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Incontinence Advice

Incontinence After Prostate Surgery

Urinary incontinence after prostate surgery is a common concern for many men that undergo treatment for prostate cancer. While the journey to recovery can seem daunting, the good news is that there are effective strategies and treatments available to manage and often significantly improve this condition. In this article, you will learn everything that you need to know about urinary incontinence post-prostate surgery, as we offer insights into its causes, treatment options, and supportive measures available within the UK.

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Understanding Urinary Incontinence After Prostate Surgery

Urinary incontinence, the involuntary leakage of urine, is a potential consequence of prostate surgery, often causing concern and discomfort for those affected. Two primary types of incontinence may occur post-surgery: stress incontinence and urge incontinence. 

  • Stress incontinence, characterised by leakage during activities that put pressure on the bladder, such as coughing or lifting, is particularly common after procedures like prostatectomy.

  • Urge incontinence, or an overactive bladder, results in a sudden and intense need to urinate.
In this article

How Prevalent Is Incontinence After Prostate Surgery?

On average, between 6-8% of those that undergo prostate removal will experience some form of urinary incontinence; the good news is that this is often temporary. Factors influencing the onset and duration of incontinence include the surgical method employed, the patient's age, and their overall health status.

Learn more about the factors that can contribute to prostate problems.

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Causes of Incontinence After Prostate Surgery

The prostate gland, located just below the bladder, plays a role in urine control. During prostate surgery, the internal sphincter, one of the valves controlling urine flow, may be removed or damaged, impacting bladder control. The extent of incontinence can also depend on the pre-surgery condition of the pelvic floor muscles and the presence of other health conditions.

It's also worthwhile in understanding bladder problems in men that, if left untreated, can lead to incontinence.

How Surgery Can Affect Prostate Incontinence

The removal of the prostate gland, alteration through treatments like radical prostatectomy, radiotherapy, or High-Intensity Focused Ultrasound (HIFU) can lead to what is known as prostate incontinence. These treatments, while effective in combating prostate cancer, may affect the nerves and muscles involved in bladder control, leading to conditions such as stress incontinence, where activities that increase abdominal pressure cause unintended urine leakage.

Radiation therapy, in particular, might irritate or damage the surrounding healthy tissues, exacerbating issues with bladder storage and control, thus contributing to urge incontinence, where there is a frequent, urgent need to urinate.

Factors That Impact Prostate Incontinence After Surgery

The timeline for recovery from incontinence after prostate surgery can vary greatly. Key factors influencing this include the patient's age, overall health, and the condition of bladder control prior to surgery. 

Younger, healthier patients may find their recovery period shorter, often regaining full control within a few months. Conversely, older patients or those with pre-existing health conditions might face a longer road to recovery.

Despite these challenges, the outlook is usually positive. Most patients will notice a significant reduction in urine leakage over time, with consistent improvement. Engaging in targeted exercises to strengthen the pelvic floor muscles is a crucial step in this recovery process. These exercises enhance the support for the bladder and the remaining external valve, improving control over urine flow and reducing overflow incontinence in men.

Man sitting on the bed

How To Manage Incontinence After Prostate Surgery

For those readjusting to life after prostate surgery, several practical measures can aid in managing incontinence:

  • Pelvic Floor Exercises: Regularly performing pelvic floor exercises strengthens the muscles responsible for bladder control, offering a natural and effective way to reduce leakage.

  • Lifestyle Adjustments: Modifying daily habits, such as fluid intake and diet, can alleviate symptoms. Avoiding irritants like caffeine and alcohol may also prove beneficial.

  • Use of Incontinence Products: While recovering, incontinence products can provide comfort and security, enabling men to lead active lives without concern. And for those still participating in sports with incontinence, we highly recommend using pull up pants for better movement during these activities.

Treatment Options for Incontinence After Prostate Surgery

For those with mild to moderate urine leakage post-surgery, healthcare professionals typically recommend starting with non-invasive therapies. 

