By Debra Ward RN BN, Prostate Cancer Specialist Telenurse
Over 1.3 million Australian males experience incontinence, including high numbers of men who have been treated for prostate cancer.
According to the Continence Foundation of Australia, around 1 in 10 men are affected by urinary incontinence and around 1 in 20 are affected by bowel incontinence.
If that's you, you're not alone, and help is available both before and after treatment to help you overcome this challenge.
What causes incontinence linked to prostate cancer treatment?
Both surgery and radiation therapy commonly result in temporary or lingering incontinence or bowel concerns.
Because the prostate gland sits below the bladder and surrounding the urethra, continence can be impacted by both surgery and radiation therapy for prostate cancer. The prostate is also close to the rectum and bowel, which means treatment is delicate and can impact on bodily functions.
The urethra is the tube that carries urine from the bladder through the penis to the outside of the body. Treatment for prostate cancer can damage the muscles and nerves that control urine function, and after treatment, you might leak urine, need to urinate urgently, or find it hard to urinate at all.
Sometimes, radiation therapy for prostate cancer causes bowel problems, whereby the radiation inflames the lining of the bowel. This can cause symptoms such as diarrhoea, bleeding from the rectum, gas, or pain.
For many men treated for prostate cancer, urinary problems are the most challenging side-effect of prostate cancer treatment.
The good news is, urinary and bowel problems improve quickly for many men. But sometimes they don't go away, and you may benefit from the support of a health professional who specialises in prostate cancer and urinary or bowel problems.
Types of incontinence
There are a number of ways incontinence can manifest:
- Stress incontinence - leakage during physical activity that creates intrabdominal pressure, for example - lifting, laughing, sneezing, or coughing.
- Urge incontinence - an overwhelming need to urinate, without delay.
- Mixed incontinence - a combination of the above.
- Overflow incontinence - when the bladder never completely empties, causing leakage.
- Bowel incontinence - involuntary leaking of faecal matter.
Management and treatment options
Your treatment options will depend on the underlying cause of your incontinence, but once you're diagnosed, there are a number of avenues you can explore with your health care team.
- Bladder retraining and pelvic floor exercises: Getting the support of a specialist pelvic floor physiotherapist (PFP) is worthy of consideration prior to invasive treatments even if it's many years after your prostatectomy.
- Pads: There are now a wide range of male specific pads available from the supermarket or pharmacy that you can purchase. Your PFP can advise on what pads are right for you. Tena are one of the leading providers of UI products. They're also planning to release some new products later this year so stay tuned for more updates.
- Dribble stop clamp: This is an external clamp that can help curb leakage by gently applying pressure to the penis. The advantages of this include non-medical, non-surgical, easy to use, and works well. Some men do find it to be bulky and can cause pressure necrosis, so make sure it's right for you.
- Condom drainage device: This device is an external condom catheter with a leg bag and can be used day and night as desired. Advantages are comfort, they are noninvasive, and easy to use at home. Disadvantages include the possibility of leaking if not fitted correctly and can cause skin irritation.
- Artificial Urinary Sphincter (AUS): This is a continence device requiring specialist surgical operation consisting of a balloon placed in the scrotum that activates a cuff positioned around the urethra in the penis which is activated by the man each time bladder emptying is required. Advantages are that this provides complete, discreet urinary control. The operation does require general anesthetic and takes about 60 minutes to complete. There is a high satisfaction rate for those men with moderate to severe UI.
- Sling surgery: This is suitable if you have less than 200mls of UI over 24 hours or use a pad weight of less than 400gms per 24 hours. In short, this involves wrapping surgical tape around the urethral bulb, gently moving the urethra into a new position to increase resistance in this area.
- Tablets specific for overactive bladder: If the cause of urinary incontinence is not related to the prostatectomy but more bladder dysfunction in origin, then there are medications that can help, and your urologist can guide you with this.
Prehabilitation
Prehabilitation and preoperative exercises can help prepare you for your treatment, by strengthening your urinary and bowel function.
