Management Of Urinary Dysfunction
Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow and treat irritative bladder symptoms are commonly prescribed to all men following radiation therapy for at least a few weeks. They are gradually withdrawn as symptoms improve.In cases of persistent urinary incontinence, surgical procedures, including a sling that relieves pressure buildup in the abdomen or artificial sphincters provide long lasting results.
How Long Does Incontinence Last After Prostate Surgery
Rest assured that the frequent urination you experience after surgery isnt likely to involve complete bladder emptying. Rather, the short-term incontinence experienced by most is more of a slight drip or leak. This happens most often during strenuous activity and could even occur when you sneeze, cough, or laugh.
The degree of incontinence vary from man to man and can range from almost full incontinence to just temporary leakages.
Patients who experienced normal continence prior to surgery should regain function within 6-13 months of their surgery.
To date, there are several non-invasive treatments against incontinence after prostate surgery.
Are There New Techniques That Reduce The Chance Of Becoming Incontinent
When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.
Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.
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How Can Prostate Surgery Affect Urination
Prostate surgery may be a partial or radical prostatectomy, which is the removal of some or all of the prostate gland, respectively. This is a very delicate operation, and the urethra, bladder, rectum, or urinary sphincter may become damaged in the process.
Moreover, the nerves and muscles in the area may also become damaged. All of this can cause urine to leak, especially when stress is put on the area. You can easily see why stress urinary incontinence is so common after having prostate surgery.
What Is The Prostate’s Role In Urination
When urine is emptied into the bladder from the kidneys, it’s kept inside the body by a couple of valves that stay closed until your body tells them to open when you urinate.
If youve had your prostate completely removed, youve had a surgery called radical prostatectomy. Along with the prostate gland, the surgeon has to remove one of the valves outside the prostate that open and close to let urine out or keep it in. Usually having one working valve is enough, but there might also be also be some effect on the nerves and muscles in the area from the surgery that allows urine to leak. Approximately 6% to 8% of men who’ve had surgery to remove their prostates will develop urinary incontinence.
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Surgical Approaches: Artificial Urinary Sphincter
Surgical intervention for incontinence is typically deferred for at least one year following prostatectomy. Traditionally, the AUS has been the gold standard surgical treatment for SUI after prostatectomy since its introduction several decades ago, offering the advantage of both durability and effectiveness for even severe degrees of incontinence. Initially conceptualized by Foley in 1947, the modern AUS design has evolved over several iterations, with closer resemblance to designs introduced in the 1970s by Scott and Rosen. The present models are fashioned on the concept of using an inflatable fluid-filled cuff surrounding the urethra to control continence in addition to a hydraulic pressure-regulating balloon reservoir and control pump. In the resting activated state, the cuff is inflated, thereby occluding the urethra. When the control pump, implanted in the scrotum, is squeezed manually, the cuff is deactivated. This pumps fluid out of the cuff into the reservoir, thereby depressurizing the cuff and enabling the patient to void. Unless locked in the deactivated state, the cuff automatically reactivates over the subsequent 45 to 90 seconds following deactivation to prevent further flow of urine through the urethra.
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.
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How Can I Improve Incontinence After Prostate Surgery
Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, kegels are a common treatment option for incontinence after prostate surgery. Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively. To improve muscle function, kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions . For a complete guide on performing a mens kegel, click here.)
Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.
Recovery And Care For Incontinence After Prostate Surgery
After Linwood Wright, 68, of Danville, Va., had his prostate removed following a diagnosis of prostate cancer, he experienced incontinence that he thought would eventually clear up on its own. Although it did get better, now, five years after his surgery, he is still dealing with what he terms a “minimal” problem with bladder control.
Wrights case is not uncommon, as incontinence is a frequent side effect of prostate surgery. However, according to Dr. Judd Moul, director of the Center for Prostate Disease Research in Washington, D.C., in most cases it lasts only a few weeks. Occasionally, though, it may linger, leaving the patient to manage a permanent case of incontinence.
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How Long Does Urinary Incontinence After Prostate Surgery Last
It’s impossible to say exactly how long it lasts. The chances of you having urinary problems may be influenced by your age, weight and the physical characteristics of your urethra .
However, a majority of men are eventually continent after a radical prostatectomy. In many cases, men are able to go safely without any kind of incontinence product after about three months. This is especially true of men who are healthy overall and fall into the age range of 40 to 60 years. If you are having persistent problems, its important to know that there are ways to treat urinary incontinence after prostate surgery.
What If The Incontinence Does Not Get Better
In these cases, you should see an incontinence provider to talk about available treatments. They will ask you questions about your health history, the symptoms you are having, the number of pads you use, and what treatments you have already had. They will also do an exam and may ask for a urine sample. They may do a bladder scan to see how much urine is in your bladder.
The incontinence specialist will likely talk about conservative treatments at first. More pelvic floor exercises might be recommended. You may also be given a biofeedback machine that allows you to see how strong your pelvic floor muscles are. The specialist may talk about medication options.
