Urinary Incontinence After Prostate Surgery: Everything You Need To Know

Incontinence After Prostate Surgery

Undergoing a prostatectomy (removal of the prostate due to cancer) can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.

But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.  

What causes incontinence after prostate surgery?

Urinary incontinence is a potential side effect of prostate removal surgery. The prostate surrounds the bladder. Removing it, or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence.

Is Incontinence Normal After Prostate Surgery?

Approximately 6-8 percent of men who have had surgery to remove their prostate will develop urinary incontinence. (Cleveland Clinic) The good news is that most men will eventually regain bladder control with time.

How bad is incontinence after prostate surgery?

The degree of incontinence varies from person to person and can be anywhere from full on incontinence, to light dribbles. And, the amount you leak right after surgery will likely lessen as you continue with your recovery and any additional bladder or pelvic floor treatments you may be doing.  

How long will I have incontinence after prostate surgery?

Most men who experience a loss of bladder control have symptoms for 6 months to 1 year post prostate surgery. However, a small percentage of men may continue to experience problems past the one year mark.

Does incontinence go away on its own after prostate surgery?

For most men, urinary incontinence will go away within about 1 year. Performing pelvic floor exercises, also known as kegels, which help strengthen the muscles that are located in the base of the pelvis between the pubic bone may help to speed the recovery process along.

Does incontinence happen if I treat prostate cancer with radiation?

Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra and bladder may be exposed, causing irritation to occur post therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however if it persists, additional treatments described below may be helpful.

How can I improve incontinence after prostate surgery?

Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, kegels are a common treatment option for incontinence after prostate surgery.  Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively.  To improve muscle function, kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions (sitting, standing, lying down, etc.). For a complete guide on performing a men’s kegel, click here.)

Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.

What treatments are available to me if my incontinence doesn’t go away after a year?

While kegels and behavioral therapy work well for most men with mild to moderate leaking, they may not be completely effective for some. Luckily, there are still some options for treating bladder leakage after prostate surgery.

Another surgery is sometimes needed when bladder leaks persist for more than a year after surgery. This may consist of having a urethral sling procedure, or an artificial urinary sphincter.

With a urethral sling procedure, a synthetic mesh tape is implanted to support the urethra. Up to an 80% improvement has been seen with this procedure and some men stop leaking completely.

An artificial urinary sphincter is used in patients who have more severe urinary incontinence that is not improving, or for those patients who may have had a lot of damage to the sphincter muscle after prostate surgery. An artificial urinary sphincter is a mechanical ring that helps close the exit from the bladder.

As will all surgeries, these come with pros and cons and potential complications. Be sure to discuss these options with your doctor. 

Incontinence after prostate surgery forums.

Going through prostate cancer and having your prostate removed can be a physically and emotionally trying time in life. Many men are unprepared for the extent to which they may experience bladder leaks after prostate removal and it can be disheartening to have undergone surgery only to experience a loss of bladder control for a period afterward.

Fortunately, this is usually resolved within a year. During that time though, you may find that you need someone to talk to about your experience. Finding a forum or message board filled with people who can relate can help ease some of the tensions that you may be going through. 

The NAFC message boards are a great way to connect with others who may also be experiencing incontinence, due to prostate surgery or other conditions.  They’re free to join and the forum is anonymous so you can speak freely without the worry of feeling embarrassed or ashamed. NAFC is proud of this amazing group of individuals who visit the forums and courageously share their stories, offer support, and provide inspiration to each other. We encourage you to check it out!

What To Do About An Enlarged Prostate?

What To Do About An Enlarged Prostate

Enlarged prostates are common as you age. Men aged 60 and older have a 50/50 chance of having an enlarged prostate and those who are 85 have a 90% chance. Those may be scary stats, but what exactly does having an enlarged prostate mean? Is it something to worry about? And if so, what are the treatment options? Keep reading to learn more about this very common condition and what it may mean for you.

Anatomy Review – function of the prostate

The main function of the prostate glad is to serve as a reproductive organ. It is responsible for producing prostate fluid, which is one of the main components of semen. The prostate gland muscles also help to transport semen into the urethra during ejaculation.  

The prostate gland sits just below the bladder, where the bladder and urethra (the tube that inside the penis that carries urine and semen out of the body) connect. In early life, it’s about the size and shape of a chestnut, and grows to different sizes throughout a man’s life. 

What causes the prostate to get enlarged?

As men age, the prostate gland grows. It’s estimated than as many as 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). While it’s unclear why the prostate begins to grow, its thought that an excess of certain hormones may be to blame.

