What is Urinary Incontinence?
Urinary incontinence is the loss of bladder control, ranging from some leaking to complete loss of bladder control. Symptoms may include pain, increased urgency, and urinary frequency. Urinary incontinence and its symptoms can be caused by a number of factors. However, they are typically caused by damage to the nerves and muscles that control urinary function during primary treatment for prostate cancer.
There are several types of incontinence, the most common of which are stress incontinence and urge incontinence:
- Stress incontinence is the involuntary leakage of urine when coughing, sneezing, straining, or doing anything that puts stress on the abdomen. This is the most common type about prostate cancer survivors. Some people with severe stress incontinence have nearly constant urine loss (sometimes referred to as total incontinence).
- Urge incontinence occurs when you feel the “urge” to urinate but cannot make it to the toilet in time. This is generally due to bladder spasms and often responds to medical therapy.
Urinary incontinence may be short or long term as a result of treatment or the cancer. Most men experience quick improvement over the first several months. However, there are ways to manage long-term incontinence and live a full life.
What Causes Urinary Incontinence?
Urinary incontinence is the primary urinary side effect for men undergoing a prostatectomy (surgery). About 25 percent of men report frequent leakage or no control at six months.
Radiation treatment also causes issues with incontinence. External beam radiation can irritate both the urethra and the bladder causing swelling of the prostate.
Watch Dr. Lowentritt from Chesapeake Urology discuss urinary incontinence:
Treatment Options for Urinary Incontinence
There are many ways to manage or treat urinary incontinence. For most men, symptoms of urinary incontinence tend to lessen over time. However, urinary incontinence for any amount can be uncomfortable and frustrating to deal with it. Consider the following management options:
- Bladder training which consists of scheduled bathroom trips at specific times to retrain your bladder
- Fluid and diet management which involves limiting intake of certain food and drink items before bedtime
- These undergarment solutions can be used alone, or in combination with other broad treatment options as needed
- They may be disposable or reusable, and are often recognized as liners, pads, or collection devices
- Kegel exercises, designed to help strengthen the muscles that support the bladder. How to perform pelvic floor exercises:
- Begin by emptying your bladder.
- Tighten the pelvic floor muscles and hold for a count of 10.
- Relax the muscle completely for a count of 10.
- Perform 10 exercises, three times a day (morning, afternoon, and night).
- Biofeedback/electrical stimulation, to help you gain awareness and control of your urinary tract muscles
- Medications may be prescribed to decrease involuntary bladder contractions and improve urinary flow, control urgency, pain, and leakage
- Commonly prescribed medicines are Flomax, Hytrin, Detrol, and Vesicare
- Collagen injections add bulk to the bladder neck and provide increased resistance to prevent urine leakage
However these methods only help a small number of men who have more severe leakage. When these treatments do not work, you may want to consider surgery for an implantable male continence device such as a urethral sling or artificial urinary sphincter.
Sling implants are a solution for men with mild to moderate incontinence. During a surgical procedure, a synthetic mesh tape sling is placed around part of the urethra, which is gently repositioned to relive pressure buildup when coughing, sneezing or lifting. The device keeps the muscles tightly closed until you are ready to urinate.
This is a minimally invasive procedure, which means that the surgeon only has to make a small cut into your body. Results are favorable for use of the sling. One study showed an average success rate of 81 percent and in another study, 94 percent of patients would recommend the procedure to a friend.
Artificial Urinary Sphincter
An artificial urinary sphincter is a solution for men with moderate to severe incontinence. During a surgical procedure, a device is placed in the body. The AUS has three parts:
- An inflatable cuff is placed around the urethra. This mimics the function of a normal, healthy urinary sphincter
- A pump is implanted inside the scrotum to control the opening and closing of the cuff and prevents transfer of fluid between the cuff and a reservoir that is implanted in the abdomen
- A small pressure-regulating balloon or reservoir is placed inside the abdomen under the muscles to maintain fluid under presser within the urethral cuff
At rest, the cuff is filled with fluid keeping the urethra closed and preventing urine flow until the man is ready to urinate. To urinate, the pump is squeezed by hand 2-5 times, deflating the cuff, opening the urethra and allowing urine to exit the body. After urination, a button on the pump is pressed and fluid from the reservoir returns to the cuff, closing the urethra once again.
This is a very successful treatment. In one study, 90 percent of patients reported satisfaction, 92 percent would have an AUS placed again and 96 percent would recommend it to a friend. This procedure is successful 70 percent of the time.