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.
Why Would Someone Choose Surgery To Treat Incontinence
Urinary incontinence is one of the most bothersome symptoms after prostate surgery. When people suffer from incontinence, they may become depressed, may no longer participate in daily activities that they used to, and may even be reluctant to spend time with friends due to potentially being embarrassed after an accident. Surgery with a urethral sling or artificial urinary sphincter is an excellent option because they can change lives and restore function.
If youve had prostate surgery and found that youre experiencing urinary incontinence, schedule an appointment with Dr. Chung. He can evaluate your situation and suggest a treatment plan for you.
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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Sensitivity Analysis And Publication Bias
Sensitivity analysis for daily pad use was performed using the leave-one-out approach in which each study was removed in turn . The direction and magnitude of combined estimates did not vary markedly with the removal of any specific study, indicating that the meta-analysis had good reliability and the data was not overly influenced by any one study. The results via Eggers test showed there was no publication bias for the findings in regard to daily pad amount for patients treated with sling .
Funnel plot for publication bias for daily pad amount for patients treated with sling.
Start Pelvic Floor Exercises
The research continually shows that doing pelvic floor exercises are a great way to recover from incontinence. However, there is also research showing that doing them before surgery can improve the speed in which you recover your normal function after surgery. Men who start completing pelvic floor exercises at least 4 weeks before surgery have up to a 35% quicker recovery in the first 3 months than men who dont preoperatively . The men who did the pelvic floor training before surgery also reported quicker times of not needing to wear incontinence pads . We recommend you start as early as possible with a pelvic floor exercise program that is progressed up to the point of surgery.
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Quality Assessment Of Included Studies
The results of quality assessment were summarized in Table 2. Using the criteria that a study with 14 or more yes responses out of 18 of the Delphi checklist was considered to be of acceptable quality , 13/26 studies that evaluated the efficacy of the sling were not of acceptable quality . None of the studies that assessed the artificial urinary sphincter had 14 yes responses indicating they were not of acceptable quality. Criteria that were lacking in studies included the reporting of additional interventions, many studies were not multi-center, patients were not recruited consecutively, there was no report of the number of subjects lost to follow up, and competing interests and source of funding support were not reported .
Current Management Of Post
- 1Urology Department, Uniklinik RWTH Aachen, Aachen, Germany
- 2Maastricht University Medical Center , Maastricht, Netherlands
- 3Bucharest University Emergency Hospital, Bucharest, Romania
- 4Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- 5Mainz University Hospital, Mainz, Germany
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What Is The Prostates Role In Urination
When urine is emptied into the bladder from the kidneys, its 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 whove had surgery to remove their prostates will develop urinary incontinence.
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Why Does It Happen
- At the point where the bladder and urethra join, there is a ring of muscles known as the bladder neck sphincter, which opens and closes like a camera shutter. The bladder neck sphincter is closed most of the time to prevent urine leaking out, but when it gets a signal from the brain, it opens to allow urine to be passed.
- If the bladder neck sphincter is damaged during prostate cancer surgery, this can lead to urinary incontinence.
- Another sphincter is part of another set of muscles below the prostate called the pelvic floor. These muscles are also involved in bladder control.
Most men regain their bladder control over time and are fully recovered within 6 to 12 months. It is important to get professional advice to help cope bladder weakness during this time.
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.
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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.
Bladder retraining
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.
Medicines
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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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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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.
Do All Men Have Incontinence After Radical Prostatectomy Surgery
No, most men see a quick improvement in continence over the first several months after the catheter is removed, but incontinence can remain troublesome in some men 1 year after surgery. Most surgeons will consider a man continent if they do not regularly use incontinence pads and only have occasional dribbling with lots of activity. Most importantly, however, is how bothersome your urinary incontinence is to you, as our goal is to improve your quality of life as much as possible.
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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.
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 Incontinence Last
One thing you should know is that most men regain continence following prostate surgery. If youre between the ages of 40 and 60, and generally healthy, the outlook is particularly good. In such cases, most men are no longer experiencing incontinence after about three months.
For others, it takes closer to a year. In such cases, there are effective treatments.
Radical Prostatectomy Retropubic Or Suprapubic Approach
Youll be positioned on the operating table, lying on your back.
An incision will be made from below the navel to the pubic region.
The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.
The prostate gland will be removed.
A drain will be inserted, usually in the right lower area of the incision.
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How Can Radiation Therapy After Prostatectomy Affect Incontinence
Some men need radiation after a prostatectomy. This treats the âprostate bedâ . 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.
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%.
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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.
Does Incontinence Happen If I Treat Prostate Cancer With Radiation
Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra and bladder may be exposed, causing irritation to occur post therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however if it persists, additional treatments described below may be helpful.
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What A Prostatectomy Entails
A prostatectomy is the partial or full removal of the prostate gland. It is a common treatment for prostate cancer that hasnt spread outside the prostate. Men with benign prostatic hyperplasia, a non-cancerous enlarged prostate, may also have this surgery.
The prostate sits just below the bladder. The urethra the tube that carries urine out of the body runs directly through the prostate. Pressure from the prostate helps hold urine in the bladder.
The result is a lack of control over urine flow, or incontinence. In general, older men have more problems than younger men with incontinence after prostatectomy.
The Procedure That Got Me Dry Again After Nine Years Of Incontinence
Like many men, Peter Barton had to deal with urinary incontinence after prostate surgery and was among those who dont see the problem improve over time. After years of using pads as the problem got worse, Peter decided to try a surgical treatment the male sling.
PETER: As a fit farmer aged 65 it was a great shock when I was diagnosed with prostate cancer back in 2008. My wife and I examined all the options for treatment and opted for robotic assisted surgery, which was then still in its early development in the UK.
The surgery went well. My excellent urologist had said that wed just got the tumour before it had broken out of the prostate and my family were much relieved as he confirmed the cancer was unlikely to return.
I was out of hospital in two days but had to wear a catheter for two weeks these were pretty miserable weeks. It wasnt painful at all, but it was awkward. It kept getting caught up on things and was constantly leaking. Things improved when the catheter was removed however I was left incontinent.
For the next nine years life was good but, although I followed instructions about pelvic floor exercises, which I know work for some men, my incontinence slowly worsened. For the first year or two I was using a size one pad the lightest. After two years, Id moved on to the number two and by the last few years I was on a number three, which needed changing several times a day. Each of these can hold a considerable amount of urine.
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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.