When my patients are diagnosed with high-grade prostate cancer, they are often and rightly concerned about urinary incontinence, which affects almost every patient at least for several weeks to several months after surgery. Why this happens revolves around simple anatomy. Every man has an external urethral sphincter that helps stop the flow of urine when a man is not trying to urinate. This structure is completed by the internal urinary sphincter within the prostate. However, during radical prostatectomy, we remove this secondary accessory sphincter along with the prostate, and there is no way to tell in advance whether the external urinary sphincter will be able to stop urine on its own.
In most patients, this change requires some adjustment time and leads to leakage and incontinence in the first few days after surgery. Fortunately, about 90% of patients regain continence within the first year after surgery. Many of these men can return to normal urination within several weeks.
That said, any (even temporary) urinary incontinence can be a significant burden on a patient’s social life, as they worry about the embarrassment of leaking or the need to always be close to the bathroom, just in case they have the urge to urinate. Patients rightly want to get off their pads or Depends as quickly as possible. Here are some ways to get you back on track faster and back to your normal urinary lifestyle as soon as possible.
Do your Kegels. Kegels are essential for strengthening the pelvic floor and improving the muscles, which allows you to maintain proper urine flow and retention. Kegels are a simple exercise that requires no skills or equipment. You must remember to do them according to your postoperative plan. For some patients who need additional help, pelvic floor physical therapy may also be an option, so please speak to my office and we will discuss whether this may benefit you in your recovery.
Improve your eating and hydration habits by eating lean, healthy meats, vegetables and whole fruits. Prioritize proper hydration because although they are opposites from a urination perspective, healthy hydration habits make a big difference in abdominal pressure and keep your bladder and urinary system as healthy as possible. If you need to modify your hydration habits, don’t limit your water intake. consume your fluids more strategically. For example, you can avoid drinking for an hour or so before an important event so you have less to worry about leaking. Remember, dehydration can be problematic and cause bladder irritation and even overactive bladder, which can worsen the symptoms you’re already experiencing.
Try holding and double urination techniques. If you have severe incontinence, you can try to hold your urine. This may include reaching the toilet but waiting an extra 10 seconds and holding your urine before urinating. There’s also what’s known as the double-pee technique, where you wait a few minutes after peeing and try again. These can increase the strength of the pelvic muscles that control urination and empty your bladder more fully, respectively.
Cialis can help. If you have had a prostatectomy, you will also experience erectile dysfunction to some extent. For most, a PDE-5 inhibitor such as Viagra/sildenafil or Cialis/Tadalafil can help restore erectile function. However, chronic low-dose Cialis can also accelerate urinary continence. We will discuss whether Cialis/Tadalafil is a good choice for you.
Don’t avoid pads. pads or adult diapers are a necessary stepping stone to return to continence. Many patients are embarrassed or somewhat embarrassed to use them, but they offer protection, especially in the early days when you have less urinary control. Don’t try to do it without your pads as you may create more stress, anxiety and embarrassment unnecessarily. Accept that you need them and work as hard as possible to minimize their use.
The bottom line
Fortunately, for most patients, urinary incontinence is temporary, and in these patients, there are ways to speed the return to normal, predictable urination. For the approximately 10% of patients who do not regain continence after prostatectomy, there are elegant surgical options, including a male urethra that supports the urethra and treats urinary leakage and mild to moderate incontinence. The artificial urinary clamp is an excellent choice for patients with more severe urinary incontinence. Both are simple surgeries that contribute immeasurably to quality of life after prostatectomy.
Don’t delay in talking to Dr. Natale if you are having problems with urinary continence after your prostatectomy. Fortunately, modern technology has made it easier to regain continence, and we’re here to make sure you live your life to the fullest with minimal interruption from urinary problems.
