Prostate Cancer: Urinary Incontinence

Urinary incontinence, or the loss of the ability to control urination, is common in men who have had surgery or radiation for prostate cancer. You should prepare for this possibility and understand that, for a while, at least, urinary incontinence may complicate your life.

There are different types of urinary incontinence and differing degrees of severity. Some men may dribble urine, whereas others may experience a total leakage. Loss of urine with a cough, sneeze or laugh is called stress incontinence and is the most common type of urine leakage men experience after prostate surgery. On the other hand, the need to frequently urinate with episodes of leakage, called urge incontinence, is the type seen most often after radiation treatment. Doctors continue to improve treatments for prostate cancer to reduce post-surgery and post-radiation incontinence.

Why Do Prostate Cancer Treatments Cause Urinary Incontinence?

It helps to know a bit about how the bladder holds urine. When urine is emptied into the bladder from the kidneys, it is stored inside the bladder until you have the urge to urinate. The bladder is a hollow, muscular, balloon-shaped organ. Urine flows out of the bladder, and leaves the body through a tube called the urethra. Urination happens when the muscles in the wall of the bladder contract, forcing urine out of the bladder. At the same time, muscles that surround the urethra relax and allow the flow of urine. The prostate gland surrounds the urethra. Because an enlarged prostate gland can obstruct the urethra, it can cause urination retention or other problems with urination.

Removing the prostate through surgery or destroying it through radiation (either with an external beam or with radioactive seed implants) can disrupt the way the bladder holds urine and can result in urine leakage. Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can, at times, damage the nerves that help control bladder function.

Are There New Techniques That Reduce the Chance of Becoming Incontinent?

When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.

Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.

What Can Be Done to Treat Urinary Incontinence after Prostate Cancer Treatment?

Treatments include:

• Pelvic floor exercises. Many doctors prefer to start with behavioral techniques that train men to control their ability to hold in their urine. Kegel exercises strengthen the muscles you squeeze when trying to stop urinating mid-stream. These exercises can be combined with biofeedback programs that help you train these muscles even better.
• Supportive care. This treatment includes behavior modification, such as drinking fewer fluids, avoiding caffeine, alcohol, or spicy foods, and not drinking before bedtime. People are encouraged to urinate regularly and not wait until the last moment possible before doing so. In some people, losing weight may result in improved urinary control. Supportive care also involves changing any medications that interfere with incontinence.
• Medication. A variety of medications can increase bladder capacity and decrease frequency of urination. In the near future, newer medications may become available to help stop some other forms of urinary leakage.
• Neuromuscular electrical stimulation. This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. With this treatment, a probe is inserted into the anus and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off.
• Surgery, injections, and devices. A number of additional techniques may improve bladder function. Incontinence products such as pads can also make you feel more comfortable.
• Artificial sphincter. This patient- controlled device is made of three parts: a pump, a pressure-regulating balloon, and a cuff that encircles the urethra and prevents urine from leaking. The use of the artificial sphincter may cure or greatly improve more than 70% to 80% of the patients.
• Bulbourethral sling. For some types of leakage, a sling can be used. A sling is a device used to suspend and compress the urethra. It is made from synthetic material or from the patient's own tissue and is used to create the urethral compression necessary to achieve bladder control.

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