Side Effects

Urinary Incontinence

Urinary incontinence is the inability to hold urine inside the bladder voluntarily or prevent leaking or dribbling. Although some men feel embarrassed discussing it, incontinence is a common medical condition and is treatable in the majority of cases.

To understand incontinence, it is important to understand the process of urination. Urine is formed in the kidneys, waste-filtering organs located in the mid-back, just below the rib cage. Urine leaves the kidneys and flows down the ureters, two thin tubes that empty into the bladder, the hollow, muscular organ that holds urine. Urination is controlled by the urinary sphincter, rings of muscles at the base of the bladder and in the wall of the urethra, the tube running from the bladder to the tip of the penis.

The sphincter normally controls the flow and leakage of urine by tightening and closing around the neck of the bladder and urethra. When the bladder is full, the sphincter relaxes and allows urine to leave the bladder. At the same time, the bladder muscles contract and squeeze urine out of the bladder. When you are finished urinating, the sphincter contracts and the bladder relaxes.

How the prostate gland affects urination

The prostate gland sits just below the bladder and completely encircles the urethra at the point where it leaves the bladder. When the prostate gland is removed in a radical prostatectomy or receives radiation therapy, damage can occur to the urinary sphincter. Depending on the extent of the damage, temporary or permanent incontinence can result.

However, when the operation is performed by an experienced surgeon who preserves the urinary sphincter and carefully rebuilds the urinary tract, there is a one percent risk of total incontinence.

A recent study at a medical center with extensive experience in performing radical prostatectomy reported 93 percent of patients with complete continence 18 months after surgery¹. Studies from other health centers report a consistently high rate of continence — between 85 percent and 100 percent — in patients from two months to 18 months following radical prostatectomy².

Treatment of incontinence depends on its type, cause and severity.

Types of incontinence

Incontinence can occur as a result of prostate disease or its treatment.

Total incontinence is a complete inability to store or control urinary leakage, independent of activity.

Stress incontinence, urine leakage with activity, is the most common type of incontinence after prostate surgery. It is usually caused by a weak or damaged urinary sphincter and results in urine leakage when you do anything that strains or stresses the bladder, such as coughing, sneezing, laughing, or exercising. Leakage may range from mild (a few drops with only the most vigorous activity) to brisk (leakage with almost any movement). Stress incontinence resolves in up to 97 percent of men affected after radical retropubic prostatectomy, but can take up to three years to resolve.

Urge incontinence causes urine to leak without any warning. You may feel as if you won't be able to reach a toilet in time. Urge incontinence results when an overactive bladder contracts without your wanting it to do so. Overactive bladder may occur as a result of prostate infection, such as prostatitis, or as a result of bladder lining irritation caused by radiation therapy. The nerves that normally control the bladder can also be responsible for an overactive bladder.

Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. This happens when blockage or narrowing of the bladder outlet by cancer or scar tissue prevents normal emptying of the bladder. Benign prostatic hyperplasia (BPH) (an enlarged prostate) can also cause such blockage. For this reason, overflow incontinence is more common in men than in women.

Incontinence after radical prostatectomy

Many men regain normal bladder control within several weeks or months after radical prostatectomy. There is no way to predict if leakage will occur and for how long. Most men experience leakage for weeks to a few months, some experience no leakage and a small percentage will have continued long-term or permanent leaking. There is a 10 percent risk of stress incontinence lasting up to three years following surgery.

Regaining urinary control

• Kegel exercises
  Kegel exercises are the deliberate tightening or clenching of the pelvic muscles. Performed regularly, they tone and strengthen the external sphincter, the rings of muscles responsible holding in urine.
  
  
  • How do I perform a Kegel exercise?
    Whenever you tighten your pelvic muscles to stop the flow of urine or prevent the passing of gas, you are performing a Kegel exercise. Tighten only the pelvic muscles; keep your abdominal, thigh and buttock muscles relaxed. Kegel exercises can be performed while sitting or standing, anywhere and anytime.
    
    

  • When can I start practicing Kegel exercises?
    You can start practicing Kegel exercises before a radical prostatectomy to retrain and strengthen the muscles that surgery may weaken. It is important to continue the exercises after surgery when the catheter is removed.

  • How often should I practice Kegel exercises?
    The number of repetitions and sets of exercises vary from doctor to doctor. What is most important is that, as with any exercise, regular and consistent practice of Kegel exercises is necessary to achieve results.
    
    
• Medications for Incontinence
  Your doctor may prescribe or recommend medications to help with incontinence. Decongestants may tighten up the muscles of the urethra and are used for stress incontinence. Anticholinergic drugs, which block messages to the bladder nerves and prevent bladder spasms, are sometimes recommended for urge incontinence.
  
  
• Biofeedback
  Biofeedback is a training program that can be used to reinforce the proper performance of Kegel exercises. The technique uses a variety of instruments to record small electrical signals emitted when the sphincter muscles are squeezed during contraction. These related signals are immediately converted into a tone or flash of light that indicate how well the action was performed. The patient then attempts to reproduce the muscle contractions that produced the correct feedback.

Until urinary control returns

• To control leakage, you can wear an absorbent pad inside your underwear or a disposable undergarment. These aids are available at your local grocery store or drugstore.
  
  
• Do not wear an incontinence device that has attached bag, a condom catheter or clamp, unless directed to do so by a doctor. These devices will prevent you from developing the muscle control necessary to regain continence.
  
  
• Until urinary control has returned, avoid drinking excessive amounts of fluids.
  
  
• Limit alcohol and caffeine intake.
  
  
• Empty your bladder before bedtime or before strenuous or vigorous activity.
  
  
• Sometimes fat in the abdomen can put pressure on the bladder; losing weight may help improve bladder control.
  
  

If incontinence persists for more than 18 months, your doctor may suggest one of the following treatments:

1 Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000;55(1):58-61.

2 Sokoloff MH, Brendler CB. Radical retropubic prostatectomy. Principles and Practice of Oncology Updates, Vol. 14, No. 9. New York: Lippincott Williams & Wilkins; 2000.

The Prostate Cancer pages of this Web site are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

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