Surgery or radiation therapy for prostate cancer may irritate the urethra or bladder or damage the urinary sphincter (muscles that contract to prevent urine from flowing out of the bladder). As a result, some degree of incontinence (inability to control bladder function) can occur after treatment.
In the initial period after radical prostatectomy for prostate cancer, men typically experience stress incontinence, in which urine leakage occurs during moments of physical strain (such as sneezing, coughing, or lifting heavy objects).
Recovering bladder control may take up to six to nine months. Fortunately, severe incontinence occurs in less than 5 percent of men following radical prostatectomy or radiation therapy for prostate cancer. The following approaches can be taken to manage incontinence:
- Use absorbent products. Wearing absorbent pads or undergarments is the most common way to manage incontinence. These products are often used right after surgery and are effective for managing mild to severe incontinence. Absorbent products are also ideal for men who have minimal leakage on occasion.
- Make lifestyle changes. Simple changes in diet and behavior can be helpful. Excess weight increases pressure on the bladder and worsens incontinence. Weight loss through calorie restriction and increased physical activity will help. Because constipation can worsen symptoms, it is important to eat high-fiber foods, such as leafy green vegetables, fruits, whole grains, and legumes. Alcohol increases urinary frequency and should be limited. Some men report being bothered by caffeine. If nighttime urination is a problem, avoid consuming liquids during the last few hours before bed.
- Do Kegel exercises. These exercises are performed by squeezing and relaxing the pelvic floor muscles that surround the urethra and support the bladder. Strengthening these muscles may improve bladder control after radical prostatectomy.
To do Kegels, you must first be able to locate where the pelvic floor muscles are (an easy way to do this is to stop and restart your stream of urine and note which muscles you are using— though you shouldn’t regularly be doing this while urinating). Contract the muscles for three seconds and then relax them for an equal time; repeat 10 to 15 times. Gradually work up to 10-second contractions. Another way is to contract and relax the muscles quickly. Many experts recommend slowly contracting the muscles until you reach a maximal contraction and then slowly release them.
You can do Kegels in sets, such as 15 to 20 repetitions, spaced throughout the day. Be sure not to use other muscles, such as your abdominal, buttock, or thigh muscles, while doing Kegels; using those other muscles won’t target the pelvic floor properly. In fact, contracting your abdominal muscles simply puts pressure on the bladder, which is counterproductive. And don’t hold your breath while doing them.
If you have trouble isolating the proper muscles, your doctor can instruct you. Kegel exercise apps are also available, but quality is variable and not all have been tested. Finally, be patient. It may take a few months before you notice any improvement.
If these self-management measures are not sufficient, your doctor can work with you to find other options that may help. These include collagen injections, surgical treatments, penile clamps, external collection devices, catheters, and medications.