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What Is An Artificial Urinary Sphincter And How Does It Help With Urinary Incontinence
An artificial urinary sphincter can help men who have moderate to severe urinary incontinence due to poorly functioning muscle or sphincter valve after prostate cancer surgery.
The AUS has three parts:
- An inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
- A pump that is inserted into the scrotum. It’s completely on the inside and not visible, and the pump controls the opening and closing of the cuff.
- A small pressure-regulating balloon that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.
If you have this surgery, youll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When youre done peeing, the cuff automatically closes again on its own.
The AUS procedure provides a very good and satisfactory result in 90% of cases. Risks are uncommon and include:
- Failure of the device .
- Erosion of the cuff into the urethra.
All of these would require additional surgery.
What Changes Do I Need To Make To My Diet
Discuss your post-surgery diet with your doctor as you will probably want to avoid or at least minimize issues such as constipation. The lack of exercise, the medication, even the stress, might affect your bowel functions. Your diet will be focused on eating more vegetables, fruits, grains and avoiding meat, especially the red one, pasta, alcohol, fast-food, sugar and processed desserts.
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What Should I Do After Radiation Therapy To Reduce Incontinence
Men should keep doing daily pelvic floor exercises. Pelvic floor exercises help strengthen the muscles at your bladder outlet, which helps to improve, regain, or maintain bladder and bowel control.
Try to do 3-10 sets of 10 repetitions every day. Some sets should be with long muscle contractions and others with quick muscle contractions:
- Long contractions: Slowly increase the time you can hold the contraction until you can hold for 10 seconds. Rest for 10 seconds between each contraction.
- Quick contractions: Quickly tighten then relax the muscles.
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.
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Why Does Incontinence Happen After Prostate Cancer Surgery
There are two sphincter muscles that help men control their urine, also called being continent. These sphincters are:
- The internal urethral sphincter: You do not control your internal sphincter. It is found at the bottom of the bladder, called the “bladder neck. This is removed during a radical prostatectomy . The prostate cannot be taken out without also taking out the sphincter.
- The external urethral sphincter: The external sphincter is found below your prostate. You can control your external sphincter and use it to stop your urine stream. You can strengthen this sphincter with pelvic floor muscle exercises .
Normally, an intact, healthy external sphincter is enough to help you remain continent after surgery. However, RP can damage nerves, blood supply, supporting structures, or the muscle which can affect the external sphincter. This damage can lead to incontinence.
Surgery To Treat Urinary Incontinence
For patients with urinary incontinence that is not improving, your doctor may recommend treatments such as an artificial urinary sphincter or a urethral sling. An artificial urinary sphincter involves the surgical implantation of a device around the urethra that controls your urine. When the sphincter is closed, it blocks the passage of urine that may leak from your bladder. It is controlled by a pump, which you squeeze when you want to urinate.
A urethral sling is also placed around your urethra, and it provides added support to the urethra to prevent urine leakage. The sling will lift the urethra and add pressure to it to help with urine retention.
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Incontinence Pads And Sheets
You might need to wear pads when you first start going out. There are different types of pads. You might be able to get some pads for free on the NHS, although this may depend on the service in your area. Some GP practices have a continence nurse you can see.
It can also help to visit places where you know there are toilets. Or you can telephone beforehand to find out about toilets and how easy they are to get to.
What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeons sophisticated maneuvers.
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Why Does Incontinence Occur After Prostate Cancer Surgery
There are two sphincter muscles that keep men continent before radical prostatectomy , the internal urethral sphincter and the external urethral sphincter. The internal sphincter is not under your control and is found at the bottom of the bladder, called the âbladder neck,â and in the prostate. This is removed during your surgery because the prostate cannot be taken out without removing this sphincter. You control your external sphincter, which is the muscle you can use to stop your urine stream and the one you can strengthen with pelvic floor muscle exercises. Normally, a healthy external sphincter is sufficient to provide continence. However, after RP, there can be some damage or dysfunction of the external sphincter, which can prevent you from recovering your bladder control. This may be due to damage to the nerves, blood supply, supporting structures, or the muscle itself as the external sphincter is located at the apex of the prostate gland.
Exercise Your Pelvic Floor Muscles
Learning how to control the pelvic floor muscles can speed up the recovery process and reduce leakage. If you dont strengthen these muscles, the leakage may persist.
Please note: Performing pelvic floor muscle exercises before and after prostate surgery is vital to your recovery. Resume pelvic floor exercises once the catheter has been removed to avoid bladder irritation and discomfort. It is recommended that you seek help from a mens, womens and pelvic health physiotherapist, Nurse Continence Specialist, or urology nurse to learn the correct technique.
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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.
Common Side Effects Of Prostate Cancer Surgery
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:
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Getting The Care You Need
So, if you are post-prostatectomy or preparing for surgery and youre concerned about getting the right type of physical therapy to ensure you can regain your continence and your freedom, heres what you should ask your therapist.
Are my pelvic floor muscles actually weak and need to be strengthened, or are they actually tight and just need to be relaxed and lengthened?
This will help ensure you get the targeted therapy you need to get back to your life after surgery.
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