Post-Prostatectomy Incontinence- Prostatectomy and the Pelvic floor part 3

If you have been following along with me for a while in these blogs we have already covered some of the more common side effects from prostate cancer treatment and prostate removal. If you haven’t, scroll down to read more about post prostatectomy pain and erectile dysfunction.  One of the most common and probably most bothersome side effects from having the prostate removed is urine leakage (or incontinence). In general this problem is divided into 2 main types. You may find that you experience one or the other and some people experience both. 

Urge incontinence- this is the most common type experienced prior to prostate removal. This is urinary leakage that occurs when you get a strong urge to go to the bathroom. This is the “if I have to go, I REALLY have to go right this minute”. Leakage occurs with this sensation. This type of incontinence can also occur with certain triggers, like pulling into your driveway, or opening the bathroom door/lifting the lid on the toilet. Sometimes these cues are so strong that when they occur, the brain and pelvic floor muscles can’t overcome the bladder muscles and some leakage occurs. 

​Stress incontinence- this type of incontinence occurs when you do something that creates pressure against the pelvic floor (coughing, sneezing, holding your breath) or increases the strain (heavy lifting, jumping, running). Often this type of incontinence occurs because the normally rigid anatomy of the prostate is gone, so the pelvic floor muscles need to pick up the slack and work harder to control leakage. 

​Nearly all men will experience incontinence at least temporarily after prostate removal. Many men who experience incontinence describe it as “mild” or “moderate” and will regain their urinary control in 6 months to 1 year; but a 1 in 5 men will experience symptoms longer term(1). It has been shown in multiple studies that the time to recover continence can be improved with a supervised exercise program, like in physical therapy. ​
I recommend at least 1 pre-operative assessment and 1 post-operative assessment approx 6 weeks after the procedure to assess your baseline function and to create an individualized exercise plan to maximize healing and function. 

So what can you do to minimize or manage these side effects?

1. The type of treatment can make a difference- surgery often leads to more significant incontinence and erectile dysfunction early on after treatment, while radiation may create different urinary symptoms (more frequency and urgency, possible bowel changes) and the erectile dysfunction, if it occurs, is often delayed. (1) 

Newer technologies including hormone related treatment may be used which may present with a variation on these symptoms as well.

1. Skill of your healthcare provider- surgeons that have done hundreds and thousands of surgeries have better outcomes typically, especially if they are using robotic assist technologies 
2. Your pre and post treatment lifestyle- there are many healthy habits that you can begin now, whether you have had a prostate cancer diagnosis or not. A well balanced diet, proper hydration, regular exercise and stress management can help. Age related fitness and lifestyle factors can affect your ability to recover after surgery or treatment.

It has been shown that men with incontinence or erectile dysfunction prior to prostate cancer treatment have a lower risk of full recovery after treatment or surgery.

Nutrition fact: A recent meta-analysis found an association between higher amounts of coffee consumption with decreased risk of prostate cancer, including a decrease in the risk for advanced prostate cancer. More research is needed to determine a cause-effect relationship or which compounds within the coffee may prove to be protective (3).

1. While Pelvic Floor PT can be effective in managing urinary side effects of prostate removal, sometimes surgery like a bladder or urethral sling may be needed to fully resolve incontinence that lasts longer than 1 year. It is important to talk to your health care providers, including a pelvic floor physical therapist to discuss your options (4).
   
   References 
   (1) Prostate Cancer foundation (PCF) patient guide 2021
   (2) Urinary Incontinence After Prostate Surgery: Everything You Need To Know - NAFC
   (3) Coffee consumption and risk of prostate cancer: a systematic review and meta-analysis | BMJ Open
   (4) Singla, N., & Singla, A. K. (2014). Post-prostatectomy incontinence: Etiology, evaluation, and management. Turkish journal of urology, 40(1), 1–8. https://doi.org/10.5152/tud.2014.222014

Author

Kristen Topliff, DPT is a wife, mom of preschoolers, and passionate pelvic health physical therapist. She has found that there is a significant need for the education and treatment of male pelvic health conditions. Kristen is also enthusiastic about helping people overcome pain and barriers to having meaningful sexual wellness.