Men who have undergone a radical prostatectomy—the surgical removal of the prostate gland to treat prostate cancer—often leak urine during physical strain, such as coughing, sneezing, or lifting heavy objects. This type of urine leakage, called stress urinary incontinence (which can also be caused by a spinal cord injury or a neurological disorder), can be a significant quality-of-life issue. The stigma attached to wet clothing and offensive odor can inflict psychological consequences, including humiliation, helplessness, fear, social withdrawal, and avoidance of sex.
Some men regain bladder control in six to nine months after surgery. For others, progress is slower and recovery takes one to two years after prostate surgery. Up to 40 percent of men have long-term but mild incontinence that isn’t bothersome enough to need treatment.
When incontinence persists
An estimated 5 percent of men have incontinence that doesn’t go away on its own after two years and is severe enough that surgery may be needed to regain bladder control.
Prolonged incontinence is usually caused by surgical disruption of the urinary sphincter or damage to the nerves that control the muscles. Unfortunately, some men wait three to five years or even longer before pursuing surgical treatment to improve their condition, according to a study by researchers at the University of Texas Southwestern Medical Center in Dallas.
In the study, published in Urology in September 2018, researchers tracked 572 men (average age, 69) over 10 years who underwent anti-incontinence surgery after radical prostatectomy. They measured theamount of time between procedures and found that two-thirds of the men waited an average of 2.7 years before pursuing anti-incontinence surgery, and one-third of them waited more than five years. Men in their 80s waited the longest—typically more than seven years.
The study had limitations, such as being performed at a single center, so outcomes may differ in other settings. Also, the researchers couldn’t determine the reasons behind the long delays before surgical treatment. However, the study is a reminder that men whose quality of life is suffering should seek timely treatment for incontinence.
If you have persistent stress incontinence, your treatment will depend in part on the degree to which incontinence is affecting your quality of life. You have two surgical options that can reduce or eliminate incontinence and improve your quality of life:
- An artificial urinary sphincter (a doughnut-shaped rubber cuff) placed around the urethra is a treatment for more severe urinary incontinence. The cuff is filled with fluid and connected by a thintube to a bulb, or pump, implanted in the scrotum. The bulb is connected to a reservoir implanted within the abdomen. The entire device is concealed within the body. The fluid in the cuff creates pressure around the urethra to hold urine inside the bladder. When you feel the urge to urinate and are ready to do so, you squeeze the bulb. This action transfers fluid from thecuff to the reservoir and deflates the cuff for three minutes so urine can drain through the urethra. Afterward, the cuff automatically refills with fluid and urine flow is again impeded.
- A urethral sling procedure is 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.
If you have mild to moderate stress incontinence, these conservative approaches might help:
- Lifestyle measures. Lose excess weight to decrease pressure on the bladder. Eat high-fiber foods to prevent constipation. Limit alcohol and caffeine intake. Avoid beverages within a few hours beforebedtime.
- Kegel exercises. Perform Kegel exercises 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.
- Absorbent products. Wear absorbent pads or undergarments.
- Bulking-agent injections. Injections of collagen or synthetic collagen-like material around the bladder neck to add bulk can provide increased resistance to urine leakage.
- Penile clamps. For severe incontinence, penile clamps compress the penis and urethra to prevent urine leakage.
- External collection devices. Condom-like devices are 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.
- Catheters. A Foley catheter is a small tube that’s 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.
This article first appeared in the May 2019 issue of UC Berkeley Health After 50.
Also see How to Train Your Bladder.