Gaining urinary control or continence after prostate surgery

Gaining urinary control or continence after prostate surgery

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One of the most stress-producing potential side effects a man may experience after a radical prostatectomy is loss of urinary continence.  This is a very understandable concern as proper urinary functioning occurs frequently throughout the course of a day.  A man who is having any issues with continence will find it to embarrassing and a hassle to deal with as it used to be an unconscious function requiring little attention.

Urinary incontinence or the loss of the ability to control urination, is considered common after the removal of the prostate.  The possibility of urinary incontinence should be thoroughly discussed with all men who will be undergoing surgery for the removal of the prostate gland helping them to know what to expect.

Generally incontinence after prostate surgery should be short-lived but at least, for a while it can complicate a man’s life.  This temporary incontinence is the result of disruption or distress to the sphincter muscles that control the release of urine.  This type of incontinence is similar to stress incontinence women may experience after delivering a baby.

The majority of men with urinary incontinence after prostate surgery will primarily experience it as a slight dribble or leak.  Rarely does it result in a complete bladder emptying.  When and if a man experiences urinary incontinence after surgery, it usually happens during strenuous activity or possibly after he sneezes, coughs, or laughs.

Why does prostate surgery cause urinary incontinence?

To understand why a man may face the issue of urinary incontinence after prostate surgery, it helps to have an understanding of the bladder and the job it performs.  The function of this hollow, muscular, balloon-shaped organ is to hold urine which the kidneys produce after filtering waste material in the blood.  Urine will travel down the ureters, tubes connecting the kidneys to the bladder.  Once the bladder is filled with urine, a person gets the urge to eliminate the urine which happens through a tube called the urethra. The prostate gland surrounds the urethra but once the prostate is removed through surgery, this disrupts the way the bladder holds urine which can result in urine leakage. 

Does incontinence last very long after surgery?

Even though recovery from incontinence after prostate surgery is unique to every man, if a man was experiencing normal continence prior to surgery then he should regain function within 3 months if not sooner.  Most men will not experience long-term incontinence after prostate surgery.

What can a man do to treat urinary incontinence after prostate surgery?

·      Kegel exercises – Performing Kegel exercises can be used successfully to help men control their ability to hold in their urine.  These easy-to-perform moves help strengthen the pelvic floor muscles and can be done anywhere. 

·      Behavior modification – This can include several different means of improving urinary incontinence.  A man can try drinking fewer fluids, avoiding caffeine, alcohol, or spicy foods and avoid drinking fluids before bedtime.  Men should be encouraged to urinate regularly and not wait until the bladder is completely full.  For some men, losing weight may improve urinary control.

·      Medication – There are a variety of medications that can increase bladder capacity and reduce the frequency of urination that a man can discuss with his doctor.  Anticholinergics are one such type of medication that can reduce the sensation or number of times a man needs to urinate during the day.  For other men, decongestants can help strengthen sphincter muscles but should only be used after consulting with a physician and under their care.

·      Surgery, injections, and devices

Even though long-term incontinence after prostate removal is rare, long-lasting incontinence can be treated through a range of different treatment options.  When and if this happens, a man should thoroughly discuss with his doctor which option is best for him.

One option is surgery.  Several surgeries are available for restoring urinary control in patients whose symptoms persist for a year or more. One type involves placing rubber ring around the tip of the bladder to help hold in urine.

Collagen injections can also provide short-term relief from issues of incontinence after prostate cancer.  This treatment improves urine control by plumping the urinary sphincter through a series of collagen injections. 

Other devices that may help could be an artificial sphincter.  This patient-controlled device is made of three parts: a pump, a pressure-regulating balloon, and a cuff that encircles the urethra and prevents urine from leaking.  This can either cure or greatly improve more than 70% to 80% of patients.  Another device is a bulbourethral sling.  A sling is a device used to suspend and compress the urethra.  It is made from synthetic material or from the patient’s own tissue and is used to create the urethral compression necessary to achieve bladder control.