Tuesday, November 22, 2022

Why Incontinence After Prostate Surgery

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How Might Surgery For Prostate Cancer Cause Urinary Incontinence

Incontinence After Prostate Cancer Surgery Explained

There are several different treatment options for men with prostate cancer and not all men with prostate cancer need to have surgery.

The main options for men with aggressive prostate cancer are:

  • Surgery to remove the prostate, which is called radical prostatectomy
  • External radiotherapy
  • High Intensity Focussed Ultrasound .

Each case is different and your specialist doctor will discuss your options with you.

Treatment to remove or destroy the prostate can damage nerves and the external urethral sphincter . This then causes stress incontinence.

Damage to the bladder following treatment for prostate cancer can also cause bladder storage problems resulting in urge incontinence symptoms.

How To Talk To Your Doctor About Incontinence

The best way to find out more about potential treatments or methods to manage your incontinence is to speak to your doctor.

Remember, the condition is not new to them and there is no reason for you to feel embarrassed. The sooner you seek advice, the sooner you can carry on as normal.

To get the most out of your appointment, try writing down information that might help with diagnosis, such as when you experience incontinence, how often, how much you leak, and any potential triggers you have noticed. This will help your GP to suggest a suitable treatment.

In the meantime, try using an incontinence product for men, such as a shield or guard, to allow you to carry on with your day, worry-free.

Post A Question On Our Forum To Receive Expert Advice

Its rare that men experience long term incontinence after prostate cancer treatment. As a general rule, if your incontinence symptoms last over a year, you should contact a Doctor. There are a number of procedures that exist to restore continence if you do find yourself with long term incontinence.

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How Long After Prostate Surgery Does Impotence Last

While ED is common right after prostate surgery, you may regain sexual function after some time. This may range from several months to 2 years. Also, remember that ED can be treated. By working with your doctor, you will be able to recover from prostate surgery and find an effective ED treatment that is right for you.

Improving Symptoms Of Incontinence

Incontinence Basics and Management Tips

Incontinence isnt an uncommon side-effect of prostate surgery, but there are ways you can improve symptoms after surgery:

  • Regular pelvic floor exercises: squeeze the same muscles you use to stop urinating mid-stream to strengthen your Kegel muscles.
  • Avoid caffeine and alcohol where possible: these are diuretics, meaning they encourage the production of urine. Try to drink a little less before going to bed too.

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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?

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.

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What Types Of Incontinence Can Occur After Radical Prostatectomy Surgery

There are two main types of urinary incontinence in men after radical protatectomy:

  • Urgency incontinence
  • Stress urinary incontinence

Urgency incontinence is when you feel the “urge” to urinate but cannot make it to the toilet in time. This is generally due to bladder spasms and often responds to medical therapy. This type of incontinence is thought to be mostly due to changes in the way the bladder behaves after surgery.

Stress urinary incontinence , is leakage of urine with exertion or effort and can happen when you cough, sneeze, lift something heavy, change position, swing a golf club or exercise. This type of incontinence may be because of damage to your external sphincter muscle as described above. Almost all men will have some degree of SUI immediately after catheter removal, and you were probably given instructions on how to perform pelvic floor exercises to improve urinary control.

Physical Therapy For Incontinence After Prostate Surgery

Urinary Incontinence After Prostate Cancer Surgery

To start, lets put an end to a big health mythkegel exercises are not just for women!

The truth is, regular Kegel exercises that strengthen the pelvic floor muscles can help men reduce their control incontinence issues, too.

To practice kegel exercises, follow these simple steps:

  • Identify the pelvic floor muscles by re-enacting what youd do if you tried to stop urinating mid-stream. It should feel like a gentle contraction between the legs. The testicles will rise slightly and the anus should contract. There shouldnt be any pain.

  • Tighten the muscles and hold for three seconds. Relax for three seconds, and try again. Aim for ten repetitions and breathe freely throughout.

  • Avoid flexing your muscles in the abdomen, thighs, or buttocks.

  • Repeat three times a day in any positionseated, lying down, or standing.

