Urinary incontinence is the loss of bladder control. It can be as mild as a small leakage or as severe as the complete inability to hold urine. UI is a common complication of prostatectomy — the surgical removal of the prostate — and it is usually temporary. However, the condition lasts longer than a year in up to 8% of men.
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What Is Post-Prostatectomy Urinary Incontinence?
Urinary incontinence (UI) is a loss of bladder control. It can be as mild as a small leakage or as severe as the complete inability to hold urine.
UI is a common complication of prostatectomy – the surgical removal of the prostate gland — and it is usually a temporary side effect. However, in up to 8% of men, the condition lasts longer than a year.
What are the types of post-prostatectomy urinary incontinence?
Urinary complications of prostatectomy can range from temporary leakage issues to more serious types of bladder dysfunction, such as:
- Stress incontinence – Occurs when physical activity – such as coughing, sneezing, or heavy lifting – puts stress on the bladder, causing urine leakage.
- Urge incontinence – A sudden, intense urge to go followed by loss of control of urine.
- Mixed incontinence – A combination of stress and urge incontinence symptoms.
How common is post-prostatectomy urinary incontinence?
A National Cancer Institute study of men six weeks out from prostatectomy surgery found that 59% of men experienced incontinence, meaning they needed to use pads. By 58 weeks, this number had dropped to 22%. However, men who were both obese and inactive had the highest rate of incontinence at 58 weeks (59%).
Being physically active appeared to help because obese men who exercised had a lower incontinence rate (25%), which was similar to the rate among non-obese but inactive men (24%).
The best results were seen in men who were both physically active and not obese, with only 16% experiencing incontinence.
What causes post-prostatectomy urinary incontinence?
The loss of bladder control after a prostatectomy is directly related to the surgery.
Structures called sphincters hold urine in the body. When you relax these sphincters, urine flows out. Normally, there are two sphincters in the male urinary tract. One sphincter is at the bottom of the bladder; the lower sphincter sits below the prostate, behind the base of the penis.
Because the urethra goes through the middle of the prostate, the prostate also holds some pressure on the urethra.
When surgeons remove the prostate, the only sphincter left in the urinary tract is the lowest one, closest to the penis. Because this sphincter is not used to working alone, it may not be strong enough at first to keep urine in the bladder.
Post-prostatectomy urinary incontinence risk factors
Risk factors for urinary incontinence after prostatectomy surgery include:
- Age – Older men are more likely to have UI.
- History of voiding dysfunction – Makes men more susceptible to UI.
- History of prior radiation or cryotherapy treatment.
- Inactivity – Sedentary men are more likely to have UI.
- Smoking – Smokers generally heal more slowly than nonsmokers.
- Weight – Obese men are more likely to have UI.
What Are the Signs and Symptoms of Post-Prostatectomy Urinary Incontinence?
Symptoms of urinary incontinence in men can range from leaking just a few drops of urine to having a complete loss of bladder control.
Doctors know that UI may become an issue after prostatectomy, and they generally advise men to wear incontinence pads after surgery to trap urine and keep clothes dry. As you recover from surgery, the amount of leaking urine should go down over time.
Urinary incontinence can be embarrassing. It may also affect your sleep, since you may have to go to the bathroom multiple times a night.
When should I see a doctor about my post-prostatectomy urinary incontinence symptoms?
If you are bothered by your post-prostatectomy UI symptoms, call your urologist or primary care provider to discuss them and what might be done to help.
How Do You Diagnose Post-Prostatectomy Urinary Incontinence?
To diagnose urinary incontinence, your doctor will take your medical history. You should talk about any illnesses, medical conditions, or surgeries you have had, including your prostatectomy.
Your doctor will also need to know how much fluid you drink, whether you consume caffeine and how much, and any medications you take. Before your appointment, it may be helpful to keep a diary of when you notice any leaks and other unusual urinary habits.
You may need other tests to determine exactly why you are leaking urine, including:
- Ultrasound of the bladder — Helps doctors look for any abnormalities of your bladder and kidneys.
- Urodynamic testing — Measures how much urine your bladder can hold, as well as whether your sphincter or muscles are weak.
How Do You Treat Post-Prostatectomy Urinary Incontinence
There are several possible treatments for UI after prostatectomy. Doctors try the simplest treatments first.
Nonsurgical treatments for post-prostatectomy urinary incontinence
Some nonsurgical treatments include:
Bladder training
Training your bladder involves emptying your bladder at specific times. In bladder training, you wait longer and longer between emptying your bladder. This method slowly gets your bladder used to holding more urine.
Your doctor may also suggest that you limit your fluid or caffeine intake at certain times of the day.
Injections
In this procedure, the doctor injects bulking agents. such as collagen, into the tissues around the urethra. The bulking agent helps the urethra close when you hold in urine.
Kegel exercise
This movement strengthens the pelvic floor muscles and sphincters around your bladder. In the Kegel exercise, you contract and relax the muscles that you would use to stop the flow of urine.
Medication
Urinary incontinence after prostatectomy is usually related to the surgery itself. But, if you are having muscle spasms in your bladder, you may need to take medicine by mouth to reduce these spasms.
Surgical treatments for post-prostatectomy urinary incontinence
Surgical treatments include:
Sling surgery
In this surgery, doctors wrap a piece of material around the urethra to move it into a different position and give it support, taking pressure off the sphincter. This minimally invasive surgery is performed through small openings and has a short recovery time.
This procedure implants an artificial sphincter made up of three parts:
- An inflatable sphincter.
- A pump.
- A reservoir.
In sphincter insertion surgery, doctors place the artificial sphincter around the urethra and behind the base of the penis, at the bottom of the bladder. It works much like a blood pressure cuff; when it is inflated, it stops the flow of urine.
The reservoir, which is placed in the abdomen, contains a small amount of liquid, while the pump sits under the skin of the scrotum. When you need to empty your bladder, you squeeze the pump, which moves the liquid out of the sphincter and into the reservoir. After a few minutes, the liquid that was pumped into the reservoir moves back into the sphincter by the force of gravity.
This surgery can be performed either under general anesthesia or while you are awake using spinal anesthesia. The recovery from this surgery generally lasts only a few days.
