Surgery or radiation therapy for prostate conditions may irritate the urethra or bladder or damage the urinary sphincter (muscles that contract to prevent urine from flowing out of the bladder). As a result, some degree of incontinence (inability to control bladder function) is common after treatment.
Urge incontinence (the strong and sudden need to urinate, followed by a bladder contraction and involuntary loss of urine) is common for a few days after catheter removal in men who have undergone transurethral resection of the prostate (TURP) for the treatment of benign prostatic enlargement (BPE) However, in the initial period after radical prostatectomy for prostate cancer, men typically experience stress incontinence, in which urine leakage occurs during moments of physical strain (such as sneezing, coughing, or lifting heavy objects).
Recovering bladder control is a slow process that may take up to six months. Fortunately, severe incontinence occurs in less than 1 percent of men after surgery for BPE and in fewer than 3 percent of men following radical prostatectomy or radiation therapy for prostate cancer. The following approaches can be taken to manage incontinence.
• Lifestyle measures. Simple changes in diet and behavior can be helpful. Excess weight increases pressure on the bladder and worsens incontinence. Weight loss through calorie restriction and increased physical activity will help. Because constipation can worsen symptoms, it is important to eat high-fiber foods, such as leafy green vegetables, fruits, whole grains, and legumes. Caffeine and alcohol increase urinary frequency and should be limited. If nighttime urination is a problem, avoid consuming liquids during the last few hours before bed.
• Kegel exercises. These exercises are performed by squeezing and relaxing the pelvic floor muscles that surround the urethra and support the bladder. To locate the pelvic floor muscles, try slowing or stopping your urine flow midstream as you urinate. Strengthening these muscles may improve bladder control after radical prostatectomy.
• Collagen injections. If urinary incontinence persists, injection of a synthetic collagen-like material around the bladder neck to add bulk can provide increased resistance to urine leakage during times of physical strain. Repeat injections often are needed because these materials are gradually broken down by the body.
• Surgical treatments. Placement of an artificial urinary sphincter (a doughnut-shaped rubber cuff) around the urethra is a treatment for more severe urinary incontinence after prostate cancer surgery. The cuff is filled with fluid and connected by a thin tube to a bulb implanted in the scrotum. The bulb in turn is connected to a reservoir implanted within the abdomen. The fluid in the cuff creates pressure around the urethra to hold urine inside the bladder. When a man feels the urge to urinate, he squeezes the bulb. This transfers fluid from the cuff to the reservoir and deflates the cuff for three minutes so that urine can drain through the urethra.
Afterward, the cuff automatically refills with fluid and urine flow is again impeded. Urethral sling procedures are a surgical option usually reserved for less severe cases. The sling is made of synthetic material and it lifts and compresses the urethra, thereby preventing urinary leakage.
• Absorbent products. Wearing absorbent pads or undergarments is the most common way to manage incontinence. These products are often used right after surgery and are effective for managing all degrees of incontinence, ranging from mild to severe. Absorbent products are also ideal for men who have minimal leakage on occasion.
• Penile clamps. An option for severe incontinence, penile clamps compress the penis and urethra to prevent urine leakage. The clamps are not recommended immediately after treatment because they interfere with the development of the muscle control needed to regain urinary continence.
• External collection devices. These condom-like devices can be pulled over the penis and held in place with adhesive Velcro straps or elastic bands. A tube drains urine from the device into a bag secured on the leg. Collection devices should not be used immediately after surgery when men are attempting to regain urinary control.
• Catheters. A Foley catheter is a small tube that is inserted through the urethra to allow urine to flow continuously from the bladder into a bag. This option is not recommended for long-term use because it can cause irritation, infection and, possibly, loss of bladder muscle control.
• Medications. Although medication can be used to help control mild to moderate incontinence, it is not effective for severe cases. Medications such as oxybutynin (Ditropan) and tolterodine (Detrol) may reduce urge incontinence by decreasing involuntary bladder contractions. Other options include nasal decongestants, such as pseudoephedrine, or the antidepressant imipramine (Tofranil), which can reduce stress incontinence by increasing smooth muscle tone in the bladder neck. Because pseudoephedrine is a stimulant that can increase heart rate and blood pressure, it should only be used under a doctor’s supervision.