Prostate Cancer And Urinary Incontinence

Exercise Your Pelvic Floor Muscles

Learning how to control the pelvic floor muscles can speed up the recovery process and reduce leakage. If you don’t 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.

More information about the pelvic floor muscles can be found on our pelvic floor and male pelvic floor pages. You can also learn more about pelvic floor friendly exercises at pelvicfloorfirst.org.au.

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.

How Is Urinary Incontinence Diagnosed

Talk with your health care team if you have a problem controlling your bladder. They will work with you to figure out the reason. They may recommend you writing down some details about your urination, including when you urinate, how often you urinate, and how much liquid is released. This is called a “voiding diary.” Your health care provider may also give you the following tests:

• Tests on a sample of your urine to look for an infection or other problems.

• A test where you cough as hard as you can when your bladder is full.

• Tests to measure pressure in your bladder.

• Tests to measure how well your urine is flowing.

• An ultrasound. This uses sound waves to create a picture of your bladder and the other body parts that control urine.

• A cystoscopy. This test uses a small, lighted tube to look inside your bladder.

• An X-ray of your bladder.

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How Is Incontinence Treated

Your health care team can usually manage incontinence. The right treatment for you depends on what type you have, what caused it, how severe it is, and how long you have had it. You might need more than 1 treatment at a time.

Bladder training. Bladder training is a way to treat incontinence without medication. Health care providers may start with bladder training before trying other treatment options. Bladder training, sometimes called bladder retraining, can include these steps:

• Learning to wait to urinate, even after you have the urge to go

• Going to the bathroom at specific times

• Controlling how much and when you drink and eat

• Biofeedback, which uses a small device to learn to control the muscles that hold urine

Physical therapy. Working with a physical therapist can help you control your bladder. During physical therapy, you may do Kegel exercises to help strengthen the muscles that hold in urine. Electrical stimulation can also be used to strengthen muscles.

Medication. Medication that can help control your bladder includes:

Medical devices. There are medical devices that can help with bladder problems. One example is a pessary, which is worn in the vagina to support the bladder.

Estrogen cream. A vaginal cream with a low dose of estrogen can help with damage caused by menopause.

Surgery. In some cases, surgery may be needed. During surgery, a sling is placed around the bladder and urethra to keep them closed. Urine flows through the urethra after leaving the bladder.

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 mans 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 .

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How Can I Help Myself

Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.

Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.

• Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
• Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
• Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
• If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
• Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
• Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
• Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
• Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
• If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.

For more information look at our How to manage urinary problems guide.

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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Lower Your Risk For Prostate Cancer

Prostate cancer is a serious disease, but early detection is key. Talk to your doctor about your risk factors and when or if you should be screened for prostate cancer sometimes as early as age 40, if youre considered high risk.

Theres no way to eliminate the risk of getting prostate cancer, Dr. Weight says, but if youre at a higher risk for developing the disease, there are steps you can take to lower your risk.

• Get regular prostate screenings.

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.

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What Treatments Are Available To Me If My Incontinence Doesnt Go Away After A Year

While kegels and behavioral therapy work well for most men with mild to moderate leaking, they may not be completely effective for some. Luckily, there are still some options for treating bladder leakage after prostate surgery.

Another surgery is sometimes needed when bladder leaks persist for more than a year after surgery. This may consist of having a urethral sling procedure, or an artificial urinary sphincter.

With a urethral sling procedure, a synthetic mesh tape is implanted to support the urethra. Up to an 80% improvement has been seen with this procedure and some men stop leaking completely.

An artificial urinary sphincter is used in patients who have more severe urinary incontinence that is not improving, or for those patients who may have had a lot of damage to the sphincter muscle after prostate surgery. An artificial urinary sphincter is a mechanical ring that helps close the exit from the bladder.

As will all surgeries, these come with pros and cons and potential complications. Be sure to discuss these options with your doctor.

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.

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Prostate Cancer Basics: Facts

• Prostate cancer is the most common malignancy diagnosed in men.
• These statistics show that prostate cancer is a widely variable disease.
• Prostate cancer has the potential to grow and spread quickly, but for most men, it is a relatively slow growing disease.
• It is important for patients to discuss with their doctors the various aspects of their particular type of prostate cancer to understand how aggressive it is and how best to treat it.

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.

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Evaluation Of Incontinence After Prostate Treatment

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

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.

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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.

How Can I Manage Incontinence At Home

Incontinence can be uncomfortable and disruptive. It can cause sleeping problems, make you feel ashamed or angry, or affect your daily life in other ways. In addition to working with your health care team to find the best treatment, there are things you can do at home to help make incontinence better or more comfortable.

• Limit how much you drink, especially coffee and alcohol. Avoid foods that can irritate the bladder, including dairy products, citrus fruits, sugar, chocolate, soda, tea, and vinegar.

• Go to the bathroom right before bedtime and any vigorous activity.

• Wear an absorbent pad inside your underwear or disposable incontinence underwear.

• Maintain a healthy weight. Extra weight can put pressure on the bladder and muscles that support it.

• Go to the bathroom regularly each day. Do not wait too long or put off going.

• Quit smoking. Nicotine can irritate the bladder. It can also make you cough and leak urine.

• Do Kegel exercises. Ask your health care team about doing Kegel exercises at home. They can make your bladder stronger. To do Kegel exercises, first tighten the muscles you use to stop the flow of urine. Then, relax those muscles. Repeat the exercise several times. During this exercise, relax the muscles in your belly, buttocks, and thigh.

Finally, it can help to find support. Talk with your health care team or join a support group for people with bladder problems. It can help you feel better to know that other people are also dealing with incontinence.

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