Prostate Cancer: Urinary Incontinence

Urinary incontinence, or the loss of the ability to control urination, is common in men who have had surgery or radiation for prostate cancer. You should prepare for this possibility and understand that, for a while, at least, urinary incontinence may complicate your life.

There are different types of urinary incontinence and differing degrees of severity. Some men dribble urine whereas others will experience a total leakage. Loss of urine with a cough, sneeze or laugh is called stress incontinence and is the most common type of urine leakage men experience after prostate surgery. On the other hand, the need to frequently urinate with episodes of leakage is the type seen most often after radiation treatment. Doctors continue to improve treatments for prostate cancer to reduce the chance of having incontinence after surgery or radiation.

Why Do Prostate Cancer Treatments Cause Urinary Incontinence?

It helps to know a bit about how the bladder holds urine. When urine is emptied into the bladder from the kidneys, it is stored inside the bladder and held inside by valves that stay closed until you "tell" them to open when you urinate. The prostate gland, which surrounds the tube that allows urine to flow outside the body, also helps to hold back urine until the time to release.

Removing the prostate through surgery or destroying it through radiation (either with an external beam or with radioactive seed implants) disrupts the way the bladder holds urine and can result in urine leakage. Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can, at times, damage the muscle valves that hold the urine in.

What Are Some New Techniques that Reduce the Chance of Becoming Incontinent?

When removing the prostate, surgeons try to save as much of the area around the bladder valves as possible, thus limiting damage to the valves. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder valves.

Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.

What Can Be Done to Treat Urinary Incontinence after Prostate Cancer Treatment?

Treatments include:

• Pelvic floor treatments. Many doctors prefer to start with behavioral techniques that train men to control their ability to hold in their urine. A popular set of exercises, called Kegel exercises, strengthens the muscles you squeeze when trying to stop urinating mid-stream. These exercises can be combined with biofeedback programs that help you train these muscles even better.
• Supportive care. This treatment includes behavior modification, such as drinking fewer fluids, avoiding caffeine, alcohol, or spices, and not drinking at bedtime. People are encouraged to urinate regularly and not wait until the last moment possible before doing so. In some people, losing weight may result in improved urinary control. Supportive care also involves changing any medications that interfere with incontinence.
• Medication. A variety of medications can increase bladder capacity and decrease frequency of urination. In the near future, newer medications will become available to help stop some other forms of urinary leakage.
• Neuromuscular electrical stimulation. This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. With this treatment, a probe is inserted into the anus and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off.
• Surgery, injections, and devices. A number of techniques may improve bladder function.
• Artificial sphincter. This patient-controlled device is made of silicone rubber and is composed of three parts: a pump, a balloon reservoir, and a cuff that encircles the urethra and prevents urine from leaking out. The use of the artificial sphincter can cure or greatly improve more than 70% to 80% of the patients.
• Collagen injections. Another treatment option is to inject collagen to "bulk up" the weakened area around the bladder. The problem with this treatment is that it is only effective for a few months and most men need repeated injections. It is also expensive. Newer injectable bulking agents may reduce the need for repeat injections, but more research is needed.
• Bulbourethral sling. For some types of leakage, a sling can be used. A bulbourethral sling is a device used to suspend the urethra. It is made from synthetic material or from the patient's own tissue and is used to create the urethral compression necessary to achieve bladder control.
• Other surgery. Your doctor can also do a surgery that has helped some men. It involves placing rubber rings around the tip of the bladder to help hold urine.

Reviewed by the doctors at The Cleveland Clinic Urological Institute.