What You Need to Know about Urinary Incontinence after Prostate Cancer Treatment
by Jeffrey Albaugh, PhD, APM, CUCNS
Men treated for prostate cancer know that when the catheter comes out, the leakage may begin. For many men, this leakage may resolve over the next year, but for some men, the issue may last longer. Research reveals approximately 15 percent of men are incontinent up to one year following either radical prostatectomy or laparoscopic prostatectomy. It can take as long as two years for men to regain urinary continence.
During prostatectomy, part of the mechanisms that maintain the urine in the bladder are removed. As a result, the remaining pelvic floor muscles must work harder to maintain the urine in the bladder with activity, coughing, sneezing, and laughing. Men may also have a more urgent need to urinate and not be able to get to the bathroom before leakage occurs. If a man has had radiation therapy, he also may have problems with incontinence related to urinary urgency.
Pelvic floor muscle exercises can be helpful in treating both urge incontinence and stress incontinence.
Types of Incontinence
To help better understand urinary incontinence, this problem can be divided into different categories. Each type of incontinence is different and requires a different approach to treatment. Urinary incontinence can often be a mixture of more than one type of incontinence.
Stress urinary incontinence involves accidental leakage of urine with activity, coughing, laughing, and sneezing. This type of incontinence is the most common in men after prostatectomy because they have lost part of the mechanisms that maintain urine in the bladder.
Urge incontinence is an accidental leak of urine associated with a strong urge to urinate. A man with urge incontinence has a sudden, uncontrolled need to urinate. Urge incontinence and urgency can occur after prostate treatment with either radiation or prostatectomy.
Overflow incontinence occurs when the bladder never empties completely, and once it is filled to capacity, the urine overflows, causing leakage. This can happen when scar tissue from radiation or surgery obstructs the outlet of the bladder. Some men may also complain of leakage of urine during sexual relations or with orgasm after prostatectomy. Although urine is sterile and a small amount of leakage is not problematic, this problem along with erectile dysfunction after prostate cancer treatment can impair a couple’s ability for sex and intimacy.
Incontinence can be treated successfully for the majority of men. Pelvic floor muscle exercises, called Kegel exercises, are a series of exercises designed to strengthen the muscles of the pelvic floor. Dr. Arnold Kegel, a gynecologist, developed these exercises in 1948 as a method of controlling incontinence in women after childbirth. Pelvic floor exercises strengthen the muscles of the pelvic floor to improve both urethral and rectal sphincter function.
The success of pelvic floor exercises depends on proper technique and adhering to a regular exercise program. Pelvic floor muscle exercises can be helpful in treating both urge incontinence and stress incontinence. There are both quick- and slow-twitch fibers in the pelvic floor muscles, so both quick and slow pelvic floor exercises should be practiced. It is important to do the pelvic floor exercises correctly, which may require you to see a specialist nurse or physical therapist who can teach you how to do the exercises appropriately and consistently. Your healthcare provider can also recommend online resources to assist you.
The Agency for Health Care Policy and Research Guideline Urinary Incontinence in Adults: Acute and Chronic Management recommends the primary treatment options for incontinence should be bladder retraining, timed voiding, and pelvic floor exercises. For urge incontinence, there are several prescription anticholinergic medications that may help control the urge to urinate. There currently are no FDA-approved medications for stress urinary incontinence. Surgical interventions for stress urinary incontinence include various sling procedures and artificial sphincters.
Although urinary incontinence is common after prostate cancer treatment, it can often (but not always) be treated successfully. It is essential for men with urinary incontinence to undergo a full evaluation and treatment of urinary incontinence by a urologic healthcare provider.
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Dr. Jeffrey Albaugh is a board-certified advanced practice urology clinical nurse specialist and director of the Ross Clinic for Sexual Health at NorthShore University HealthSystem near Chicago, IL. He specializes in treating men, women, and couples with sexual dysfunction. He also sees men undergoing treatment for prostate cancer.
Excerpted with permission from Reclaiming Sex & Intimacy After Prostate Cancer: A Guide for Men and Their Partners, by Jeffrey Albaugh, PhD, APM, CUCNS, copyright © 2012. For more information, visit drjeffalbaugh.com.
This article was originally published in Coping® with Cancer magazine, January/February 2013.