POST PROSTATECTOMY INCONTINENCE
The bladder is part of the urinary system, it fills and stores urine. The prostate gland produces the fluid which nourishes and transports sperm. The prostate is located at the base of the bladder in front of the rectum, when you pass urine, urine must pass through the prostate and urethra (pee tube). Thinking simply, when you are ready to go to the toilet, your bladder contracts, sphincters relax, and you empty your bladder. It is normal to be ‘continent’ of urine which means you do not leak urine. Surgery to remove the prostate disrupts this continence mechanism, resulting in changes to bladder control which is usually temporary.
A normal healthy bladder stores 400-600ml of urine. A healthy bladder will fill urine and store urine. Generally, you won’t think about your bladder until it ‘triggers’ you that it is time to go to the toilet. When your bladder is ‘full’ you are signalled to go to the toilet, but you can wait until it is socially appropriate and there is a toilet before you empty your bladder. When you pass urine, you should empty to completion. You should not leak urine between voids. This is referred to as being ‘continent’
Male urinary incontinence can be due to disorders of the bladder or prostate and neurological conditions. Urinary incontinence presents in various ways. Some men will complain of urgency or urge incontinence meaning that they need to go to the toilet ‘urgently’ and if they do not make it, they may leak urine. Often there are triggers such as running water. Some people have ‘stress incontinence’ meaning they leak urine when they cough, sneeze or jump. ‘Functional incontinence’ is generally due to conditions which impact your ability to get to the toilet on time. Simple things like zippers, rather than buttons can be helpful.
A continence assessment will establish the type of incontinence you have, which is crucial to implement effective management strategies. Often behavioural interventions, lifestyle interventions, pharmacological intervention (tablet medication) and pelvic floor physiotherapy may be needed. In some scenarios referral to a urologist for further investigation and consideration of surgical intervention is needed.
Radical prostatectomy, which is the complete removal of the prostate gland results in temporary incontinence of urine. The volume of leakage and the expected recovery period significantly varies dependant on many individual baseline factors. These factors include your age, weight, baseline fitness and factors relating to your prostate cancer. Talk to someone such as us, your surgeon, your Prostate Cancer Specialist Nurse or your Pelvic Floor Physiotherapist about your expected continence recovery.
For the majority of men, post prostatectomy when your catheter (urinary drainage tube) is removed you will notice that your bladder doesn’t tend to ‘signal you’ like it did previously and will seem more irritable and unpredictable. You are likely to notice altered sensations and signals and may find that you have ‘stress incontinence’ which is leakage of urine when there is pressure such as with coughing, sneezing, lifting, walking, and bending.
We expect you to see significant improvement in your bladder control in the weeks following surgery and we expect that with time, your bladder function will return to normal. In time you will respond to your bladders ‘filling’ sensation, so when your bladder is full, you go to the toilet and empty to completion. Post-prostatectomy in most cases it is anticipated your stress incontinence (leakage of urine) resolves so that you are continent (not leaking urine). Men who are at risk of a longer recovery period, heavier leakage or permanent leakage of urine are generally men who are older, have very large prostate glands at baseline, have pre-existing bladder dysfunction and who are overweight.
Whilst trying to improve your bladder control there are certain modifications you can make to your fluid intake to help regain continence and reduce frequency and urgency. Avoid irritants such as caffeinated, carbonated, citrus fluids and alcohol. This includes tea, coffee, juice and energy drinks. To optimise your continence outcomes, you are best to drink mostly water.
When time permits, try to have a lay down during the day, often you will find as the pelvic floor muscle fatigues later in the day, you will have leakage of urine. If you rest during the day and lay down, taking all the weight off the pelvic floor, this should help reduce the leakage late in the day.
It is imperative you maintain a healthy weight and healthy lifestyle as being overweight is likely to impact negatively on your continence outcomes. We recommend you implement a healthy diet and exercise regime.
Research shows seeing a specialised Pelvic Floor Physiotherapist will optimise continence outcomes. It is highly recommended to see a Pelvic Floor Physiotherapist to have a pelvic floor assessment and an individualised regime implemented. You must not over do the exercises; you should do them only as prescribed by the physiotherapist. If you experience pain in the perineum (area between the scrotum and anus), you may be overdoing the exercises which is counterproductive as the pelvic floor will fatigue which will worsen the leakage. Men’s Health Collective, your surgeon or Prostate Cancer Specialist Nurse can direct you a physiotherapist in your area.
We recommend men’s disposable or washable continence products; men’s disposable pads are specially designed for men and look like ‘padded cricket boxes’. There are also ‘underwear style’ pull up men’s pads available. Most men however prefer the ‘cricket box’ style disposable pads which just stick into your normal underwear (presuming you do not wear baggy boxer shorts!!).
You can purchase pads from your local pharmacy or supermarket; however, most men prefer to order them online. They can be purchased online through a chemist, or at a major product wholesaler such as Independence Australia or Surgical House. Tena, Depend and Molimed are common brands. Men’s washable underwear and swimmers are also available, you can purchase these online through Night N Day Comfort. This company also stock continence bed linen – this shouldn’t be needed, most men are ‘dry’ at night, but some men like these for security or for leakage of urine with sexual activity.
There are various other continence aids such as penile clamps and condom drainage systems which can be discussed with you and implemented if needed. Penile clamps (terrible name!) are excellent for men who just want to not feel themselves dribbling in certain situations. Great examples are while exercising, while attending meetings or while at social events. These should only be used following comprehensive continence assessment or under the direction of a specialist, here at Men’s Health Collective, we can help with this, alternatively, you can speak to Pelvic Floor Physiotherapist, other continence specialist or urologist.
Climacturia, or leakage of urine with orgasm following prostatectomy is important to prepare for. This is often a temporary problem but occasionally be ongoing. Some men notice a dribble of urine and some experience a squirt of urine. Urine is not harmful and preparing yourself and your partner for the potential for this to happen is important so you aren’t surprised. Emptying the bladder before sexual activity and milking the penis is helpful, sometimes lasso style constriction rings can be used and ongoing pelvic floor exercises are helpful. If the leakage is unmanageable, sexual activity in the shower, or using a condom are options. Some men will also notice leakage with arousal. At Men’s Health Collective we can help you with climacturia and leakage with arousal, as can your Pelvic Floor Physiotherapist.
There are various government funding schemes for continence products for eligible patients who fit certain criteria.
As registered Clinical Continence Advisors, we can provide a continence assessment, implement a management plan and establish funding for continence products.