Incontinence After Prostate Surgery

What is incontinence after prostate surgery?

Urinary incontinence is when you can’t control urination (peeing). It often occurs in people assigned male at birth (AMAB) after surgery for prostate cancer like a prostatectomy (removal of your prostate) or radiation therapy.

People who have prostate cancer treatment may experience two types of urinary incontinence:

• Stress incontinence: This means you leak pee (urine) when you cough, sneeze or lift something heavy. This happens because of stress or pressure on your bladder. This type of incontinence is more of a risk after prostate removal surgery than after radiation treatment.
• Urge incontinence: This is when you feel a sudden need to pee right away (overactive bladder) and leak pee before you can make it to the bathroom. Other people may not feel their bladder being “full,” so they leak pee. This type of incontinence is more of a risk after radiation treatment than after prostate removal surgery.

After prostate removal surgery, urinary incontinence is usually temporary. It may take a few months up to a year, but eventually, you should be able to control when and how you pee. Your healthcare provider can work with you on treatments for incontinence after prostate surgery.

How common is incontinence after prostate surgery?

About 6% to 8% of people who’ve had surgery to remove their prostates will develop some type of urinary incontinence (usually temporarily).

What causes incontinence after prostate surgery?

When your pee drains into your bladder, it’s kept inside by two valves (sphincters) that stay closed until your body “tells” them to open when you pee. There’s an internal and an external valve.

If you have surgery to remove your prostate, the internal urine valve has to be removed as part of the prostate surgery. The external urine valve that you control to let urine out or stop your flow will still work.

Usually, having one working valve (the external valve) is enough to keep your urine control, but this depends on your pelvic floor muscles and nerves also working well.

On the other hand, radiation therapy for prostate cancer can also affect your sphincter and bladder because radiation damages and irritates healthy tissue in the area. This can impact how well they function.

How long does incontinence last after prostate surgery?

It’s hard to say exactly how long incontinence after prostate surgery lasts. It varies from person to person. The following factors play a role:

• Your age.
• Your overall health, such as if you have obesity or other medical conditions.
• Typical bladder control (before surgery).

For example, people who are healthy overall and under age 60 are much less likely to experience long-term urinary incontinence. On the other hand, someone who is 80 is more likely to have bothersome incontinence if they have treatment for prostate cancer. Some people experience full-on incontinence where they can’t hold any amount of pee and have to use a product like a pad or diaper, while others only sometimes dribble tiny amounts of pee.

The good news is that with treatment, you should gradually experience less leakage. The average time it takes most people to regain control of urination is less than three months.

How is incontinence after prostate surgery treated?

How your healthcare provider treats incontinence mainly depends on how severe your symptoms are and how long it lasts. It also depends on what type of incontinence you have (stress, urge or both).

If you find you’re having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medication or physical therapy exercises for your pelvic floor muscles. People who have leakage lasting longer than three months or more severe symptoms may need surgery. Your provider usually recommends the noninvasive therapies first before recommending surgery.

At-home remedies for incontinence after prostate surgery

There are several types of incontinence products, like absorbent pads or diapers, that you can purchase at your local supermarket or drugstore. Devices like an incontinence clamp can also help, but you should discuss using one with your provider. It works by clamping your urethra so pee doesn’t leak.

How can I strengthen my bladder after prostate surgery?

Exercises that strengthen your pelvic floor, called Kegels, are often the first line of treatment for incontinence. Your healthcare provider may recommend Kegels to improve how your pelvic floor muscles work. Some providers combine Kegels with a therapy called biofeedback.

Your pelvic floor muscles are a group of muscles that hold pelvic organs up like a hammock. They also support healthy bladder and bowel function. If you’re born with a prostate, you may not have ever strengthened your pelvic floor before (because you didn’t need to). However, when your prostate is removed, you now have to rely on your pelvic floor muscles. That’s why pelvic floor exercises are very important after prostate removal surgery.

Pelvic floor strengthening works very well for people with mild to moderate leakage. If your symptoms don’t improve, your provider may recommend additional treatments.

What medication is used for incontinence after prostate surgery?

If you have urge urinary incontinence, certain medications can help. Some of these medications work by relaxing your bladder to increase how much pee your bladder can hold. Others influence how your brain sends signals to your bladder to tell it that it’s full. Your healthcare provider will discuss which medications may work for you as well as their potential side effects.

There’s no good medication for the other type of incontinence (stress incontinence).

What kinds of surgeries treat urinary incontinence after your prostate is removed?

If you have bothersome stress urinary incontinence after prostate surgery that lasts longer than six months to one year, your healthcare provider may recommend surgery. There are two main types of surgery for urinary incontinence: the urethral sling and the artificial urinary sphincter (AUS).

Urethral sling

In a urethral sling procedure, your healthcare provider makes a small cut in your perineal area (the space between your anus and scrotum). Then, they put a synthetic mesh tape around part of your urethra to lift it back up to its typical position. This often helps people with mild to moderate stress urinary incontinence who don’t see improvement with pelvic floor strengthening.

Artificial urinary sphincter (AUS)

An artificial urinary sphincter (AUS) can help people who have severe stress urinary urinary incontinence because they had prostate cancer surgery and now their muscle or sphincter valve doesn’t work as it should. An AUS is a device that helps restore the “open and close” function of your sphincter.

It has three parts:

• An inflatable cuff for around your urethra. The cuff closes off your urethra to prevent leaking pee.
• A pump for inside your scrotum that controls the opening and closing of the cuff.
• A small,s pressure-regulating balloon (about the size of a ping-pong ball) in your abdomen. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.

If you have this surgery, you’ll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When you’re done peeing, the cuff automatically closes again on its own.

Can you prevent incontinence after prostate surgery?

Your surgeon tries to limit how much damage occurs around your bladder and sphincters during prostate cancer surgery. While advances are always being made, you can still expect at least temporary incontinence after prostate surgery. The exact degree and symptoms you’ll experience vary depending on your age and health, the extent of the cancer and whether you also had radiation or other treatments. You should discuss your concerns about incontinence with your healthcare provider.

When should I call my healthcare provider?

Contact your healthcare provider if you experience symptoms of urinary incontinence after prostate surgery. It may be uncomfortable to talk about, but your healthcare provider is there to help you.

Can you overdo Kegels after a prostatectomy?

Yes, it’s possible to overdo Kegels after prostate surgery. If you do Kegels in excess, you could tighten your pelvic floor too much. This can also result in uncomfortable symptoms like spasms or constipation. It’s best to perform Kegels and other pelvic floor exercises under the direction of a physical therapist or another healthcare provider.

A note from Cleveland Clinic

Losing control of urination after prostate surgery can be frustrating. If you experience this symptom and it begins affecting your quality of life, talk to your healthcare provider. You aren’t alone. Many people who have prostate surgery go through the same thing. Your provider can recommend ways to treat urinary incontinence with things like physical therapy, medication or surgery. The good news is that most people eventually regain control of their bladders.