Prostate Cancer & Urinary Incontinence

By Jeffrey Albaugh, PhD, APRN, CUCNS
Appeared in the September, 2012 issue of Quality Care®

Prostate cancer is the most common non-skin cancer in men affecting one in every six men. Fortunately most of the time early stage prostate cancer is very survivable with treatment. That means that for many men, their emphasis is placed on quality of life after prostate cancer treatment. All treatments have both positive and negative effects; prostate cancer treatments are no different. The negative effects of prostate cancer treatment can impact quality of life in terms of satisfaction with life.

There are several effective treatments for prostate cancer including surgical removal of the prostate, radiation therapy, hormonal therapy and active surveillance (carefully monitoring prostate cancer progression and intervening when necessary). The most common treatment for early stage prostate cancer over the past several decades continues to be surgery (prostatectomy-prostate removal). The most common long-term side effect after removal of the prostate, radiation therapy or hormonal therapy is erectile dysfunction (the inability to get and keep erections sufficient for sex intercourse). The second most common problem is urinary issues (incontinence, urgency and/or frequency).

Urinary incontinence is an accidental loss of urine and may occur after prostate removal or radiation of the prostate. Studies about incontinence in men after either radical prostatectomy or laparoscopic prostatectomy showed that as many as 84-87% of men were continent but it can take as long as two years for patients to regain bladder control.1 The urine leakage begins when the catheter is removed. For some men, this leakage may stop over time with consistent pelvic muscle exercises but it does not always stop. Urinary frequency, urgency and getting up at night more frequently to urinate may also occur after prostate surgery or radiation. Some men may leak urine during sexual climax after prostate surgery. Although this may be disturbing to a man and his partner, urine is typically sterile and the leakage during climax is not usually problematic for partners. It may help to empty the bladder completely right before sexual relations. Some men may still be disturbed by urinary leakage during climax. These men may want to wear a condom to catch the urine during climax. Wearing a condom may be further complicated by erectile dysfunction, which may make applying and keeping the condom impossible if the erection is not rigid or hard enough.

To improve bladder control after prostate cancer treatment, it is important to be proactive in terms of learning how to do correct pelvic floor exercises, following a progressive exercise program to improve bladder control. The pelvic floor is made up of a group of several muscles that support the abdominal organs and hold tension around the urethra (the tube that carries urine out of the bladder). Pelvic floor muscle exercises (Kegels) are a series of pelvic muscle exercises designed to strengthen the muscles of the pelvic floor and to calm the overactive bladder. Dr. Kegel developed pelvic floor exercises in 1948 for women after childbirth. The success of pelvic floor exercises depends on proper technique and adhering to a regular exercise program. Pelvic floor muscle exercises can be helpful in treating urinary frequency, urgency, nocturia, urge and stress incontinence. There are both quick and slow twitch fibers in the pelvic floor muscles and it is important to do both quick and slow pelvic floor exercises. The pelvic floor exercises need to be done correctly and this may require the help of a specialist nurse or physical therapist who can teach you to do the exercises appropriately and consistently. There are also written instruction on the exercises available in NAFC's Pelvic Muscle Exercise leaflet. The Agency for Health Care Policy and Research (1996) and the American Urological Association (May 2012), Urinary Incontinence in Adults: Acute and Chronic Management guidelines recommends the primary treatment options for incontinence should be bladder retraining, timed voiding and pelvic floor exercises. For urge incontinence, there are several prescription medications that may help control the urge to urinate. There currently are no FDA approved medications for stress urinary incontinence. Surgical interventions for stress incontinence include various sling procedures and artificial sphincters to control stress urinary incontinence. Although urinary incontinence is common after prostate cancer treatment, both problems can often (but not always) be treated successfully. It is essential for men with these problems to make an appointment for a full evaluation and treatment of urinary incontinence.

References:
1Jacobsen, N. E., Moore, K. N., Estey, E., & Voaklander, D. (2007). Open versus laparoscopic radical prostatectomy: a prospective comparison of postoperative urinary incontinence rates. Journal of Urology, 177(2), 615-619.
2Sacco, E., Prayer-Galetti, T., Pinto, F., Fracalanza, S., Betto, G., Pagano, F., et al. (2006). Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. British Journal of Urology International 97(6), 1234-1241.

This article was adapted from copyrighted information in the book “Reclaiming Sex and Intimacy after Prostate Cancer Treatment” by Jeffrey Albaugh available at www.drjeffalbaugh.com

About The Author
Jeffrey Albaugh, PhD, APRN, CUCNS, is a board-certified Advanced Practice Urology Clinical Nurse Specialist and director of the North Shore University Sexual Health Clinic in Evanston, IL. He has cared for thousands of patients with sexual dysfunction and prostate cancer for more than 18 years in urology and over 26 years of patient care. Dr. Albaugh specializes in treating men, women and couples with sexual dysfunction. He also sees men undergoing treatment for prostate cancer. Prior to working at North Shore University, Dr. Albaugh practiced at Northwestern Memorial Hospital in Chicago for almost 25 years. In addition, he led the Jesse Brown VA Medical Center Sexual Health Clinic in Chicago for over 4 years.