Symptoms of an enlarged prostate include the following:

  • A weak or interrupted urinary stream

  • The sudden urgency to urinate

  • Frequent urination

  • An inability to empty the bladder during urination

  • Trouble initiating urine flow, even when you feel like your bladder is full.

Should I worry? 

Even if your prostate becomes enlarged, it may never become an issue for you. The problems start when the prostate begins to constrict or block the urethra. This can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. And, because the bladder still continues to send signals that it needs to empty, urgency and frequency can occur (this is also known as overactive bladder).  If left for too long, the bladder may become distended, making it even harder for it to empty completely. 

For these reasons, it’s important to see your doctor right away if you start experiencing any of the symptoms listed above. Additionally, the symptoms of an enlarged prostate can also mimic those of other conditions, such as bladder cancer or overactive bladder. Your doctor will be able to help diagnose your condition to determine an appropriate treatment.

What’s the treatment for an enlarged prostate?

There are many treatment options for enlarged prostate, depending on your symptoms.

Active surveillance, or “watchful waiting” is a term used to describe the act of monitoring your condition regularly for any changes. This approach is often used for men whose symptoms are mild and not too bothersome. 

There are several medications that are approved for BPH, but most of them fall into two categories: Alpha blockers and inhibitors. Both are effective at treating BPH and sometimes are even prescribed in combination with each other.  

Non-invasive treatment options include things like laser therapy, which decreases the size of the prostate by removing some of the tissue, or laser vaporization, which enlarges the prostate obstruction and opens the urethra.  Transurethral microwave therapy or transurethral needle ablation are other non-invasive treatment options that destroy excess prostate tissue that is causing blockage.

Finally, surgery is also commonly used to help relieve symptoms of an enlarged prostate. The most common form of surgery is transurethral resection of the prostate, or TURP. This surgery requires no incisions, relying instead on a surgical instrument inserted through the tip of your penis and the urethra. Using this tool, the doctor is able to trim excess prostate tissue that may be preventing the flow of urine. 

Other less common surgeries are also used to both trim excess tissue from the prostate, or to decrease pressure on the urethra in order to make urinating easier. You can read more about additional surgical options here.

Patient Perspective: Brad's Story

Brad's Story - Opening Up About Incontinence

My friends and I are close. Growing up in a small town, we’ve always been there for each other – to joke with, lean on in hard times, and to razz each other. We have a tight-knit group of 5 and they’ve been my chosen family since I was 12. It’s hard to believe so much time has passed since our early days, but here we all are.

I experienced incontinence after having my prostate removed in 2013. It wasn’t a fun thing to go through, and I certainly didn’t enjoy it, but the one thing that made it easier was that I knew to expect it – and that I wasn’t the only one.

You see, one of my buddies in our group, Joe, had also gone through something similar a few years back. He pulled me aside before surgery and told me that the worst thing that was going to happen was that I’d probably have some leaks – maybe a lot. It had happened to him for at least a year after his surgery and he said it was “hell “.

But he told me that the thing that had made it worse was not knowing it was coming, That was why he was talking to me – he wanted to me to know that I wasn’t alone. And, if it weren’t for his advice and pick-me-up talks, I don’t know how I would have gotten through that first year.

I’ve recovered well and don’t really experience the leaks anymore. But I still talk about it. Because that’s what we should all do with those we are close to. You never know who might benefit from your experience, or who might also go through something similar and just need a friend or to know they are not alone.

Don’t let your own embarrassment get in the way of opening up to your loved ones. I’m sure glad Joe didn’t.
 
Brad T., Auburn, AL

Patient Perspective: Samuel's Story

Samuel's Story - Getting Help For Incontinence, Enlarged Prostate

How many of you men have incontinence? How many of you would admit if you did?  It’s a hard thing to come to terms with as a man. I know, because I’m one of the "lucky ones" who has been hit with this condition.

I had been noticing the need to use the bathroom more frequently for a while, but didn’t think much of it until I was on vacation with my wife a few years ago. We were in DC, walking around, being the typical tourists, when I suddenly felt the need to go. I wasn’t totally familiar with the area, and it was crowded, so it took me a while to find a bathroom. Unfortunately, it took me too long. I leaked – just a little bit, but enough to be able to tell. Luckily, I had a sweatshirt with me so I just wrapped it around my waist and told my wife we needed to head back to the hotel.

I was so embarrassed. She didn’t understand what had happened until we got back and saw that I needed to change my pants. And even then, it was hard for either of us to comprehend what had happened – I’m a grown man! I shouldn’t be wetting myself. We both brushed it off as a fluke and went on with the rest of our trip.

