minute per day spinning bike program.. Within 3 days all my leakage stopped, my stream went from sporadic to full and I stopped wearing pads!I asked a massage specialized and she said I had strengthened muscles around my bladder and urinary system therefore helping my post surgery problems 10 fold. I am now in my 4th week of standing spinning and I feel like a new person. I only urinate 2 times a night instead of 5-6.
Yoga, I found, has plenty of exercises designed to strengthen the muscles of the pelvic region. Further, its a way of toning the muscles without the heavy lifting and the physical exertion that a patient recovering from abdominal surgery ought to avoid, and it offers an effective, long-term way of helping the body to recover.
DYNAMIC PELVIC FLOOR EXERCISES
The physiotherapist Stuart Doorbar-Baptist, in his talk, explains this very well.
NOT A SOLUTION:
I read somewhere that Obesity has a negative effect on incontinence so you should reduce your weight.
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Urinary Problems After Prostate Cancer Treatment
Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate .
If youre starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment youre having, and on whether or not you had urinary problems before starting treatment.
If youve already had prostate cancer treatment and you have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.
Depending on the type of problems youre having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.
Watch Paul’s story below for one man’s experience of managing urinary problems after prostate cancer treatment.
What Are The Different Surgeries For Incontinence
There are three main types of surgery for men who have incontinence after an RP:
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What Types Of Incontinence Can Happen After Rp
There are two main types of urinary incontinence after RP:
- Urgency incontinence is when you feel the need or urge to urinate but cannot make it to the toilet in time. This is often due to bladder spasms and medication can help. This type of incontinence is caused by changes in the way the bladder behaves after surgery.
- Stress urinary incontinence is leakage of urine with movement or effort and can happen when you cough, sneeze, lift something heavy, change position, or exercise. This type of incontinence may be caused by damage to your external sphincter muscle. Almost all men will have some degree of SUI right after their urinary catheter is taken out. A urinary catheter is placed short term to collect urine during and while recovering from surgery. You may be taught how to do pelvic floor exercises to help with urinary control.
How Long Will I Have Incontinence After Prostate Surgery
Men will typically have a urinary catheter inserted which will help drain the urine from the bladder after the surgery. The catheter is needed until the urethra heals, which typically takes anywhere from 1-3 weeks. After the catheter is removed, it can take several weeks or more to completely stop leaking. Most men who experience a loss of bladder control have symptoms for 6 months to 1-year post prostate surgery. However, a small percentage of men may continue to experience problems past the one-year mark.
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Who Is At Risk For Developing Incontinence
It is not known why some men have incontinence that continues after surgery and others do not. SUI after surgery could be caused by::
- Larger prostate size before its removal.
- Diabetes or other neurological diseases.
- A lot of blood loss during surgery.
- Need for cutting nerves during surgery.
- Size or stage of prostate tumor.
- Radiation after surgery .
- Previous surgery for BPH.
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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How Common Is Urinary Incontinence After Prostate Surgery
If you have a radical prostatectomy, a tube called a catheter will be placed inside your bladder to allow urine to drain. When the catheter is removed, most men will have some difficulty controlling their urine flow.
For most men, the urinary leakage will improve in the months following surgery. In an NHS trial, 46% of men needed to use absorbent pads six months after having a radical prostatectomy. But, one year on from having the procedure, this figure had improved to 17%.
What Can Help With Urinary Frequency And Urgency
There are treatments that can help with urinary frequency and urgency, as well as things you can do yourself.
If you need to urinate more often than usual or sometimes leak before reaching the toilet, you could try a technique called bladder retraining. This can help you control when you urinate, and help you hold on for longer. Speak to your specialist continence nurse or physiotherapist for more information.
Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks. If you can’t have anto-cholinergics, you may be offered mirabegron tablets.
Percutaneous posterior tibial nerve stimulation
This treatment may help some men to urinate and leak urine less often. A needle is placed under the skin just above your ankle. A low electrical current is passed through the needle to affect the nerves that control urination. This can help stop the bladder from emptying before its full.
Youll normally have PTNS once a week for 12 weeks. Each treatment lasts about half an hour. PTNS has no serious side effects, although the area where the needle enters the skin may feel a little sore afterwards.
Sacral nerve stimulation
This is sometimes called Sacral Neuromodulation . A small wire is surgically placed against the sacral nerve in your lower back. The other end of the wire is connected to a small box . The SNS device makes mild electrical pulses that stimulate the sacral nerve to help you regain control of your bladder.
