Urinary incontinence (loss of urinary control) is common in men who have undergone surgery or radiation therapy for prostate cancer. Patients should be prepared for the possibility of urinary incontinence and should understand that, at least for a time, it can be a problem in their lives.
There are many different types of urinary incontinence and they vary in severity. Some men may have dribbling urine, others may have a diarrhea.
- Urinary incontinence when coughing, sneezing, or laughing is called stress incontinence, and it is most common in men who have undergone prostate surgery.
- Frequent and leaky urination is called urgent incontinence, and this is the most common type of incontinence after radiation therapy.
Doctors will continue to improve the treatment of prostate cancer to reduce the risk of urinary incontinence after surgery and radiation therapy.
Why does prostate cancer treatment cause urinary incontinence?
Knowledge of how the bladder stores urine helps answer this question. After urine is excreted from the kidneys, it enters and is stored in the bladder until the body has the urge to urinate. The bladder is a hollow, muscular, sac-like organ in which urine flows out of the bladder and out of the body through a tube called the urethra. During urination, the muscles in the bladder wall contract, forcing urine out of the bladder. At the same time, the muscles around the urethra relax to allow urine to pass. The prostate gland wraps around the urethra, so prostate enlargement can block the urethra and cause urinary retention or other conditions related to urination.
Destroying the prostate through surgery to remove it or through radiation therapy (using an external particle beam or placing radioactive particles) can disrupt the way the bladder stores urine, causing it to leak. Radiation therapy reduces the capacity of the bladder and causes spasms, which in turn force urine to pass. Surgical procedures can sometimes damage the nerves that help control bladder function.
Are there new technologies that can reduce the risk of urinary incontinence?
Surgeons try to reduce damage to the sphincter by removing as much of the prostate as possible, preserving the area around the bladder and the sphincter around the urethra. The surgeon uses sophisticated computer projections to fine-tune the radioactive particle placement process so that the radioactive particles destroy the prostate while limiting damage to the bladder.
However, any patient currently undergoing radiation therapy or surgery to treat prostate cancer should expect possible problems with urinary control. With newer techniques, some patients will have only temporary problems with urinary control, and many will regain full bladder control in due course.
How is urinary incontinence treated after treatment for prostate cancer?
Treatment options include:
- Strengthening pelvic floor muscle exercises. Many doctors prefer behavioral technique training to enhance a man’s ability to control the outflow of urine. Kegel exercises strengthen the muscles that the body contracts when it stops urinating during urination, and the exercise can be combined with biofeedback therapy to help better exercise these muscles.
- Supportive care. This therapy includes behavior modification, such as reducing fluid intake, avoiding caffeine, alcohol, or spicy foods, and not drinking water or other beverages before bedtime. Patients are encouraged to urinate regularly and not to wait until the last minute to go to the bathroom. For some patients, weight loss may improve urinary control. Supportive care also includes changing any medications that have an effect on urinary incontinence.
- Medication. Many medications can increase bladder capacity and decrease the frequency of voiding. In the near future, newer medications will be available to prevent other forms of urine leakage.
- Neuromuscular electrical stimulation therapy. This therapy is used to retrain and strengthen weak urinary muscles and improve control of the bladder. The treatment involves inserting a probe into the anus and causing an electric current to flow through the probe at a level below the pain threshold, causing contractions. The patient is instructed to contract the muscle while the probe is energized. When the muscle contracts, the current is cut off.
- Surgery, injections, and related devices. Some methods can improve bladder function.
- Artificial sphincter. This is a patient-controlled device that consists of three parts: a pump, a pressure-regulating ball, and a cuff that surrounds the urethra and prevents urine leakage. The use of an artificial urinary sphincter can cure or greatly improve symptoms in more than 70 to 80% of patients.
- Ball urethral suspension. For some types of leakage, a suspension device may be used to suspend and compress the urethra. The device can be made of synthetic materials or from the patient’s own tissue and is used to achieve the urethral compression necessary for bladder control.
- Other procedures. Doctors may also perform a procedure that has helped many men, which places a rubber ring around the tip of the bladder to help store urine.