Post Prostate Surgery Survival Guide

A lot of men experience bladder problems, including urinary incontinence, after prostate surgery.  While it’s a common side effect of treatment, it can often add another stage of discomfort after an already difficult experience.
 
There are many different types of urinary problems associated with prostate cancer treatment which vary in severity, from post prostate surgery leakage to total urge and stress incontinence. If you’re considering surgery or any other kinds of treatment for prostate cancer, it’s important to be aware of the possible bladder issues you might experience. 
 
With that in mind, we’ve put together a list of common prostate cancer treatments and the different urinary problems they could cause. Remember to ask your doctor about these side effects and the possible treatments.

What causes post prostate surgery incontinence?

To understand the link between prostate cancer and incontinence, it’s useful to know how the bladder works. Urine is passed from the kidneys and stored inside the bladder until you need to urinate. It then leaves the body through the urethra, which the prostate gland surrounds. If the prostate gland becomes enlarged it can obstruct the urethra and cause urination problems.

Surgery to remove the prostate (a radical prostatectomy) can affect the urination process and cause bladder leakage. This is often due to damage to the nerves that control the bladder, or the surgeon removing one of the valves outside the prostate that releases urine. Radiotherapy to destroy the prostate can also decrease the bladder’s capacity and cause spasms that lead to bladder leakage.

Post prostate surgery leakage

Many men experience stages of incontinence after a prostatectomy, the most common of which is urine leakage. During prostate surgery, a tube called a catheter is inserted into the penis to drain urine from the body, which stays in for about seven to ten days. Because surgery often damages the nerves around the bladder and urethra, a lot of men find it difficult to control their bladder when the catheter is first removed. 
 
The severity of incontinence after a prostatectomy differs depending on the individual. Some men only experience little leaks from pressure put on the bladder when they exercise or sneeze, called stress incontinence, while others may leak larger amounts. 
 
Similarly, the recovery time from post prostatectomy incontinence also varies. While most cases improve after one to six months, some men experience post prostate surgery leakage for a year or longer and others never fully recover. In either case, incontinence pads or pants can help protect against post prostate surgery leakage and help you keep control.

Possible radiotherapy bladder side effects

Radiation cystitis
Having radiotherapy for prostate cancer can irritate or inflame the bladder and urethra, a condition known as radiation cystitis. Radiation cystitis symptoms include:
• a burning sensation when you urinate
• bladder or urethral pain
• difficulty urinating
• blood in your urine
• more frequent or urgent urination, including at night (Nocturia)
 
See your doctor if you experience any of these symptoms to get a recommendation for treatment. There are also things you can do yourself, including drinking plenty of fluids and avoiding caffeinated drinks and alcohol, which can aggravate the bladder.
 
Urinary frequency and urgency
A lot of men who have had radiotherapy for prostate cancer feel the need to urinate more often and urgently, a condition called urinary frequency. When this happens at night, this is known as Nocturia
Other men may experience urge incontinence after radiotherapy. This is the feeling of being in constant or urgent need to urinate, resulting in being unable to control the bladder and subsequently urine leakage. 

Urine retention
Some men may have difficulty passing urine after radiotherapy, known as urine retention. This can happen if the nerves that control the bladder are damaged or the urethra becomes narrowed. Radiotherapy can also cause the prostate to swell and block the urethra, resulting in retention. 
 

Bladder problems after high intensity focused ultrasound (HIFU)

• Stress incontinence – having HIFU can cause many men to experience urine leakage as a result of sneezing or exercise, known as stress incontinence. This is more likely if you’ve already had radiotherapy. 
• Urine retention – HIFU can also cause swelling to the prostate, necessitating a catheter to drain the urine. HIFU may also cause the urethra to narrow, resulting in retention.
• UTI – Some men may get a urinary tract infection after having HIFU, which can be treated with antibiotics. 

Treating incontinence after prostate surgery

If you’re experiencing post prostate surgery leakage your doctor might suggest a number of treatments. This will depend on the type and severity of the incontinence. Operations to treat incontinence after prostate surgery include:
 
• Urethral sling – a minimally invasive procedure where a small piece of material is placed around part of the urethra to keep it closed and prevent urine leakage. 
• Artificial urinary sphincter – an artificial urinary sphincter can help men who experience more severe incontinence due to a poorly functioning sphincter valve post prostate surgery. An AUS is usually only recommended for men who still leak large amounts of urine six months after surgery.
 
Aside from these operations, your doctor might recommend non-invasive treatments, such as medications and lifestyle changes. Both incontinence and frequent urination can be treated with bladder training so you don’t have to go as often, monitoring your fluid intake, and exercises to strengthen your pelvic floor. These can also help you to manage bladder weakness at night. 
 
In either case, from pads to pants our range of incontinence products for men can help protect you from mild to moderate leakage. Visit our product site to shop now. 
Sources 
 
https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/urinary-problems
https://my.clevelandclinic.org/health/treatments/8096-prostate-cancer-urinary-incontinence-after-surgery
https://www.webmd.com/urinary-incontinence-oab/mens-guide/urinary-incontinence
https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/radiotherapy/pelvic-radiotherapy/difficulty-passing-urine-after-pelvic-radiotherapy