Anyone who suffers from urinary incontinence will tell you it’s a distressing problem that often has a serious impact on their quality of life. That is, if they’ll talk about it at all. Many people find the subject too delicate to bring up and consequently may not seek the help they need.
For men with prostate cancer, urinary difficulties are a common side effect resulting from treatment. Leakage may be heavy immediately after surgery and usually decreases gradually and disappears in the following months, although for some men, it can persist. But incontinence doesn’t have to control your life. Fortunately, many options are available to help treat the causes and deal effectively with the symptoms. Among these, education is a key factor to success.
Types of incontinence
Male voiding dynamics are complex, involving both involuntary and voluntary control. The prostate plays a role in this process; one of its functions is to compress the urethra to help avoid leakage. Surgery to treat prostate cancer can affect voiding and bladder control by damaging the urethral sphincter and other muscles and nerves around the bladder. Radiation (external beam and/or brachytherapy) may irritate the bladder and increase urinary frequency. New techniques aim to cause the least harm possible, but most men still experience at least some temporary consequences.
The main urinary problems that can arise are:
- Stress urinary incontinence (from sphincter damage): causes leakage when you cough, sneeze, lift objects or change positions (e.g. get up from a chair or out of a car)
- Overactive bladder symptoms: frequent, sudden and/or intense urges that lead to frequent urination and may result in leakage if you cannot get to the bathroom in time (urge incontinence)
- Mixed incontinence: a combination of symptoms of stress and urge incontinence
Start with thorough assessment
After your primary treatment, follow-up with your doctor will include assessment of your urinary function. This is your chance to bring up any problems you’re experiencing. Depending on the type and severity of the problem, a urologist might prescribe medications or even surgical treatment. Your doctor may also refer you to a nurse continence advisor (NCA) or physiotherapist (or a home care nurse depending on the availability of NCAs or physiotherapists in your area). The job of these professionals is to conduct thorough evaluations and help you develop an action plan based on exercises and lifestyle changes. They will educate you on how your bladder/pelvic floor muscles work, what’s causing your leakage, and your part in regaining urinary control. If doing exercises on your own doesn’t help, you may be referred to a specially trained physiotherapist for extra assistance such as biofeedback or electrical stimulation.
Treatment solutions
A variety of management options are available:
- Behavioural techniques may be a good place to start. These aim at “retraining” you to keep track of your voiding patterns (e.g. by keeping a record or diary) and to consciously suppress the urge to urinate. You may have to make certain lifestyle changes such as regulating your fluid and caffeine intake, diet and weight, getting sufficient exercise, keeping your bowels regular, etc.
- Pelvic floor exercises: Also called Kegel exercises, these are designed to strengthen the pelvic floor muscles that keep the bladder in place and the urethra tightly closed. NCAs or specialized physiotherapists can explain how these exercises work and how to do them properly. It’s important to practise the exercises regularly and to have patience — it can take time before you see the results, but they’re usually worth it!
- Medications: There are several prescription medications available for overactive bladder and urge incontinence.
- Surgical solutions: If other approaches don’t help, your doctor might recommend surgery to treat stress incontinence. Techniques can include: the insertion of an artificial urinary sphincter that you control with a valve implanted under the skin; sling procedures in which a strip of synthetic material is used to support and compress the urethra; an inflatable balloon placed near the bladder neck to lift the bladder and improve continence. Another option is to inject a bulking agent, such as collagen, to reinforce the tissue surrounding the urethra.
- Absorbent products: While many men might find it embarrassing or difficult, they might have to rely on pads, briefs or other protective incontinence products at some point. They come in disposable or reusable (i.e. washable) models and range in shape, size, absorbency, etc. Some are designed especially for men. Your needs may vary depending on when you’re wearing them (day or night) and your level of activity, and you might have to try different kinds to see what suits you best. You can request samples of most products at your pharmacy or at specialty medical supply stores. Large grocery stores also carry good-quality products. You can also buy protective pads for chairs, beds and car seats. Ask any nurse specialist or pharmacist for advice.
- Clamps: Various types of penis clamps are available to help stop leakage. These can be used during short periods of increased activity (e.g. golfing), but should be released regularly and monitored carefully.
Empower yourself!
Living with the side effects of prostate cancer treatment can be challenging. While urinary incontinence can have a definite impact on your quality of life, the worst approach is to suffer in silence. For the best results, learn all you can about what’s causing your urinary problems and ways you can regain control. Remember that help is out there, and don’t hesitate to ask a member of your healthcare team for advice.
Gloria M. Harrison is a Nurse Continence Advisor at the Urogynecology Clinic, Royal Alexandra Hospital in Edmonton, Alberta and a continence consultant with Griffiths Consulting.
