Prostate cancer is the most prevalent male cancer. A man with prostate cancer may not have symptoms at first, but the earliest signs of the disease tend to be those of lower urinary tract obstruction - hesitancy, post-void urine dribbling, decreased force of stream, and the feeling of incomplete bladder emptying.
Although prostate cancer treatments attempt to destroy only cancer cells, they may also damage healthy cells and tissues. Side effects include urinary incontinence and erectile dysfunction, which will vary from person to per and depend on the type and extent of treatment.
Two surgical procedures may be used as treatments for incontinence that is caused by damage to the sphincter. One is the insertion of an artificial urinary sphincter. Approximately eighty-nine percent of men receiving this treatment achieve total dryness. The other treatment, collagen injections, has a reported success rate of approximately forty percent.
Although some men feel embarrassed discussing incontinence, it is a common medical condition and is treatable in many cases.
The major side effects associated with prostate cancer treatment are urinary incontinence and erectile dysfunction.
The prostate gland surrounds the male urethra, the tube that urine passes through from the bladder to the outside. If cancer grows in the prostate, it squeezes the urethra causing an obstruction that allows less and less urine to pass, and the bladder has to work harder to force the urine out.
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.
One study reported that 93 percent of men had complete continence 18 months after surgery - this at a very experienced facility performed by qualified medical professionals.
Treatment of incontinence depends on its type, cause and severity.
Your doctor or urologist diagnoses prostate cancer through a rectal examination that shows an enlarged prostate but will also test the blood level of prostate specific antigen (PSA) as an additional sign. PSA levels greater than 10mg/mL indicate a sixty-six percent chance that prostate cancer is present.
For men with cancer that has not spread to other organs in the body a cure by surgery is the objective. Surgery includes a small cut in the lower part of the stomach above the pelvic bone or a small cut is made in front of the anus.
Most men experience some urine leakage after surgery which typically goes away. Men can experience urine leakage with a cough, change in position, or for no reason at all and it can be as minor as a few drops of urine lost or cause experiences of sopping wet clothes and furniture.
One third to fifty percent of men will experience urine leakage following surgery. Unfortunately, a number of surgeons fail to mention this. Urine leakage following prostate surgery can be due to stress, urge or a combination of both.
Types of Incontinence
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.
The sphincter may become damaged during surgery. As a result, urine is lost at times when the bladder pressure exceeds the pressure in the urethra, such as during a sneeze, cough, hitting a golf ball or changing positions. Stress incontinence after prostate surgery may be temporary or permanent, depending on the amount of damage to the nerves and blood vessels supplying the bladder and urethra.
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.
Urge incontinence may also occur after prostate surgery and involves an "involuntary loss of urine that is associated with a strong need to void." Urge incontinence may occur as a result of the bladder muscle's efforts before surgery to overcome the obstruction of the bladder outlet due to the enlarged prostate gland that "squeezes" the urethra. The bladder can become bigger over time and contracts forcefully to overcome the bladder outlet obstruction. After surgery, the bladder continues to contract forcefully and the man may not be able to hold back urinating.
If urge incontinence is seen in men soon after surgery, it may be due to < b>bladder nerve damage b> that affects the bladder's ability to store urine at low volume. Mixed incontinence, a combination of stress and urge incontinence, can also occur when bladder instability and urethral sphincter weakness both occur.
Some doctors have found that patients who practice Kegel exercises (strengthening the pelvic muscles) before surgery regain bladder control more quickly following surgery. Combining pelvic muscle exercise with bladder retraining (urge inhibition) for men with both stress and urge incontinence can decrease urine leakage, urine urgency and frequency - referred to as overactive bladder.
Regaining Control of Urination
Kegel exercises 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 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.
Managing Incontinence After Prostate Cancer Treatment
If the incontinence cannot be completely corrected, you can still lead an active, dignified lifestyle. Learning how to live with incontinence is important because it can otherwise disrupt your quality of life. Fear, anxiety, isolation, and embarrassment are common feelings.
There is no one right way to deal with incontinence. The goal is to find what works best for you. There are many disposable absorbent incontinence products that can help you remain active and comfortable: pads can be worn under clothing; adult briefs and undergarments are available; and under pads can be used to protect the bed linens, mattresses and chairs.
Here are questions we at The CareGiver Partnership are most often asked:
- What's the best product to use?
- Does day or night make a difference?
- How much absorbency does the product provide?
- Can it be seen under clothing?
- Is it disposable or reusable?
- Is it comfortable when moving or sitting down?
- Can I have the shipped to my home discreetly?
Our experienced Product Specialist will help answer your questions or send you samples to try before you buy (1-800-985-1353).
- 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:
- When incomplete closing of the urinary sphincter causes persistent stress incontinence, a series of collagen injections may be given to narrow the bladder neck and reduce leakage.
- Men with overflow incontinence can help prevent too much urine from collecting by learning to insert a catheter periodically to drain their bladder. A condom catheter placed over the end of the penis drains leaking urine into a bag that is worn under the man's clothing.
- A stricture (narrowing) of the urethra caused by scar tissue can block the flow of urine and result in overflow incontinence. Strictures can be treated by incising the scar tissue surgically or by dilating (stretching) the urethra.
- In severe and persistent cases of incontinence, an artificial sphincter may be implanted surgically.
ACS: All About Prostate Cancer
An overview of many aspects of prostate cancer.
Family Doctor - Prostate Cancer
Prostate cancer is the most common type of cancer found in American men, other than skin cancer. This site provides men with the information they need to make informed decisions.
MayoClinic - Prostate Cancer
This comprehensive overview covers symptoms, causes, risk factors and treatments of this common cancer.
NIH SeniorHealth: Prostate Cancer
Offers a table of contents with definition, causes and risk factors, symptoms and diagnosis, treatments and research, and frequently asked questions.
National Cancer Institute - Prostate Cancer
Information about prostate cancer treatment, prevention, genetics, causes, screening, clinical trials, research and statistics from the National Cancer Institute.
National Prostate Cancer Coalition
Information about prostate cancer.
Sloan-Kettering - Prostate Cancer
Memorial Sloan-Kettering's approach to treatment is based on a dynamic model of prostate cancer, in which physicians define therapeutic goals for each patient at the time of diagnosis and then redefine these goals as the disease unfolds. You can find information about their expertise in treating patients with prostate cancer.
Urology Channel provides comprehensive, trustworthy information about urologic conditions.
WebMD - Prostate Cancer
Find in-depth prostate cancer information here on prevention and causes, diagnosis, and the symptoms of prostate cancer.
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American Cancer Society: