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: Nick's Story

Nick's Story - Incontinence After Prostate Removal

In August of 2015, I underwent surgery to have my prostate removed.  I had been diagnosed with prostate cancer the year before and my doctor had been closely observing me since then. 

When it seemed that my cancer was growing more quickly than he liked, he suggested surgery.  “Afterall”, he said, “you’re only 63.  You can still have a long life without worrying about this.”

So, after a lot of research, I went for it.  I knew there would be complications afterward, but incontinence was not something that I had anticipated being that big of a deal.  I thought I’d probably have to wear diapers for a couple of weeks and that would be the end of it. 

Boy was I wrong. 

Nine months later and I was still having a difficult time making it to the restroom.  It was so embarrassing as a man to face this problem. I couldn’t do the things I wanted to because I was scared of having an accident or a leak, and I felt ashamed of the bulky diapers that I was forced to constantly wear. 

I finally made an appointment with a surgeon in May to discuss a sling procedure and will be having the procedure done next month.  I’m hopeful that this will be a solution for me so that I can get on with my life and get back to doing the things that are important to me. 

Nick W., Houston, TX

Your Guide To The New Prostate Screening Guidelines

Prostate Cancer Screening Guidelines

The new guidelines on prostate cancer screening have left some men wondering what they should do. Here’s a quick breakdown on what the US Preventative Services Task Force recommends.

Prostate cancer is the 3rd leading cause of cancer death in men in the US, with about 1 in seven men being diagnosed in their lifetime.   You may have recently heard the news that, despite previous cautions against getting screened for prostate cancer, new recommendations from the US Preventative Services Task Force are now recommending that men ages 55 to 69 at least have a discussion about prostate-specific antigen (PSA)-based screening, including the risks that go along with it.  So, what’s the deal? Will the test help or hurt you?

It depends. Back in 2012, the USPSTF recommended no routine screening at any age, because of the potential harm that could result after testing, including:

  • False Positives: A fair amount of PSA testing has suggested that prostate cancer may be present when there is in fact no cancer. Elevated PSA levels can be caused by many other things that don’t have anything to do with cancer. This can lead to worry and anxiety, and follow up tests that may not be needed.
  • Risk of infection with additional tests. In order to dig deeper after a PSA test, follow-up tests are done, which can potentially cause complications (fever, infection, bleeding, urinary problems, and pain).
  • Even if prostate cancer is diagnosed correctly, it sometimes never causes a problem for men. However, it’s difficult to tell what cancers will, or won’t be an issue later on, so most of the time, aggressive treatment is performed.
  • Treatment for prostate cancer can lead to other side effects, including erectile dysfunction, or urinary or fecal incontinence.

Due to these potential risks, the USPSTF recommended against screening men, since the benefits of screening really didn’t really outweigh the expected harm that could result. What has changed? 

The US Preventative Services Task Force now recommends that men ages 55 to 69 years of age should talk with their doctor about the potential benefits and harms of PSA screening for prostate cancer, and should make individualized decisions on how to proceed. This decision was made after determining that the potential benefits and harms of PSA tests are closely balanced in men ages 55 to 69. However, men over 70 are still recommended to not receive PSA screening.

Really, what all this boils down to is you. No longer should you just ignore the test if you are within the 55-69 age range. After all – it has been shown that of 1,000 men screened, testing may prevent up to 1 to 2 deaths from prostate cancer and up to 3 cases of metastatic prostate cancer over the course of 13 years.

But, you should weigh your options. Have an open dialogue with your doctor about your specific risks – your background and health history, your lifestyle, your healthcare beliefs and wishes – these are all important factors to take into consideration when deciding if and when to get tested.

You should also talk with your doctor about what the course of action would be if your PSA levels do turn out to be on the high side. While this could be a sign of cancer, it may also be caused by something else, such as enlarged prostate, which can be treated.

In the end, the Task Force is really just recommending a discussion. Which is something you should be having with your doctor anyway. Talk with your doctor about the risks so that together you can make an educated decision about your options.

Ask The Expert: Are There Other Things Besides Prostate Trouble That Can Cause Incontinence In Men?

Prostate Trouble and Incontinence

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: Are There Other Things Besides Prostate Trouble That Can Cause Incontinence In Men?

AnswerProstate problems in men typically get the blame for incontinence issues for good reason – many men experience issues with their prostate (BPH, prostate cancer) which can often cause incontinence, even if it’s just for a brief time. But there are other conditions that may be contributing to the root of the issue as well. Being overweight can put extra pressure on the bladder, which may cause leaks. Certain foods can also irritate the bladder, causing incontinence – especially if you’re already prone to the condition.  Additionally, neurological conditions, such as Parkinson’s or diabetes can lead to neurogenic bladder, where the brain is unable to communicate properly with the bladder. Even still, urinary tract infections or blockages can lead to bladder troubles.

The most important thing to consider is that incontinence is generally a symptom of something else, and can almost always be treated. If you’re experiencing bladder leaks, see your doctor today and ask for help. Your doctor will be able to dig deeper to find the root cause of your incontinence and work with you to find a solution.   

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Have a question you'd like answered? Contact us!

Incontinence During Sex - It Happens To Men Too

Incontinence During Sex Happens To Men Too

Prostate cancer is one of the most common types of cancer in men. According to the American Cancer Society, 1 in 7 men will get prostate cancer in their lifetime (only skin cancer has a higher rate).  And, while many men will go on to survive prostate cancer, the side effects of treatment can be difficult to deal with for many.

