If you have undergone treatment for prostate cancer, you have probably seen “urinary incontinence” as a side effect of a variety of treatments. Incontinence, or the involuntary leakage of urine, is caused by weakened or damaged bladder muscles. These muscles can become damage for any number or reasons, including prostate issues and nerve damage.
Because most prostate treatments occur near the urethra, incontinence is almost always a side effect of cancer treatment, particularly radical prostatectomies.
What causes incontinence?
The urinary tract starts at your kidneys, which filter waste from blood and cleanse your system. The waste and excess water filtered by your kidneys combines and is flushed from the body in the form of urine. Urine enters two small tubes – called ureters – which lead to the bladder. Once the urine enters the bladder, nerves tell the muscles of the bladder to contract and push the urine into the urethra, which carries the urine out of the body.
The internal sphincter, a muscular valve attached to the urethra, prevents urine from leaking out unless specifically signaled by the nerves. Occasionally, these nerves get mixed signals or become damaged, which causes urinary leakage or the sensation of a full bladder. This is called incontinence.
There are three types of urinary incontinence:
Urge incontinence, where you may feel the sudden need to urinate, even if you have just gone or your bladder is not full
Stress incontinence occurs when and stress is placed on your lower abdominal wall. this can be brought about by laughter, sneezing, or lifting heavy objects.
Overflow incontinence, or the involuntary release of urine due to weak bladder muscles or a blocked urethra. This type of incontinence is characterized by a sudden release of urine, difficulty urinating despite the urge to do so, and urine leakage while asleep.
In men, urinary troubles are often due to prostate issues such as benign prostatic hyperplasia, prostatitis, or prostate cancer.
The urethra runs through the prostate gland, located between the bladder and the penis. In surgeries like radical prostatectomies, which remove the prostate, and during procedures like cryoablation, which seeks to remove cancer cells with targeted freezing, the nerves controlling the urethra and the internal sphincter are at risk of becoming damaged. Even with a skilled surgeon, post-surgical swelling can make urination difficult without a catheter.
Options for treating incontinence
Most men are able to fully recover from urinary incontinence after some times following their surgeries or procedures, and there are several treatment options to ease the discomfort of incontinence during recovery.
Certain behavioral treatments can help men recover normal bladder function. These include limiting fluids at specific times during the day and a process called “timed voiding,” where individuals plan trips to the bathroom.
Perhaps one of the most effective types of “bladder training” are Kegels, which are exercises designed to strengthen the muscles that support the bladder and bowels, called the pelvic floor. These exercises involve contracting the muscles that you use to control the flow of urine.
Medications can also be beneficial in treating urinary problems. Alpha blockers, such as FloMax, are designed to prevent the abdominal contractions that lead to urge incontinence. Ditropan is another alpha blocker that is designed to relax the bladder and alleviate the pain of bladder spasms caused by urge incontinence.
When Surgery is an Option
While most men regain bladder control after prostate treatments, some do not. Age, type of treatment, and previous bladder function are all factors in determining how well bladder function will return after undergoing prostate surgery.
Surgery may be an option for men who have ongoing incontinence, recurrent urinary tract infections, or moderate to severe amounts of blood in their urine.
For some men, a prolene bulbourethral sling can be used to treat stress incontinence. Prolene is a synthetic polypropylene, which is a polymer used in mesh. This suture is used for its durability and its ability to approximate soft tissue with minimal tissue reactivity. This sling is designed to treat incontinence by elevating and supporting the urethra so the internal sphincter is able to function properly on its own.
Mesh sling incontinence surgery is typically done as outpatient surgery, which means a patient would be able to return home in as little as 24 hours. This surgery is extremely effective, but if you are considering undergoing this procedure, there are a few things you will need to know:
What to Expect
Before Prostate Cancer Surgery
Every surgeon handles surgeries differently and each patient is unique. It is, therefore, important to follow your doctor’s pre-and-post-surgery routines carefully and to communicate your health concerns – and any medications you are taking that may interfere with the anesthesia – as accurately as you can.
Most doctors recommend that you stop taking aspirin or other blood thinning medications two weeks prior to surgery, as they interfere with the clotting necessary to heal after the surgery. The night before your surgery, you will only be able to consume clear liquids, and nothing at all after midnight to prevent obstructions during the procedure.
During your pre-op, you will also be asked to undergo a urodynamic test to asses how well your urinary tract is functioning, as well as a 24 hour pad test, to monitor the volume of urine leaked and the number of pads you use. The surgeon may also request a cystoscopy, which uses a thin, lighted instrument that allows him or her to look inside your bladder and urethra.
Prior to the sling implantation, you may also be instructed on how to catheterize yourself, as swelling after the surgery can make urination difficult.
During Prostate Cancer Surgery
Implanting a mesh sling can be done under a general anesthesia and or, occasionally, under a spinal anesthesia.
The surgeon will make a small incision in your perineum (the area between the scrotum and rectum), and the bulbar urethra, or the descending tubelike structure of the bladder, will be dissected. Two additional small cuts will be made on the scrotum, and trocars will be used to guide the sling in place and elevate the urethra. The prolene mesh will be tailored to maintain tension on the urethra, and will be held in place with surgical tape.
After the sling is in place, the doctor will stitch you back up. All of the stitches and glue will dissolve on their own.
Following the surgery, you may have a catheter in place until the swelling subsides. Once the catheter is removed, it may take a few weeks to urinate normally.
As with any surgery, recovery is important. You may run the risk of bleeding or infection. In order to reduce your risk and ensure that your tissue heals properly, it is important to avoid strenuous activity and lifting heavy objects, which may tear your sutures.
You don’t have to live with incontinence.
Incontinence may be a side effect of prostate cancer treatments, but it does not have to be permanent. There are several options for treating urinary difficulties. Talk to your doctor about the best option for you.
And as always, talk with us about finding your best life insurance coverage options for prostate cancer survivors.