Recovery from prostatectomy or prostate removal is a grim topic that thousands of men have to deal with every year. While prostatectomy is, by any measure, a life-saving procedure, it comes with important post-operative considerations. Over the years, we have improved the techniques and technology that have enabled the sparing of major nerves in the area. However, even the best prostatectomy virtually guarantees some urinary incontinence for some time afterwards. Many patients are happy to know that urinary incontinence eventually resolves in about 90 to 95% of patients. Urinary incontinence can be treated with elegant and practical solutions for the rest of the patients.
Urinary incontinence after prostatectomy
The urinary incontinence that almost all men experience after their prostatectomy is related to the urethral valves or sphincters that each of us has. Before a prostatectomy, we have two valves that regulate the flow of urine, but one of these valves must of course be removed along with the prostate. there is no sure way to know if the remaining valve will have sufficient function and strength to stop the flow of urine on its own. Herein lies the unpredictable urinary function after surgery.
With that said, getting back to continence after prostatectomy can take anywhere from a few weeks to a year and sometimes even longer. However, we feel that one year is an appropriate cut-off point to begin discussions about surgical treatments to improve continence.
However, because the process is so long, patients often do not recognize that they are making progress and become frustrated. While this is normal, we encourage our patients to stay the course and recognize that while it is slow, their progress can be completely normal. Below, we will discuss the stages of continence after prostatectomy. Of course, not everyone will follow the same path, but that’s generally what we like to see.
Phase 1
Initially, almost all patients will experience leakage and will need multiple pads daily. These absorbent pads help the patient continue their daily life without worrying about an embarrassing accident. Patients will be instructed on how and when to change their pads and how to perform exercises, including Kegels, to strengthen the pelvic floor and achieve continence earlier.
Phase 2
Eventually, patients will get to the point of sleeping through the night without leaking. This is an important step that gives patients a lot of hope. At first, they may not be able to get to the toilet in time and will leak immediately after waking up. Again, this is a common course as continence improves.
Phase 3
At some point, relatively soon after, the patient should be able to hold their morning urine until they reach the toilet. During this stage, they probably won’t hold urine after that night, as daily activities will cause them to leak.
Phase 4
Eventually, the patient will spend most of the day—let’s call it around 4 p.m. – before it leaks. This late afternoon leak is due to fatigue and the right muscles not having the endurance to get through the rest of the day.
Reclaiming Temperance
Finally, the patient will eventually be able to go through the day without leaking and find a dry pad by the end of it. During this stage, many patients wear a pad in case there is a leak, thus avoiding any potential embarrassment or worry associated with their incontinence. We usually let them do this for a while as they gain confidence that they will no longer leak during the day. However, this safety pad, as we call it, or crutch, can begin to work against the patient’s long-term goals. By leaning on this crutch all the time, patients may not put proper emphasis on going to the bathroom when needed and being diligent with their urinary habits. Therefore, ultimately, we would strongly encourage patients to eliminate this last safety pad and live without the backup plan.
What if I haven’t regained continence?
Unfortunately, there are some patients who, for one reason or another, have not been able to regain their urinary continence, even after a year or more of diligent practice and patience. For these patients, there are solutions, so they don’t have to resign themselves to a life of wearing pads and worrying about leakage. Two surgical procedures, the artificial urinary clamp and the male urinary sling, may help train patients with next steps. Both options are discussed elsewhere on our site, representing minimally invasive and highly effective solutions to the current problem.
Our comprehensive postoperative prostatectomy program
After prostatectomy, most patients will experience some erectile dysfunction in addition to the urinary incontinence discussed above. Dr. Natale has seen too many patients suffer for years or even decades with these problems when there are solutions to help. Therefore, we have a team of three professionals and our dedicated office staff to assist you with post-operative concerns. Dr Natale, Gregg McKittrick, our consultant pharmacist and Lis Mallers, our sex therapist, all work together to help patients get through this difficult time and get them back to erectile and urinary function as quickly as possible. Of course, the first step is to contact us to learn more. Dr. Natale is always eager to help his patients and others fully navigate the turbulent waters of prostatectomy recovery.
Related topic:
Treatment of erectile dysfunction after prostatectomy