A common treatment for prostate cancer is a radical prostatectomy, or the complete removal of the prostate.  This is generally considered a good approach especially if the cancer is contained within the prostate gland and has not spread.  However, one side effect of this procedure is often incontinence.

Stress urinary incontinence, the type of incontinence that happens when you place pressure on the bladder, is common for men who have had their prostate removed or are undergoing other treatments for prostate cancer.  Treatment can sometimes weaken the bladder muscles, causing leakage when a man sneezes, coughs, exercises, or even during sex.  This can be extremely embarrassing for men, and can be discouraging when going through the healing process of having a prostatectomy. The good news is that many men regain full control of their bladder with time after a prostatectomy.

here are 4 tips that may help you avoid some awkward situations in the bedroom:

  • Try to watch your fluid intake in the hours leading up to sex.

  • Avoid consuming bladder irritating food and drinks, such as caffeine, chocolate, or alcohol.

  • Prior to sex, completely empty your bladder.

  • Keep a thick towel nearby in case of any accidents

While this problem can be an embarrassing one, keep in mind that many men deal with this in the months after prostate cancer treatment and with time, this condition should improve.  If you still experience problems a few months after your treatment, talk to your urologist about treatments for incontinence.  He or she can help you navigate the many options available to you and find one that fits best with your needs.

Ask The Expert: Surgery For BPH?

Ask The Expert: Surgery For BPH?

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: What types of surgery options are available for BPH?

Answer: BPH, or Benign Prostatic Hyperplasia, is when a man’s prostate is enlarged.  BPH is a common occurrence in aging men, but may not always require surgery.  Surgery may be considered if you have certain issues (you can’t urinate, have seen blood in your urine, have a partial blockage in your urethra, or have kidney damage), or if your symptoms are so bothersome that surgery makes sense to you.

The typical surgical option that is usually used is transurethral surgery of the prostate.  This is where surgical instruments are passed through the opening in the penis to the prostate. Transurethral resection of the prostate (TURP) is the most common type of transurethral surgery used for BPH. This is when a portion of the prostate is removed.  Other methods of removing some of the prostate include laser therapies, transurethral microwave therapy (TUMT), or transurethral needle ablation (TUNA).  Transurethral incision of the prostate (TUIP) is also sometimes used, which places incisions on the prostate which help to relax the opening to the bladder and allow urine to flow from the bladder more freely.

If you are considering surgery for BPH, talk with your doctor about these options and decide together which one may be the best for you.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

Overactive Bladder in Men

Overactive Bladder In Men

You've all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That's overactive bladder (OAB). You've also seen ads of men rushing to the bathroom at football games. Those ads say it's a prostate or "growing problem" - the prostate is getting too big or causing a blockage resulting in the bladder becoming overactive. Whether you are a man or a woman, if you have to rush to get to the bathroom to urinate, you might have overactive bladder.

Most of the time, there are other symptoms that accompany OAB - including frequency of urination, loss of urine control on the way to the bathroom, or waking from sleep to urinate. Sometimes OAB presents with other related symptoms such as difficulty starting urination, having to push or strain, and having a weak stream. Occasionally it can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted temporarily into the bladder to let the urine out.

The causes of overactive bladder are different in men and women. In men, about two-thirds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well. These include weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones, and even bladder cancer. Neurologic conditions such as Parkinson's disease, nerve damage from a stroke, multiple sclerosis, and diabetes can also cause symptoms of OAB.

So, if you're a man and you have OAB, what should you do? The first step is to see your doctor. The doctor should take a brief history focusing on the urinary tract and previous medical conditions and procedures. The doctor then should examine you.

Typical examinations include a digital rectal examination, focus neurological examination, and anal sphincter tone. The doctor should also check a urine specimen for infection or microscopic blood. He/she should also check how well you are emptying your bladder. That can be done by a simple examination or by an ultrasound - a simple, non-invasive, painless test done in the office. If there are signs of infection, you will be started on antibiotics and you should be better within a matter of days.

Once you are better the doctor might suggest that you have more tests to determine why you got the infection in the first place. The usual reason is that there is a blockage by the prostate and he/she might recommend treatment for that.

If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, your doctor will probably recommend either a medication called an alpha-blocker or want you to see a urologist right away.

An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage. It is also effective in relieving the OAB symptoms. If the medication alone or a combination with other medications does not alleviate your symptoms, then you should see a urologist.

The urologist will likely recommend more tests to determine the cause of your symptoms. He/she may want you to complete a diary for 24 hours in which you record the time and amount of each urination, perform an uroflow test (urinating into a special toilet in the bathroom that measures how fast the urine comes out) and check for residual urine with an ultrasound.

On the basis of these tests, he can determine whether there might be a blockage by the prostate. If there is, he will likely prescribe an alpha-blocker, if you are not already taking one, or possibly add another type of medication called a 5 alpha reductase inhibitor, if the prostate is enlarged. If there are no signs of a blockage he/she may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate.

These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, surgical treatment of the blockage by the prostate is effective in the vast majority of men and those results are long lasting too.

The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions, and no or very short hospital stay. There are very few serious complications and the success rate is very high.

In conclusion, most men with OAB also have prostatic obstruction. Treatment of the obstruction is effective in majority of patients. For those without obstruction, there are a variety of effective treatments.