But a few weeks later at the gym, it happened again. And then again while doing some yard work at home. I started to feel like my body was betraying me. Why was this happening? I didn’t tell my wife that the problem had persisted until a few months later, when it was clear that I would need to get some help. She was so understanding and helpful. She did some research online to see what may be causing it and the treatment options available, helped me find a urologist to talk to, and even came with me to my appointment.

I’m happy to say that after talking to the doctor and getting treatment, I’m doing much better. Turns out I had an enlarged prostate so I’m on medication for that and it’s greatly reduced the need to run to the bathroom every five minutes, not to mention the leaks.

This has been a very humbling experience, but I’m glad that I opened up to my wife about it and that she was so understanding and helpful. I’m not sure I would have had the strength to get to a doctor about this had it not been for her pushing me along. Now, I’m leak free and am able to travel, workout and do pretty much what I want again without having to worry.

Samuel M., Cheyenne, WY

When The “Going Problem” Becomes A Growing Problem

urinary incontinence in men

Concluding his 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia, Dr. Richard Roach, of Advanced Urology in Oxford, FL, shares the story of a patient who found an alternative to chronic urinary catheter use.  

In my first two posts on the BHEALTH blog, I outlined the link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH) while highlighting some of the challenges of using indwelling catheters to treat BPH-related symptoms. For many individuals, there are significant drawbacks to long-term catheterization, among them a significantly heightened risk of infection and a variety of lifestyle restrictions. In this, my final post on BPH-related incontinence symptoms, I would like to share a story of one of my patients, and detail how an innovative treatment option transformed his life and ended his reliance on urinary catheters.  

Ray is a 65-year-old man who lives in The Villages, Florida. He was diagnosed with an enlarged prostate when he began experiencing severe BPH symptoms in October 2014. Like many men, he was placed on a Foley catheter, which drained his bladder but also led to discomfort, pain and self-consciousness. For more than six months, continuous use of the Foley catheter severely impacted even the most basic of Ray’s daily activities, and soon a series of urinary tract infections (UTI) led to frequent hospital stays. It was during one of his hospital visits that I was called to treat a UTI.

Ray had a very different future in mind before catheterization interrupted his life. He never envisioned himself spending the rest his days using a catheter; just six months earlier he was an avid golfer with a thriving social life and in relatively good health. Now he was weak, self-conscious about his leg bag and battling one infection after the other. 

During our first meeting he explained that much of his day revolved around catheter care. Ray explained that he was looking for a solution that worked with his lifestyle, not against it. Ray believed he was out of options, but he shared that he wanted just three things:

1.    Restore his continence and ability to naturally urinate

2.    End the recurring urinary tract infections

3.    Resume the daily activities he cherished most

And in Ray’s case, there was a solution. Several weeks after I first examined Ray, we inserted a temporary prostate stent to keep his urethra open and maintain urine flow. Prostatic stents are not yet widely adopted, but I have used them in my practice with great success. Like many patients using a temporary prostate stent with similar physical conditions, Ray immediately saw the benefits: he was able to fill and empty his bladder naturally, he had no more concerns about catheter maintenance, and he resumed nearly all of the daily activities that he couldn’t perform during his period of chronic catheterization. 

“Using the catheter was just not a nice way to live,” Ray told me. “With the stent in place, I felt normal again. Quite simply, I was able to resume my life. I felt healthier physically and mentally, just extremely fortunate to have found an option like the stent to replace the catheter and lead to a more permanent solution to my health problem. The stent saved me from using the Foley for the rest of my life.”

Ray’s case isn’t unique. Men all over the world struggle with incontinence due to BPH and other BPH symptoms. While some patients are not candidates for removal of the catheter, urologists have a wide variety of prostate treatment options. Every chronically catheterized patient should have a discussion with his urologist to understand if a catheter-free lifestyle is possible. 

As we close this series, I encourage all men suffering from symptoms of BPH (incontinence or otherwise) to bear in mind the importance of open dialogue and awareness of alternatives. Find out what treatment options are available to you; ask the right questions and be an informed healthcare consumer. It could make all the difference in the world. 

Best of health, and thanks for reading!

 
 

The Hidden (And Not-So-Hidden) Dangers Of Treating Incontinence With Urinary Catheters

Treating incontinence with catheters

Treating incontinence with catheters

This is the second in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia. Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses the challenges of using urinary catheters to treat men with BPH-related incontinence, and the drawbacks of long-term catheterization.  

In my last BHEALTH blog post, we touched on the peculiar, yet common link between BPH and incontinence. Among other topics, we reviewed the progression of BPH disease state, to the point that symptoms begin to manifest themselves through urge and stress incontinence. Likewise, we also discussed the role that urinary catheters play in men who are not good candidates for BPH therapies.

