Incontinence after prostate surgery

Temporary incontinence after prostate surgery is quite normal.

After prostate surgery, many men experience temporary urinary incontinence. The good news is that in most cases, the incontinence will subside on its own after prostate surgery. In order to go through everyday life without restrictions until then, incontinence products specially developed for men can serve as support.

Why does prostate surgery often lead to incontinence?

Surgery may be necessary for both benign and malignant enlargement of the prostate. We will go into more detail about these two forms in the course of this article.

If the prostate has to be surgically removed, parts of the urethra and its sphincter are often affected. As the name suggests, this muscle at the bladder outlet is responsible for opening and closing the bladder. Damage can impair the ability of the sphincter muscle.

However, whether the sphincter is actually affected depends very much on the age of the patient, certain previous illnesses, but also the surgical technique and the size of the prostate.

Alleviate stress and urge incontinence through targeted training

If the muscle is injured during the operation, the result is often so-called stress incontinence, whereby "stress" in this case means an increased pressure build-up due to sneezing, coughing, laughing or carrying heavy objects. This leads to involuntary leakage of urine. Stress incontinence - often also called stress incontinence - is the most common form of urinary incontinence after prostate surgery, but urge incontinence (often called overactive bladder) can also be a possible consequence. Those affected report a constant urge to urinate, although the bladder is hardly filled.

Unfortunately, it is anatomically very difficult not to injure the urethra during prostate surgery because the prostate encloses the upper part of the urethra and parts of the sphincter. Fortunately, there is still the external sphincter muscle, which is usually not affected and can be strengthened through targeted training. The incontinence is thus alleviated over time.

Here are some simple pelvic floor exercises that you can easily integrate into your everyday life.

In addition to prostatectomy, treatment with radiotherapy can also weaken the bladder muscles, resulting in male urinary incontinence.

Causes of overflow incontinence in men (incontinence due to chronic urinary retention)

The enlargement of the prostate is often manifested by problems with urination. The growth of the prostate causes the urethra to become increasingly narrow, which can lead to overflow incontinence or urge incontinence. 1 This happens with both benign and malignant enlargement.

It does not have to be cancer: Benign enlargement

While the prostate gland in young men is still about the size of a walnut, the number of prostate cells increases steadily in the course of life. The prostate gland grows and closes more and more tightly around the urethra. This change has nothing to do with prostate cancer, but it can still have an impact on continence. According to Prostata Hilfe Deutschland2 , about 20% of people aged 50 to 59 and 70% of people over 70 have benign prostate enlargement. This is often associated with the following symptoms:

• Frequent urination, even at night
• Problems starting to urinate
• A weak urine stream and the feeling that the bladder is never really empty
• Or even involuntary leakage of urine

The treatment of benign prostate enlargement depends on the individual symptoms and the size of the prostate. Both medication and prostate surgery can be considered. Your doctor will be happy to advise you on this.

Risk factors for benign prostatic changes include taking hormones, hereditary factors, an unhealthy diet, smoking and alcohol consumption.

Prostate cancer particularly affects older men

Prostate cancer is the most common type of cancer in men. According to the German Cancer Society3 , 60,000 men are diagnosed with prostate cancer in Germany every year. While this type of cancer is rare in younger men, the risk increases sharply with age.

Incontinence often only temporary

According to Prostata Hilfe Deutschland4 , almost every man has difficulty controlling his bladder directly after surgical therapy. After about 3 months, every second man is still affected, but in the following months this number continues to decrease. 18 months after radical prostatectomy (prostate removal), 4 to 21 out of 100 men still report that they lose urine unintentionally, especially in stressful situations like coughing, sneezing or laughing. In these cases, the pressure in the abdominal cavity increases and thus also on the bladder. After 5 years, about a quarter of those affected still use incontinence aids such as pads or disposable trousers. In about 7%, urinary incontinence remains permanent.

Besides incontinence, erectile dysfunction can also occur after prostate surgery. As with incontinence, however, the symptoms improve in many men after a few months.

Hygienic support for the time after prostate surgery

The ability to control the bladder and retain urine can be reduced to varying degrees after a prostate removal.

For mild to moderate incontinence, even narrow sanitary pads and penis pouches can help. MoliCare® MEN PADS are especially suitable for active men. They are anatomically shaped and comfortable to wear thanks to the breathable textile back.

You can find the correct use of MoliCare® Premium MEN PAD here in the video.

How to improve bladder control

Since part of the sphincter muscle usually remains after surgical removal of the prostate, it can be specifically trained to take over for the muscle that was removed. The difficulty is that many people do not know where exactly this muscle is located and how it can be strengthened. It is therefore advisable to work with a specially trained physiotherapist, especially in the beginning. You can find out more about this at the clinic.

Basically, you can think of the pelvic floor as a muscular plate that supports the organs in the abdominal cavity and has openings for the urethra and the intestines. The better trained this muscle plate is, the more pressure it can keep away from the bladder, especially under stress.

This improves bladder control again. Pelvic floor exercises are easy to learn and can also be integrated into everyday life. Success usually comes after a few weeks, so be patient and keep at it.

In addition, pelvic floor training can be supported by other measures. Modern biofeedback, electrostimulation or surgical methods can be used for this purpose.

You can find more information about pelvic floor training for men here.

Other treatment method: minimally invasive surgery

If regular pelvic floor exercises do not lead to an improvement in incontinence, there are other options that your doctor will be happy to advise you on.4 For example, minor surgery can help reduce uncontrolled urine leakage. In most cases, however, part of the sphincter muscle must still be functional for this type of therapy. 

Sources:

1     https://www.prostata.de/prostata/beschwerden/harninkontinenz#:~:text=%C3%9Coverflow incontinence%20(ischuria%20paradoxa)%3A%20urine loss,also%20micturition%C3%B6runs).

2     https://prostata-hilfe-deutschland.de/gutartige-prostatavergroesserung-bph/

3     https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/prostatakrebs/definition-und-haeufigkeit.html#:~:text=Life%20year%20is%20prostate%20the%20eldest%3B%20the,among%20all%20cancers%20in%20Germany

4     https://prostata-hilfe-deutschland.de/inkontinenz-prostatakrebs-behandlung/