Incontinence After Surgery: What to Expect
Complete removal of the prostate offers men the strongest cure from prostate cancer. However, over half of men having prostate surgery experience incontinence after surgery as a side effect of having their prostate removed. The good news is that there are new techniques and surgical procedures which can minimize the problem. Furthermore, for most men, urinary incontinence after surgery lessens or completely stops in 6 to 18 months. Here is why the problem happens and what to expect:
How the Bladder Works
To understand how surgery causes incontinence, it helps to know how the bladder works to hold urine. The kidneys empty into the bladder, which is a muscular, balloon-like organ. Urination occurs when the bladder is full and the muscles in the wall in the bladder contract and push urine out of the body through a tube called the urethra.
How Prostate Enlargement Disrupts Urination
At the same time that the muscles in the bladder contract to push out the urine, the muscles in the urethra which hold urine back are relaxed. When the urethra is unconstricted, urine flows naturally and is stopped easily by contracting the muscles at the top of the urethra which is called the bladder neck sphincter. The prostate surrounds the urethra and, when it is enlarged, can press against the urethra and make it harder for the hollow tube to open and let urine flow out quickly and easily.
Why Incontinence After Surgery Occurs
The prostate is a male reproductive organ which is usually the size of a walnut and sits underneath the bladder. The urethra runs through the center of the prostate. At the point where the urethra and the bladder meet, the bladder neck sphincter opens and closes to hold urine in or let it flow out. When the prostate is removed, these muscles can be damaged and cause incontinence after surgery. There are several different types of urinary incontinence which can differ in the degree of severity, from dribbling to uncontrollable leakage.
Stress Incontinence After Surgery
The most common kind is known as "stress incontinence" and occurs when a person does something that pushes down on the bladder such as:
- Coughing, laughing or sneezing.
- Lifting, bending or walking.
- Pushing, pulling, or moving to sit or stand.
Urge Incontinence After Surgery
Urge incontinence is the sudden, overwhelming need to urinate a large amount of urine. Triggers can be hearing, seeing or touching water. Urge incontinence is the type most seen after radiation treatment for prostate cancer which can decrease bladder capacity and cause it to spasm. However, surgery can also sometimes damage the nerves which control bladder functioning and cause urge incontinence.
After-Dribble Incontinence After Surgery
Another problem can be that the urethra does not completely empty and a small amount of urine can drip out on clothes. To minimize after-dribble:
- Sit down when urinating to make sure bladder is fully emptied.
- Don't allow elastic on pants or underwear to put pressure on the scrotum, which can prevent the urethra from fully opening.
- Place fingertips behind the scrotum and press upward and forward to help urine flow.
Treatment for Incontinence After Surgery
While most men will find that incontinence improves over time, the problem can be reduced by:
- Pelvic floor exercises such as Kegel exercises which aim to strengthen the other muscles underneath the bladder which control urine flow.
- Drinking smaller amounts of water throughout the day as opposed to larger amounts less frequently.
- Not drinking at all before bed.
- Reducing or eliminating caffeine which stimulates the bladder and is a diuretic, causing increased urine production.
- Obesity can increase the problem, so weight reduction before or after surgery can help.
- Medications are sometimes prescribed to help patients who aren't helped by other means.
- Collagen injections, bulbourethral sling surgery or artificial sphincter implants may be considered if the condition does not improve after a year.
Prognosis for Long-Term Recovery from Incontinence After Surgery
Most men who have incontinence after prostate surgery can expect to have the symptoms improve over time. In fact, the majority of men completely recover in 6 to 18 months, especially if they have used pelvic floor exercises and lifestyle interventions to help reduce incontinence after surgery. Longer-term incontinence after surgery should be discussed with a physician who may advise medications or surgical options. Expecting and planning for incontinence after surgery can make the recovery process smoother and easier.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.