Pelvic floor exercises, otherwise known as Kegels, are frequently advised to strengthen the muscles that support bladder control. These exercises are crucial for rebuilding the foundation of the urinary system, especially after the structural changes following prostate removal.

Additionally, lifestyle adjustments and the use of incontinence products such as adult incontinence products can offer immediate relief and confidence. For some, devices like incontinence clamps, which prevent urine leakage by applying gentle pressure on the urethra, can be beneficial. However, the suitability and use of such devices should always be discussed with a healthcare provider to ensure they are a safe and effective option.

Medication and Surgery Alternatives

In cases where pelvic floor exercises and lifestyle modifications do not yield the desired improvement, medication might be a more viable option, particularly for managing urge incontinence. These medications aim to either relax the bladder for increased capacity or adjust the signals between the brain and the bladder, enhancing control. It's important to note, though, that medication effectiveness varies, and options for stress incontinence are more limited.

For incontinence persisting beyond three months or for more severe symptoms, surgical options may be considered. These interventions seek to provide a more permanent solution to regain urinary control and significantly improve quality of life.

Urethral Sling Procedure

The urethral sling, a minimally invasive surgery, involves placing a synthetic mesh around the urethra. This mesh acts as a supportive hammock, lifting the urethra into a position that improves urine control. The procedure is especially beneficial for men experiencing mild to moderate incontinence and who haven't seen significant improvement from other treatments. 

Artificial Urinary Sphincter (AUS)

This device mimics the function of a healthy sphincter, with an inflatable cuff placed around the urethra, a control pump in the scrotum, and a pressure-regulating balloon in the abdomen. The AUS is activated manually, allowing the user to control urination with precision. While more complex than the sling, the AUS has shown high satisfaction rates among recipients, significantly reducing or eliminating leakage.

Bulking Agent

For those seeking less invasive options, treatments like the injection of polyacrylamide hydrogel (Bulkamid) offer a middle ground. Bulkamid injections help tighten the urethra's lining, improving closure and reducing leakage. This procedure is quick, usually performed under local anaesthesia, and can be repeated if necessary to maintain effectiveness.

Non-Surgical Options for Incontinence After Prostate Surgery

Of course, it is better to opt for non surgical options before considering surgical choices, as most of these can be handled naturally and in your free time.

Bladder Training Techniques

This method is useful for those unsure of how many times a day to urinate, and therefore stabilise bladder capacity and control. By gradually increasing the time between urination, you can significantly improve your ability to hold urine, reducing the frequency and urgency of bathroom trips.

Medication Options

For symptoms of an overactive bladder, medications provide another layer of support. Antimuscarinics such as Oxybutynin, Tolterodine, and Solifenacin, along with beta-3 agonists like Mirabegron, relax the bladder muscles, increasing its storage capacity and reducing leakage. Your healthcare provider will recommend the most suitable medication based on your specific symptoms and health profile.

Lifestyle Adjustments and Support Tools

These include the following:

Seeking Advice From Your Healthcare Provider

It's important to maintain open communication with your healthcare provider about any ongoing symptoms of incontinence. If you notice persistent or worsening symptoms, or if you experience discomfort from overdoing pelvic floor exercises, seeking medical advice is crucial.

FAQs

How long does discomfort last after prostate surgery?

Discomfort following prostate surgery typically lasts for a few weeks, but the duration can vary depending on individual recovery rates and the specifics of the surgery.

What is the most common complication of prostate surgery?

The most common complication of prostate surgery is urinary incontinence, with varying degrees of severity and duration experienced by patients.

When is the first bowel movement after prostatectomy? 

The first bowel movement after a prostatectomy usually occurs within a few days post-surgery, although this can vary based on individual factors and post-operative care.

Is it possible to perform too many Kegel exercises after undergoing a prostatectomy?

Indeed, excessive Kegels post-prostate surgery can lead to an overly tightened pelvic floor, potentially causing discomfort, spasms, or constipation. It's advisable to undertake Kegels and similar pelvic floor exercises under the guidance of a physical therapist or healthcare professional.

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