Managing Incontinence for Men with Cancer
When you lose control of your urine or have leaking or dribbling, it’s called urinary incontinence. A lot of men have incontinence after treatment for prostate cancer, but it can happen after being treated for other cancers too. If you have this problem, you are not alone. Urinary incontinence might only last a short time. In time, the muscles that control the passing of urine may get strong enough to control urination again. But incontinence can also be a long-term side effect of cancer treatment. Be sure to talk to your doctor if you are having trouble controlling your urine. There are ways to help.
Sometimes incontinence is caused by more than one problem. Your doctor will ask you questions and order tests to learn what’s causing your incontinence. Knowing your type of incontinence will help you and your doctor find the best way to manage it.
Types of Incontinence
The three most common types of incontinence are:
This is the most common type of incontinence after prostate surgery. It happens when the muscle that squeezes the urethra to keep urine in the bladder is weak or damaged, or the nerves that help the muscle work have been damaged. (The urethra is the tube that carries urine from the bladder out of the penis. The muscle that squeezes to close it is called the urethral sphincter.)
Stress incontinence may cause you to leak urine when you cough, laugh, sneeze, lift heavy objects, or exercise. You may sleep through the night without having to get up to go to the bathroom, but leak when you get up in the morning. Going to the bathroom more often is a way to handle stress incontinence.
When the bladder does not empty well and the amount of urine made is more than it can hold, it’s called overflow incontinence. Signs of overflow incontinence may be getting up often during the night to go to the bathroom, taking a long time to urinate, or having a weak, dribbling stream with little force.
You may pass small amounts of urine but not feel empty. Or you may feel like you have to go to the bathroom but cannot. It may cause you to leak urine throughout the day. Overflow incontinence is usually caused by a blockage or narrowing caused by scar tissue. It also may happen when the bladder muscle cannot squeeze well enough to get all the urine out.
Incontinence products, such as pads worn under your clothing, are available to help keep you active and comfortable.
Urge incontinence may be called overactive bladder. It’s when the bladder muscle contracts too often, usually suddenly and without warning, and you cannot control it. In this type of incontinence, even a small amount of urine in the bladder can trigger a strong need to pass urine. Because you cannot hold a normal amount of urine, you go to the bathroom a lot and may wet yourself if you don’t get there right away. You might feel as if you have a weak bladder, or that liquids go right through you. You might even wet the bed at night. This may be caused by a prostate infection or irritation from radiation therapy.
Treatment for Incontinence
If you have problems with incontinence, let your doctors know. You might feel embarrassed talking about this, but remember this is a common problem. Your treatment will depend on the type and cause of the incontinence and how bad it is.
Doctors who treat men with cancer, especially those who treat prostate cancer, should know about incontinence and be able to suggest ways to help, such as:
♦ Kegel exercises to help strengthen your bladder muscles. These exercises involve tensing and relaxing certain pelvic muscles. Not all doctors agree about their usefulness or the best way to do them, so ask your doctor about doing Kegels before you try them.
♦ Catheters to collect urine may help. One option is a rubber sheath called a condom catheter that can be put over the penis to collect urine in a bag. For some types of incontinence, self-catheterization may be an option. To do this, you put a thin tube into your urethra to drain and empty the bladder at regular times. Most men can learn this safe and usually painless technique.
♦ Compression (pressure) devices can be placed on the penis for short periods of time to help keep urine from coming out.
♦ Medicines to help the muscles of the bladder and the muscles that control urine flow. Most of these medicines affect either the muscles or the nerves that control them. These medicines work best for urge incontinence.
Surgery may be used to correct long-term incontinence. Blockages may be removed. Material such as collagen may be injected to tighten the muscle that controls urine flow. If incontinence is bad and not getting better, an artificial muscle controlled by a scrotal pump can be implanted to squeeze the urethra, or a small device called a urethral sling may be implanted to press the urethra against the pubic bone. Ask your doctor if these treatments might help you.
♦ Incontinence products, such as pads worn under your clothing, are available to help keep you active and comfortable. Adult briefs and undergarments are bulkier than pads but provide more protection. Bed pads or absorbent mattress covers can also be used to protect the bed linens and mattress.
When choosing incontinence products, keep in mind the following checklist. Some of these questions may not be important to you, or you may have others to add.
- How much does the product hold or absorb? How long will it protect me?
- Can it be seen under my clothing?
- Is it disposable? Reusable?
- How does it feel when I move or sit down?
- Which stores near me carry the products? Are they easy to get?
- How much will it cost? Does my insurance help pay for these products?
Even if your incontinence cannot be completely stopped, it can still be helped. You can learn to manage and live with it so you can do the things you want and need to do.
You can also follow some simple precautions that may make incontinence less of a problem. For example:
♦ Empty your bladder before bedtime or before strenuous activity.
♦ Avoid drinking too much fluid, particularly drinks with caffeine or alcohol and citrus juices, which can irritate the bladder and make you have to go more often.
♦ Because fat in the abdomen can push on the bladder, losing weight sometimes helps improve bladder control.
♦ Quit smoking to reduce coughing and bladder irritation caused by tobacco use.
♦ Talk to your doctor about all medicines, vitamins, herbs, and supplements you’re taking. Some may affect urine control.
Fear, anxiety, and anger are common feelings for people dealing with incontinence. Fear of having an accident may keep you from doing the things you enjoy most – taking your grandchild to the park, going to the movies, or playing a round of golf. You may feel isolated and embarrassed. You may even avoid sex because you are afraid of leakage.
Incontinence is more than a physical problem. It can disrupt your quality of life if it’s not managed well. There is no one right way to cope with incontinence. The challenge is to find what works for you so you can return to a normal daily life. Talk with your doctor about the best ways to manage your incontinence. Get the help you need.
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You may find it helpful to talk with other men who are dealing with incontinence. Ask your doctor or nurse, call the American Cancer Society at (800) 227-2345, or search for resources on the ACS website, cancer.org., to see if any support groups meet in your area. You might also find other men to talk with online on ACS’s Cancer Survivors Network at csn.cancer.org.
Reprinted by the permission of the American Cancer Society, Inc., from cancer.org. All rights reserved.
This article was originally published in Coping® with Cancer magazine, January/February 2014.