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What Are The Non
Pelvic floor exercises have been shown to speed up how quickly the pelvic floor recovers after prostate cancer surgery.
London Urology Specialists have dedicated physiotherapy support for you during this period of recovery, and the British Association of Urological Surgeons has some excellent advice for men on how to perform pelvic floor exercises correctly.
You may also be offered bladder training that can be useful alongside pelvic floor exercises. This involves working with your doctor to learn how to gradually increase the time between needing to urinate and actually urinating. It can take up to six weeks to train your bladder in this way, but it can also be very effective.
Medications may help with overactive bladder symptoms . Common medications include the antimuscarinics oxybutynin, tolterodine and solifenacin, and the beta-3 agonists mirabegron. These medications work by relaxing the bladder, allowing it to fill with urine and successfully store it without causing urine to leak.
Your doctor will advise what drugs may work best for you and how to take them.
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
Bed protectors and handheld urinals
Internal male sling
Like all treatments, there can be side effects.
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What Is Urinary Incontinence And How Is It Related To Prostate Cancer Surgery
If youve had prostate cancer surgery, you might experience stress incontinence, which means you might leak urine when you cough, sneeze or lift something that is heavy. This happens because of stress or pressure on the bladder. There is also a type of incontinence that is called urge incontinence. When this happens, you are hit with a sudden need to urinate right away and have leakage before you can make it to the bathroom.
The Best Type Of Therapy For Incontinence Following Prostate Surgery
Its hard enough for men to have to deal with pain and swelling following prostate surgery, yet that can be only the beginning of the issues to be dealt with.
The truth is that after a prostatectomy, not only do many men deal with erectile dysfunction, almost every patient has incontinence immediately post-surgery. And, for up to 20 percent of them, that incontinence can persist two years after the surgery, and beyond.
Thats why doctors recommend that men who have gone through prostate surgery and are not seeing improvements in their incontinence issues within the first few months receive physical therapy.
But, theres a problem with that
Not all men who undergo physical therapy for their incontinence get better.
Now, thanks to a new study from UT Southwesterns Departments of Urology and Physical Medicine and Rehabilitation, we not only know why but what you can ask your therapist in order to get the help you need to regain that control.
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Impact Of Male Incontinence On Quality Of Life
Depression and decreased quality of life have been found to co-occur in patients struggling with incontinence. Fear of leaks in public and the required changes & limitations that incontinence has on daily life can have a big impact on well-being. It can make such a difference to be able to carry out previously enjoyed activities, especially after going through the trauma of cancer. Whether it be golfing with friends, having a pint down at the pub, or going for your morning run, you can get back to normal life by treating Urinary Incontinence head-on.
Surgical Approaches: Male Slings
In recent years, various novel surgical treatments have been introduced as alternatives to the AUS. Anti-incontinence procedures can be classified into non-adjustable male slings , adjustable male slings , and adjustable balloon devices . Unlike the AUS, which compresses the urethra circumferentially, thereby interfering with venous blood flow and predisposing the patient to urethral atrophy and even erosion, the male sling compresses only the ventral aspect of the bulbar urethra, leaving the dorsal and lateral blood flow intact. Moreover, tissue, including the bulbospongiosus muscle, is left intact over the urethra, serving as a cushion between the urethra and the sling and further minimizing the risk of erosion.
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Treating Urinary Incontinence After Prostate Surgery
- Kegel exercises Performing Kegel exercises can help men control their ability to hold in their urine. These easy-to-perform moves help strengthen pelvic floor muscles while doing them anywhere.
- Bladder training Train your bladder to delay urination by holding off for ten minutes when you feel the urge to urinate. This can help reduce frequent bathroom trips to no more than every two and a half to three hours.
- Double voiding Urinate, then wait for a few seconds or up to a minute or more and try again. Doing so helps you learn to empty your bladder to avoid overflow incontinence.
- Scheduled toilet trips Urinate every two to four hours during the day rather than waiting until you have the urge to go.
- Fluid and lifestyle management There are several different means of improving urinary incontinence. Try reducing fluid consumption at least two hours before bedtime, avoid acidic foods, alcohol, caffeine, or spicy foods, lose weight if necessary, and increase physical activity.
- Medication There are a variety of drugs called anticholinergics helping improve how much urine the bladder can hold thus reducing urinary sensation and frequent bathroom trips. Decongestants can help strengthen sphincter muscles for other men but should only be used after consulting with a physician.