Walking is also known to strengthen the pelvic floor.

However, please avoid exercises that put any significant pressure on the bladder or urethra, e.g. sit-ups and weight lifting.

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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.

Stress Urinary Incontinence After Prostate Surgery

Prostate surgery may come with unintended side effects, including urinary incontinence which is the partial or total inability to control your bladder. In stress urinary incontinence, you experience urine leakage when coughing, sneezing, lifting heavy objects, or putting any other type of physical stress on your body that affects your abdominal and pelvic area.

Why does this happen? Will it ever go away? Lets talk about what causes stress urinary incontinence after having prostate surgery, and where you can go for medical help in keeping it under control.

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Surgery For Urinary Incontinence Due To Presumed Sphincter Deficiency After Prostate Surgery

Background

Urinary leakage after surgery to remove the prostate for benign or malignant disease is a well-known and often feared outcome. Although a small amount of incontinence may not cause a problem, larger degrees of incontinence can have a major impact on a man’s quality of life. Improvement in urinary leakage may occur six to 12 months after the prostatic surgery, but for men with persistent bothersome leakage despite conservative therapy such as pelvic floor exercises, surgery may be offered.

Study characteristics

We searched scientific databases for trials that had considered the effectiveness of the surgical treatments of urinary incontinence after prostate surgery in men. The trials had to compare surgical treatment versus no treatment, non-surgical treatment, or another surgical treatment. The evidence is current to April 2014.

Key results and quality of the evidence

There are five main types of surgery and, despite some of them being in use since the 1990s, we found only one trial that met the inclusion criteria. There was very low quality evidence that the implantation of an artificial urinary sphincter might be more effective than injectable treatment, but with more adverse effects and higher costs. There was no evidence about the other types of surgery.

To determine the effects of surgical treatment for urinary incontinence related to presumed sphincter deficiency after prostate surgery for:

– men with prostate cancer – radical prostatectomy .

Evaluation Of Incontinence After Prostate Treatment

AMI ATOMS

Guideline Statement 9

Clinicians should evaluate patients with incontinence after prostate treatment with history, physical exam, and appropriate diagnostic modalities to categorize type and severity of incontinence and degree of bother.

Discussion

There is no formal evidence regarding the effects of history and physical exam on outcomes of IPT treatments however, there is universal agreement that taking a history and performing a physical examination should be the first step in the assessment of anyone with urinary incontinence.73 There is strong evidence that a history of pelvic RT74,75 is associated with the severity of incontinence, especially stress incontinence,76,77 after prostate surgery.

The Panel believes that before treating IPT, it is critical to categorize the type of incontinence and the severity and degree of bother of incontinence. The status of prostate cancer also should be known, particularly for men who are candidates for salvage RT, which may impact efficacy of continence treatment.

History is the first step in determining the type of incontinence, which is important because treatments for SUI and urgency incontinence are very different. In cases of mixed incontinence, it can be important to determine which component is more prevalent and bothersome, though many investigators feel that treatment outcomes for urgency incontinence may be difficult to determine in the face of significant sphincteric insufficiency.

Guideline Statement 10

Discussion

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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.
  • Infection.

All of these would require additional surgery.

What Is A Urethral Sling Procedure And How Does It Help With Urinary Incontinence

In the urethral sling procedure, a synthetic mesh tape is placed around part of the urethra, moving the urethra into a new position. This is a minimally invasive procedure, which means that the surgeon only has to make a small incision in the perineum .

Your provider may recommend a urethral sling procedure if you have mild to moderate urinary incontinence after a radical prostatectomy that hasnt improved using other more conservative measures. It’s highly successful in helping men overcome incontinence, or reduce episodes of leaking urine.

Before the surgery, the provider may do some tests, including the following:

  • A urodynamic study, to test how well the bladder is working.
  • A 24-hour pad test .
  • A cystoscopy, a test in which the doctor looks inside the bladder with an instrument called a cystoscope.

You dont have to donate any of your own blood before surgery.

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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.

