Managing incontinence after prostate cancer treatment

One of the possible side effects of surgery or radiation to remove the prostate as part of treatment for prostate cancer is incontinence. For men who undergo radical prostatectomy, surgery that removes the entire prostate, there is a 2% to 15% risk that they may develop incontinence. In some cases, the issue is a short-term one. Other men face long-term incontinence. But there are several approaches to managing this problem and minimizing its effect on your quality of life, from non-invasive strategies such as exercises, lifestyle changes, and medications to surgery.

Why can prostate cancer treatment cause incontinence?

The kidneys produce urine and empty it into the bladder. When you urinate, the urine travels through a tube called the urethra, which is surrounded by muscles that control the flow of urine and by the prostate gland. Surgically removing the prostate or destroying it by using radiation can change the bladder’s ability to hold urine, damage the nerves that help control the function of your bladder, or cause bladder spasms, which in turn can allow urine to leak.

The most common type of incontinence after prostate cancer treatment is stress incontinence. This can occur when you sneeze, cough, laugh, exercise, or lift something heavy. If there’s a blockage or narrowing of the urethra caused by scar tissue, you may experience overflow incontinence. In this type of incontinence, the bladder may not empty completely or may not be able to hold all the urine that is produced. The third common type of incontinence is called urge incontinence, sometimes known as overactive bladder. It occurs when the bladder muscle contracts too often.

The spectrum of treatment options

There are a number of different ways manage post-prostate cancer treatment incontinence, including:

• Exercises to strengthen pelvic floor muscles: Also called Kegel exercises, this approach focuses on building strength in the muscles that are used to stop the flow of urine by tensing and relaxing the muscles of the pelvic floor.
• Lifestyle changes: Changing certain behaviors can minimize the impact of incontinence on your daily life. These changes include drinking less fluid and avoiding caffeine, alcoholic beverages, and spicy food, which can affect your need and urge to urinate. Doctors also recommend urinating regularly rather than waiting until you really need to go. For some men, losing weight may also help.
• Medications: There are several different of categories of medications your doctor may suggest. Anticholinergics prevent the bladder from contracting or spasming. Although doctors don’t have a definitive understanding of how they work to treat incontinence, some men experience fewer episodes of incontinence when taking tricyclic antidepressants. There are also medications that reduce the amount of urine produced.
• Catheters: There are several different types of catheters that can be used to drain urine from the bladder. Some remain in place for an extended period of time and some are removed immediately after use. There is also a non-invasive type of catheter called a condom catheter.
• Surgery: Men who have long-term incontinence that affects their quality of life may consider surgical treatment for the condition. Options include minimally invasive urethral bulking procedures that are performed endoscopically and inject material underneath the lining of the urethra to make the urinary passageway smaller; a bulbourethral sling made from synthetic material or from the patient’s tissue, which suspends and compresses the urethra; and placement of an artificial urinary sphincter to help better control the release of urine.