In Australia, thousands of men suffer with a prostate condition every year. Where some are considered mild, other conditions can seriously impact the person’s health – including prostate cancer.
As the second most common cancer in Australia today, it is likely you or someone you know is undergoing treatment for prostate cancer right now. And while many treatments are successful in curing the cancer altogether, they can sometimes leave other health issues behind in their wake, giving patients a new cause for concern.
One of the most common side effects after prostate surgery is incontinence. But why is this the case, how does it happen and what can be done to manage it? Read on to learn all about incontinence after prostate surgery.
It is completely normal to experience a degree of sphincter weakness incontinence once the catheter is removed after surgery.
Symptoms may include stress incontinence, frequency, urgency, urge incontinence, post-micturition dribble, nocturia and nocturnal enuresis. The severity of incontinence varies: some men will have very little bladder control, some men will only have minor leaking for a few days.
Incontinence after prostate cancer treatment.
What Is Post-Prostatectomy Incontinence?
Incontinence is the term used for a loss of bladder control. When the muscles in the bladder weaken, it becomes difficult to ‘hang on’ to urine and control when to allow it to pass.
Some men with prostate cancer need surgery to treat the condition. The most common type of surgery is a prostatectomy, which involves a surgeon removing part of the prostate and any surrounding area affected by bad cancer cells.
On the positive side, a prostatectomy gives most patients a high chance of survival – yet the likelihood of those patients developing incontinence is also very high.
The three types of urinary incontinence are:
Urge incontinence – when you feel a need to urinate immediately after doing so
Overflow incontinence – when the muscles are too weak to empty the bladder fully
Stress incontinence – when urine escapes as a result of pressure to the bladder (coughing, sneezing, laughing or lifting a heavy object)
There are several signs you are suffering from prostate cancer incontinence, including:
- Slow or interrupted flow of urine
- Difficulty passing urine
- Needing to pass urine more frequently
- Burning or pain when passing urine
- The need to urinate immediately after doing so
- Rushing to urinate
- Blood in the urine
You may notice one or several of the above signs after a prostatectomy. If this is the case, you should speak with a medical professional as soon as possible.
Why Urinary Incontinence After Prostatectomy Happens
Incontinence is a problem for men, whatever its origins, and it is certainly the case when it occurs as a result of prostate cancer surgery.
Just as a prostatectomy is now a widespread procedure to treat men with prostate cancer, so are its side effects – particularly urinary incontinence. Why is this the case?
Where the bladder meets the urethra, a group of muscles called the bladder neck sphincter open and shut to control the urine flow. Sometimes, during the prostate surgical procedure, the bladder neck sphincter is damaged, which causes the shutter to fail. With no control mechanism, urine then escapes at will.
For some men, incontinence after prostate surgery is a bigger challenge than dealing with cancer itself. Losing control of the bladder is inconvenient and embarrassing, and it is a condition most men want to rectify as quickly as possible.
How to Manage Prostate Cancer Incontinence
There are several ways to treat post-prostatectomy incontinence, and here are the most common ones used in Australia.
PELVIC FLOOR TRAINING
This non-invasive treatment involves exercises designed to retrain the pelvic floor so that the muscles strengthen and become capable of supporting the bladder.
Some patients will begin pelvic floor training before their prostate surgery, which can reduce or even prevent incontinence from happening afterwards.
For those who suffer from incontinence post-prostatectomy, pelvic floor training helps most men regain full bladder control between three and six months after their surgery.
MEDICATION
The most popular medications for treating post-prostatectomy incontinence are called Anticholinergics. The common ones include Enablex, Ditropan XL, Detrol LA, the oxytrol patch, and imipramine.
The success rates for these medications vary and come with many side effects, such as constipation, a dry mouth, and blurred vision.
ARTIFICIAL URINARY SPHINCTER
This is another surgical treatment and one recommended to patients suffering from severe urinary incontinence. Again, the surgery takes place in a hospital, usually within a day, although overnight stays are common for easy post-surgery patient assessment.
The artificial urinary sphincter is a device made from silicon, consisting of a reservoir, a cuff and a pump. Once surgically inserted behind the scrotum, the cuff works like a healthy urinary sphincter, squeezing the urethra closed to keep urine in the bladder. When the patient activates the pump, the urine drains to the reservoir and is allowed to pass.
Once inserted, the surgeon deactivates the device for approximately six weeks while the body recovers. At that stage, it is activated, and the patient is trained fully on its operation.
Post-treatment side effects include a high temperature, fever, prolonged pain, and ongoing problems with urinating. Patients experiencing any of these symptoms are advised to seek immediate advice from a urologist.
ARTIFICIAL URINARY SPHINCTER
This is a surgical treatment and one that many urologists recommend to patients suffering from mild to moderate stress incontinence. It is performed in a hospital by a surgeon, usually within a day, and is a highly successful treatment method.
Here, the surgeon creates a sling using tissues from the patient’s body or a synthetic mesh and places it under the urethra via an incision in the perineum. The sling forms a cradle under the urethra and prevents urine from escaping.
Most patients see an immediate improvement to their incontinence as a result of this procedure. Discomfort and fatigue are common afterwards, although they tend to pass quickly (usually within 72 hours of the procedure). Any inflammation, excessive pain or a high temperature, and you are advised to contact your GP or urologist.
As with all medical conditions, please discuss your treatment options with a professional before taking any mediaction.
Finding The Right Treatment For Post-Prostatectomy Incontinence
As with any medical condition, there are different ways to treat the patient – some better suited than others, depending on many factors such as age, lifestyle and personal preference.
If you have recently undergone cancer surgery or will receive treatment soon, remember: you are not alone. Professionals are waiting to help you discuss your options for the treatment itself or any side effects you are experiencing.
Katelaris Urology is an expert in prostate cancer surgery and side effects, with a qualified professional team ready to support your needs, whatever your age or situation.
If you have questions or need help managing prostate cancer side effects like urinary incontinence, don’t hesitate to contact our team today.
Frequently Asked Question
How can I tell if I have prostate cancer incontinence?
There are several common symptoms of incontinence resulting from prostate surgery. If you are experiencing difficulty when urinating – pain when urinating, the need to go more often, blood in the urine or persistent bladder leaks – speak with a urologist and have them determine a formal diagnosis.
Who can I speak to about post-prostatectomy incontinence?
If you have recently undergone a prostatectomy, your medical team will have spoken with you about the potential side effects caused by the surgery. Urinary incontinence after prostate surgery can be treated easily – speak with a specialist who will establish the best course of treatment based on your age, health and lifestyle.
How long will my incontinence last after prostate surgery last?
Typically, prostate cancer incontinence is short-lived and often goes away by itself in a matter of days. For some patients, symptoms will persist if left untreated, which can be uncomfortable. To understand the best treatment to suit your circumstances, we recommend you speak with a urologist as soon as possible.
References
Prostate cancer: Causes, symptoms & treatments, Cancer Council. Available at: https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer
Worldwide cancer data: World cancer research fund international (2022) WCRF International. Available at: https://www.wcrf.org/cancer-trends/worldwide-cancer-data/#:~:text=Global%20cancer%20incidence%20in%20men&text=The%20top%20three%20%E2%80%93%20lung%2C%20prostate,5%25%20were%20stomach%20and%20liver
Australian Cancer Research Foundation: Backing brilliant (2023) ACRF. Available at: https://www.acrf.com.au/
