The two basic types of incontinence are urinary and fecal. The various treatments for prostate cancer may lead to either or both types. The most common, urinary incontinence, is usually temporary and that permanent incontinence can sometimes be repaired. However, temporary may sometimes mean more than a year, and the repairs available for more serious incontinence will not necessarily return things to the way they were.
Urinary IncontinenceReasons for Urinary Incontinence
Fecal Incontinence
Reasons for Fecal Incontinence
The urethral sphincter muscles keep the bladder the organ from emptying. When it is time to urinate, the bladder signals the brain. At the appropriate time, the brain signals the bladder to contract and the sphincter muscles to relax.
Stress incontinence (also urinary stress incontinence and stress urinary incontinence) usually occurs because the muscles that surround the urethra are weak. Certain movements, such as picking up a heavy object, getting up from a chair, jogging, or even laughing or sneezing can compress the bladder and force urine out. Stress incontinence is most common among men who have had prostatectomies.
Urge incontinence is the feeling you sometimes have when you hear running water: the desire (and need) to get to a toilet as quickly as possible. It is not uncommon in children and older adults.
Urge incontinence may have several causes, such as an involuntary bladder contraction. As with stress incontinence, the cause following a form of treatment for prostate cancer may be weak pelvic floor muscles.
Overflow incontinence is not likely to be a post-procedural problem. It is usually caused by some sort of bladder obstruction, infection, or injury. (It can also be the result of an enlarged prostate.) In brief, the bladder cannot be fully emptied, and small amounts of urine overflow from time to time.
Frequency incontinence is more likely to develop as a result of an enlarged prostate. It is not a common result of a procedure. It may, however, develop if a man develops the habit of emptying his bladder more often than is really necessary, especially during the night. In that case, the bladder will "learn" to empty itself when it is at only a small part of its capacity.
Several things can happen that may lead to urinary incontinence. Not all are necessarily related to the prostate, prostate cancer, or the procedures.
SurgeryThe urethra (the tube that carries urine from the bladder) passes through the prostate. The urethra is cut during the operation, so that the prostate can be removed. It is then sewed to the neck of the bladder. To allow it to heal, the patient must wear a catheter (a tube that runs from the bladder to a bag outside the body).
Radiation or cryotherapy. Urge incontinence is common in the period following the procedure. Stress incontinence can occur if the sphincter muscles, urethra, or bladder are damaged. Also, both techniques lead to the gradual shrinking of the prostate due to the disposal of dead cells. It is therefore possible that if the loss of bulk is not compensated by a strengthening of the muscles, some form of incontinence may persist.
Among the solutions are:
CathetersAbsorption products (pads or underwear)
Habit training (timed voiding)
Collagen injections to narrow the urethra.
Pelvic Muscle Exercises (Kegels)
Foley catheters are used following most procedures, in some cases (notably surgery) it is necessary, in other cases it is done for a short period (usually overnight) to ensure that there will be no problems.
Condom catheters are attached to the outside of the penis (painlessly). A condom-like sheath ends in a tube that empties into a container that is strapped on to the leg. (These are also used by men who find themselves in situations in which they cannot, or do not wish to, find a toilet. The link below is aimed at men who go to sporting events.)
Yes, the same material plastic surgeons use to enlarge lips can be used to narrow a wide urethra. One study of 31 men found that "Our data suggest that collagen injection improves 35 percent but cures a minority of patients (less than 10 percent) with post-radical retropubic prostatectomy incontinence." (Division of Urology, University of Pennsylvania)
Some doctors suggest that you only do the Kegel exercises while standing and urinating.
Biofeedback appears to be significantly helpful. (J Enterostomal Ther 1990 Mar-Apr;17(2):67-76)
Some insurance companies provide coverage for bladder retraining.