Table : Impotence And Incontinence

Incontinence after Prostate Surgery

The reported statistics on the likelihood of developing impotence or incontinence after prostate cancer treatment vary widely, as shown by the ranges below.

Procedure 30%50% 2%

How did the operation go? And when did it become apparent that you might take longer to recover than you had been led to believe?

The operation went fine. I went back to work very quickly, and in most respects I felt fine. I was incontinent immediately after surgery, but I was led to believe that the problem would straighten itself out within a few weeks or months. But it didnt.

Did you share your concerns about incontinence with your surgeon?

I did, during follow-up visits after the surgery. I probably visited him three to four times during the first six months after surgery. He told me the problem would get better, and for the first month or two, I believed that. But as time went on, nothing was getting any better.

And he didnt seem to care. In a typical visit, I waited a half hour or an hour to see him for literally five minutes, and then he moved on to the next person. So I finally gave up on him.

What sort of problems were you experiencing?

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Continence After Prostate Cancer Surgery How Long Does It Last

A prostatectomy is a procedure that can affect a man both physically and emotionally. Undergoing such a surgery may come with various reasons for anxiety and fear. Incontinence may be one of them.

The prostate is an important gland in the body that regulates many physical functions, including the urinary and sexual functions. Once removed through radical prostatectomy, negative side-effects may result. The most common reasons for concern are:

  • Urinary incontinence
  • Sexual dysfunction

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.

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What Is Urinary Incontinence And How Is It Related To Prostate Cancer Surgery

Urinary incontinence is the loss of the ability to control urination . Urinary incontinence sometimes occurs in men who’ve had surgery for prostate cancer.

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.

Step 1a: Measure The Pads

Pelvic Floor Repair Exercises

This is a crucial step to track progress. I track my progress on this .

Measurements at the beginning are not completely comparable with later measurements. In the earlier days one visits the toilet excessively, so initial measurements are actually lower than they would have otherwise been. As one develops the capacity to hold more and for longer, the fuller bladder leads also to heavier leaks but this is a good thing. Measurements also vary by ones level of fitness or wellness. If one is sick and sneezes a lot, there will be heavier leakage. In my case, the later stages have involved extreme exercises, so these measurements are largerthan they would otherwise have been.

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Urinary Incontinence After Radical Prostatectomy

Prostate Cancer surgery, specifically a radical prostatectomy is commonly used as a curative measure to treat prostate cancer, and surgeons aim to retain urinary continence and sexual function during the procedure of removing the prostate . A Radical Prostatectomy, however, remains a challenging urologic procedure because the prostate is in close proximity to the bladder, rectum, and neurovascular supply to the penis. An adequate resection of the prostate without damaging surrounding tissue presents tradeoffs between cancer control and preservation of functional outcomes such as continence and potency.

There are many different surgical techniques and approaches for radical prostatectomy. The technique, approach and skill of the surgeon will influence the rate of incontinence and recovery thereof. Initial urinary incontinence is present in up to 98% of patients post-prostatectomy . With correct management, the majority will achieve continence within a year. Approximately 90% of men will achieve continence 6 months after laparoscopic robotic prostatectomy and after that, there is a minimal improvement with only 4% more gaining continence after 6 months.

What If The Incontinence Does Not Improve Or Is Bothersome

If you have a bothersome amount of incontinence or if it does not improve with the above measures, many men will benefit from seeing an incontinence practitioner. There is a wide range of treatments available.

Once you decide to see an incontinence practitioner, be prepared to answer questions regarding the type of symptoms you are having, the number and type of pads you might be using, and previous treatments you have had for prostate cancer and for incontinence. You should be honest about how much the incontinence bothers you, and how willing you are to have additional treatments, potentially including surgical procedures.

During your first visit, the incontinence specialist will take your history and perform an exam. You will likely be asked to give a urine sample to rule out infection or blood in the urine. A “bladder scan” is often done in the office to see if you are completely emptying your bladder when you urinate.

The incontinence specialist will likely discuss more conservative treatments at first. A more rigorous pelvic floor exercise program 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 also discuss various medication therapies.

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