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After Prostate Cancer Surgery – Managing Urinary Incontinence

by Mary H. Palmer, PhD, RNC, FAAN

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Be aware of situations that can cause leakage, such as laughing.

It’s not uncommon for men who undergo surgical treatment for prostate cancer to experience involuntary urine loss (called urinary incontinence) after surgery. Our society places high value on continence, often making people who lose control of their bladder ashamed, embarrassed, and sometimes reluctant to seek help. Despite Thoreau’s famous quote about men who “lead lives of quiet desperation,” there are steps men can take to manage or conceal incontinence and to regain continence.

The urinary sphincter, a ring of muscle that opens to release urine or closes to hold urine, is located at the base of the bladder. Without the sphincter, urine would continually drip from the bladder. The prostate gland, also located at the base of the bladder, surrounds the urethra. Urine and semen pass through the urethra. The area around the prostate and urethra is rich with blood vessels and nerves that are vital to maintaining normal functioning of the bladder and urethra.

Incontinence can go away, or resolve, over time as tissue heals and the sphincter regains its strength.

Author of Article photo

Dr. Mary H. Palmer

Surgical removal of the prostate may traumatize or damage the urethra, the sphincter, and the blood and nerve supplies to these structures. If the sphincter is sufficiently weakened, urine can escape from the bladder. This is known as stress incontinence, the most common type of incontinence after surgery. Some men experience another type of incontinence, urge incontinence. This type of incontinence occurs when the bladder muscle contracts with such force that urine leaks out.

Many men have either stress, urge, or mixed (a combination of stress and urge) urinary incontinence immediately after surgery. Incontinence can go away, or resolve, over time as tissue heals and the sphincter regains its strength.

The following may help prevent or control incontinence:

  • Keep a bladder record. This record will help you find patterns to your voiding habits and incontinent episodes. Note what happened before an incontinent episode and try to prevent it from occurring the next time you need to void.
  • Perform pelvic floor muscle exercises (PFMEs, also called Kegel exercises). These exercises consist of contracting your pelvic floor muscle (the muscle you tighten to keep from passing gas) for three seconds and then relaxing it for three seconds. Do these exercises three times a day in sets of 10 to 15 while in the sitting, standing, and lying positions.
  • Avoid alcoholic beverages, which can overload the bladder.
  • Avoid bladder irritants. Caffeine can act as a bladder irritant, and some people report bladder irritation from certain citrus juices and spices.
  • Drink plenty of fluids. Your bladder needs to store urine to function correctly. By drinking adequate amounts of fluid, you also avoid constipation.
  • Avoid squeezing the bladder. Be aware of situations that increase pressure on your bladder and cause leakage, including lifting, bending, coughing, sneezing, and laughing. Before you cough, sneeze, or change position, you can do a quick PFME to prevent urine from escaping. It’s also important not to let your bladder stay full for a long period of time. If you feel like you have to go to the bathroom and it has been a couple of hours since the last time, then go.
  • Use disposable absorbent products to help you contain any accidental leaks while you are regaining control. Many different products on the market are designed to contain urine and prevent odor and skin problems. Use a disposable absorbent product designed for the amount of urine you typically lose.
  • Exercise regularly. Physical exercise helps your body regain strength and may help your overall well-being.
  • Seek professional help. There are professionals who specialize in urine control issues who may prescribe medications, exercises, collagen injections, or surgery to help you regain control. If uncontrolled urine loss makes you feel depressed, seek psychological help.

Urinary incontinence can be distressing, but it is important to realize you are not alone; help is available. Important steps to taking control are doing PFMEs; avoiding alcohol, caffeine, and other bladder irritants; drinking plenty of fluids; keeping your bowels regular; and maintaining overall health and a positive outlook.

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Dr. Mary H. Palmer is the Helen W. and Thomas L. Umphlet Distinguished Professor in Aging at the University of North Carolina at Chapel Hill School of Nursing, interim co-director of the UNC Institute on Aging, and co-director of the UNC Interdisciplinary Center for Aging Research. She also serves as an associate editor of the Journal of the American Geriatrics Society and serves on the editorial boards of Geriatric Nursing and Clinical Geriatrics. Dr. Palmer is a Fellow in the American Academy of Nursing and the Gerontological Society of America.

This article was published in Coping® with Cancer magazine, May/June 2010.