Prostate Cancer

Managing incontinence

Many men face urinary incontinence (inability to control urination) after treatment for prostate cancer. Incontinence can range from mild to severe, and this inconvenient side effect can usually be managed so you can continue with your daily life with little disruption.

Types of incontinence

Three common types of incontinence are stress incontinence, overflow incontinence and urge incontinence.

  • Stress incontinence, the most common type of incontinence following prostate surgery, happens when the muscle that squeezes the urethra to keep urine in the bladder is weak or damaged, or the nerves that help the muscle work have been damaged. As a result, urine may leak out when you cough, laugh, sneeze, lift heavy objects or exercise. You typically sleep through the night without having to get up to go to the bathroom, but have urine leak out when you get up in the morning. Frequent trips to the bathroom can improve stress incontinence.
  • Overflow incontinence occurs when the bladder does not empty well and the amount of urine made is more than the bladder can hold. Usually caused by a blockage or narrowing caused by scar tissue, overflow incontinence may happen when the bladder muscle cannot squeeze well enough to release all the urine. You may get up often during the night to go to the bathroom, take a long time to urinate or have a weak, dribbling stream with little force. In addition, you may pass small amounts of urine but not feel as though the bladder is empty, or you may feel like you have to go to the bathroom but cannot. Urine may leak throughout the day.
  • Urge incontinence is sometimes referred to as having an overactive bladder. When the bladder muscle contracts too often, usually suddenly and without warning, it is difficult to control. Even a small amount of urine in the bladder can trigger a strong need to urinate, necessitating frequent bathroom trips. Daytime or nighttime accidents may occur.

Personal care products

Adult briefs and other incontinence products can help keep you active and comfortable. Bed pads and absorbent mattress covers offer additional layers of protection for your sheets and mattress.

Many products are on the market so before you buy, consider these important questions:

  • How absorbent is it? How long will it protect me?
  • Can it be seen under my clothing?
  • Is it disposable? Reusable?
  • Is it comfortable? How does it feel when I move or sit down?
  • Which stores near me carry it? Is it usually in stock?
  • How much will it cost? Does my insurance help pay for it?

Treatments for incontinence

Understanding what type of incontinence you have will help identify your best treatment options. Your doctor will rely on you to be open about your symptoms and may order tests to learn more before suggesting treatments. Remember, incontinence is a common problem and your honesty will help your doctor make you more comfortable faster.

Surgical procedures can change the position of your bladder or remove a blockage from an enlarged prostate. In serious cases of incontinence, the surgeon may implant a sling to hold up the bladder or place an artificial urinary sphincter (device that constricts) around the urethra to prevent or reduce leakage.

Catheters and compression devices to collect urine or stop leakage, such as a condom catheter (which fits over the penis and drains urine into a storage bag), a penile clamp (which stops leakage with a v-shaped foam cushion that presses on the urethra) or a small urethral plug, are options.

Medications that will tighten or relax your muscles may be prescribed, depending on the problem. These drugs can have side effects, so make sure to learn about the benefits and risks. An injection of collagen into the urethra, which narrows the passageway for urine, also may help.

Kegel exercises are a drug-free way to help strengthen your pelvic muscles, which may restore some bladder control. These exercises involve tensing and relaxing certain pelvic muscles (see below).


Kegels put you in control

Pelvic floor exercises, commonly known as Kegels (kee-gulz), are simple exercises men can perform anywhere, at any time, to help manage bladder leakage, one of the most unwelcome side effects of prostate cancer treatment.

The urethra is often damaged during prostate cancer surgery, affecting bladder control and causing urine to leak or dribble. Strengthening your pelvic floor muscles, which wrap around the urethra and contract to hold back the flow of urine, may help reduce leakage.

Kegels will not interact with any erectile dysfunction drugs or other medications; however, do not practice Kegel exercises if you have a catheter in your penis.

Kegels are helpful before and after prostate surgery.

To get started:

  1. First, make sure you’re flexing the correct muscles (not your abdomen, thighs or buttocks). To be sure, tighten the muscles used to hold back gas or try to stop urinating mid-flow. If you stop or even slow the urine stream, you’ve located the right muscles. Note: Doctors do not recommend stopping the flow of urine frequently because it is not safe to do long term.
  2. Tighten your pelvic floor muscles, hold the contraction for 5 to 10 seconds, and then relax for 10 seconds. Avoid holding your breath. Instead, breathe freely during the exercises.
  3. Repeat three times a day. Aim for at least three sets of 10 repetitions a day. As your muscles get stronger, set a goal of 100 repetitions.

Keep in mind that these exercises may not eliminate your bladder incontinence, but with consistent practice, you could see a marked improvement in just weeks.

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