If your cancer hasn't spread outside of your prostate gland, surgery may be an option. The most common type of prostate cancer surgery is radical prostatectomy. This removes the whole prostate gland.
While this surgery can sometimes cure prostate cancer, it does have risks. After surgery, you may leak and have trouble controlling the flow of pee, which is called incontinence.
If incontinence doesn't go away or is severe, it can affect your quality of life. That's why it's important to talk to your surgeon about this possible complication before your procedure.
Your surgeon can help you understand your likelihood of incontinence based on these risks, and tell you what (if anything) you can do to help prevent urinary problems.
Ask for Nerve-Sparing Surgery
Find out whether you can have nerve-sparing surgery, which avoids cutting the nerves that control erections and urination. The risk of incontinence is about twice as high after surgery that doesn't spare these nerves.
Practice Pelvic Floor Muscle Exercises
Pelvic floor muscles sit under your bladder and support it. You use these muscles to start and stop the flow of urine when you pee. Pelvic floor muscle exercises, also called Kegels, strengthen these muscles. Doing them before surgery could help you get urinary function back faster afterward.
To do these exercises, squeeze your pelvic floor muscles as if you were trying to lift them up. Hold the muscle squeeze for 5 seconds, then release. Try to do sets of 10-20 pelvic floor muscle exercises, 3-4 times a day.
Starting these exercises 3-4 weeks before your surgery will give your muscles time to get stronger. You can also do pelvic floor muscle exercises after surgery.
If you have trouble finding the right muscles to squeeze, biofeedback can help. A small probe inserted into your rectum lets you see your pelvic floor muscle activity on a video screen, so you know when you're squeezing the right muscles.
Exercise the Rest of Your Body
Try to do the 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercises a week that government guidelines recommend. If you meet these guidelines you’re almost 20% less likely to have incontinence 6 weeks after prostate surgery. If you aren't already active, try walking 1-2 miles a day to get your body ready for surgery.
Why Does Prostate Surgery Cause Incontinence?
Your prostate sits right under your bladder. It wraps around your urethra – the tube that urine passes through on its way from your bladder out of your body. Prostate surgery sometimes damages a valve called the sphincter that keeps urine in your bladder, or nerves that help the sphincter work.
Incontinence is a risk whether you have open surgery, laparoscopy, or robotic-assisted surgery. Up to 80% of men have incontinence after prostate surgery, but it's usually temporary. About 70% of men are continent within 3 months after surgery. By the 1-year mark, after a radical prostatectomy around 85%-91% of men are free from incontinence.
Types of Incontinence
Stress incontinence. This is when pee leaks when you sneeze, cough, laugh, or lift something. It's the most common type of incontinence after prostate surgery.
Urge incontinence. If you feel an urgent need to go, and you leak urine before you can get to the bathroom.
Overflow incontinence. When you have a weak urine flow and you can't fully empty your bladder. This can happen if scar tissue from surgery narrows or blocks the bladder opening.
Continuous incontinence. If you can't control your pee at all. It's rare after prostate surgery.
Incontinence is one side effect you may be able to reduce or even prevent. Here are a few things you can do before surgery.
Talk About Your Risks
Before your surgery, ask your doctor about all the risks that could increase your chance of having incontinence after prostate surgery, including your:
Age. The muscles that control urination weaken as you get older. If you are over 65, you are more likely to have urinary problems.
Urinary problems. If you already had incontinence before surgery, you're more likely to have it afterward.
Weight. If you are overweight or obese, you may have more symptoms right after surgery. But by one year post-surgery, weight is no longer a factor.
Past treatments. You're more likely to have incontinence if you've already had prostate surgery. One reason is that a past prostate surgery makes the procedure more complicated to perform. Urinary problems are also more common if you had radiation therapy to the prostate before your surgery.
Health. Having diabetes or another chronic condition can complicate your recovery from prostate surgery.
Urethra length. The urethra is the tube that runs from your bladder through your penis to carry pee out of your body. If you have a longer urethra, you may get your continence back faster than those with a shorter urethra.
Race. One study found that Asian-American men were 24% less likely to regain continence a year after their surgery than men of other races. Urethra length could be one possible reason for the difference in outcome.