So let’s now take a closer look at this population of men who must rely on urinary catheters to manage BPH-related incontinence symptoms, and examine the shortcomings of long-term catheter use:

Losing the ability to void naturally 

The first (and most obvious) drawback of chronic catheter use is losing the ability to urinate at-will. Of course, managing supplies and components can be a hassle, but there are also health concerns associated with preventing your bladder to fill and empty on its own. Chronic catheterization, particularly with an indwelling catheter, can increase the risk for deterioration in overall bladder health, which can lead to a permanent inability to store and drain urine naturally, or even cancer.

Heightened infection risk 

Perhaps the most immediate health concern with chronic catheter use is the heightened risk of infection. According to the Centers for Disease Control, more than 500,000 patients each year in the U.S. develop urinary tract infections (UTIs) while in the hospital, and indwelling urinary catheters (commonly known as Foley catheters, which reside inside the bladder for either a short or long period of time) are the leading cause. And the CDC numbers only count UTIs acquired while in the hospital; many others develop infections from long-term indwelling catheter use at home.

Compromises to quality of life 

The last, but no less important, drawback of chronic catheter use is the impact on quality of life. Many men are simply unable to perform day-to-day activities inside and outside the home. The embarrassment or inconvenience of a drainage bag is a commonly lamented life-limiter, and some types of catheterization restrict a man’s ability to be sexually active, which can strain relationships.

These challenges represent the key reasons that healthcare professionals around the world are seeking alternatives to long-term catheter use. And though it’s not always feasible to have a catheter removed, it’s important to point out that there are alternatives to long-term catheterization.

The final post in this series will highlight the story of one such patient who stopped using a catheter after several challenge-fraught years, and gained back his ability to urinate when he wanted to – without components or supplies, without infections and (most importantly for him) without any significant compromises to his everyday life.

Read part 3 of this series here.

 
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
 

When Going Gets Tough, The Tough Become Incontinent

Incontinence in Men Due To Benign Prostatic Hyperplasia (BPH)

This is the first in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia (BPH). Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses disease state, symptoms and treatments.

Bearing in mind the fantastic wealth of resources available on the National Association for Continence BHEALTH blog, I thought I would take the opportunity to focus on a somewhat lesser known facet of continence: the unique link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH).

The classic male patient with BPH often experiences both filling and emptying symptoms. These could manifest themselves in the form of frequency, urgency or weak stream, among others. Patients with BPH will often tell me they feel like they have to go all the time, but can’t seem to go when they stand at the urinal. It’s a perplexing (and frustrating) feeling.

So why am I contributing to a continence blog writing about a population of men who can’t pee? In short, these men often experience stress and overflow incontinence.

It’s counterintuitive, but when you give it some thought, it makes sense.

BPH causes the prostate to enlarge. This growth can cause narrowing of the prostatic urethra, which makes the process of urination more difficult. All the while, the bladder must work harder to overcome the resistance from the obstruction in the urethra. If left untreated, the bladder’s muscular lining will thicken, causing it to weaken and become less efficient at draining – in some cases irrevocably. 

It’s usually at this juncture that symptoms become severe. Men suffer from incomplete emptying, even after using the restroom, and always have the feeling of being “full.” Their frequent trips to the restroom at night cause sleep cycle interruptions. With the bladder stretched, sneezing, laughing or coughing can cause leakage, or in more extreme cases the bladder may leak because it’s simply too full.

If they haven’t found a urologist by this point, usually we find them … recovering in the hospital from acute urinary retention. In this setting, the most immediate relief comes in the form of catheterization, either from an indwelling or intermittent catheter. Usually, the patient’s bladder health and overall physiology dictate whether a de-obstructive procedure to remove prostate tissue will provide more permanent relief.

For a smaller percentage of men, particularly those who have aversions to the risk of surgery, or more commonly, health complications that prevent a surgical de-obstructive procedure, catheterization is the only solution. Yet chronic catheterization comes with several important drawbacks, including:

  1.    Losing the ability to void naturally
  2.    Heightened infection risk
  3.    Compromises to quality of life

In the next post on this topic, we’ll delve into these three issues in more detail, as we take a closer look at urinary catheters. Part 3 of this series will also cover the amazing story of a patient who was brought back from the brink after years of struggling with chronic catheterization for BPH symptoms. But first, let me add a few closing thoughts on the theme of BPH-induced incontinence.

I can’t stress enough how important it is to get regular screenings for bladder and prostate health. Checkups like these should be likened to that of mammograms or stress tests. Furthermore, males experiencing the symptoms above should seek medical guidance from a urologist as early as possible, preferably well before incontinence becomes a focal point of symptoms.

Read Part 2 of this series here.

 
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.