After prostate surgery, some men have to deal with a somewhat uncomfortable and distressing problem: involuntary urination. Many people are embarrassed to talk about this in public. But it is actually a very common condition. The most important thing is that there are very good treatments for this. So let's talk about this openly and honestly today.
What does this inability to control urine mean?
Simply put, urinary incontinence is the inability to control the flow of urine. This condition can occur after a prostate cancer surgery (prostatectomy) or after radiation therapy.
It can generally be divided into two main types. Understanding the difference between the two is important for treatment.
| Incontinence type | Simply explained |
|---|---|
| Stress Incontinence | This is when a small amount of urine leaks out when there is pressure on the bladder. For example, you may leak a few drops of urine when you cough, sneeze, laugh loudly, or lift something heavy . This type is most common after surgery to remove the male gland. |
| Urge Incontinence | This is when you suddenly have a strong urge to urinate . This is similar to a condition called "Overactive Bladder." You may leak some urine before you can even run to the bathroom. Some people don't even realize their bladder is full. This type of urge is more likely to occur after radiation therapy. |
The good news is that this condition after surgery is usually temporary . Within a few months to a year, you should be able to control your urine again. Your doctor will guide you through the necessary treatment.
Why does this happen after surgery?
Let's understand it this way. Our bladder is held in place by two sphincters, muscle systems that act like two valves. Like two water taps. One is on the inside, the other is on the outside. When we urinate, these valves open based on a signal from the brain.
During a vasectomy, the internal sphincter is removed. However, the external sphincter, which you can control, is still functional.
Usually, if one valve is working well, it is enough to control your urine. But it also requires your pelvic floor muscles and nerves to work well.
On the other hand, radiation therapy can also damage healthy tissue in the area, which can affect the function of the bladder and its valves.
How long will this situation last?
It's hard to say exactly how long this will take. It varies from person to person. There are several factors that can affect this:
- your age.
- Your overall health status (for example, whether you are obese or have other medical conditions).
- How was your urinary control before surgery?
For example, a healthy person under the age of 60 is less likely to have this condition for a long time. But for someone in their 80s, it can be a little more troublesome. Some people can't hold in any urine at all and have to use pads or diapers. Others may only leak a few drops of urine occasionally.
But remember, with treatment, this condition gradually improves. Most people are able to regain urinary control within about three months.
What are the treatments for this?
Treatment depends on the severity of your symptoms, how long they have been present, and what type you have (Stress, Urge, or both).
Usually, the doctor first suggests non-surgical, simple treatments.
Things you can do at home
There are products you can buy from pharmacies or supermarkets to help manage your incontinence, such as absorbent pads or adult diapers. There are also devices like an incontinence clamp that can help prevent leakage. But you should definitely talk to your doctor before using anything like this.
Kegel exercises to strengthen the bladder
This is one of the first and most important treatments for this condition. Kegels are exercises that strengthen the muscles at the bottom of your pelvic floor.
Think of these muscles as a hammock that holds up your pelvic organs. They also help with bladder and bowel control. After your prostate is removed, you now have to rely almost entirely on these muscles. That's why these exercises are so important.
Warning: It is not good to do Kegel exercises too much. If you do, the muscles can become too tight, which can lead to problems like pain or constipation. Therefore, it is best to do these exercises under the guidance of a physical therapist or your doctor .
Sometimes, doctors combine these exercises with a treatment called biofeedback, which helps you identify and control these muscles more precisely.
What medications are used for this?
If you have `Urge Incontinence` (the sudden need to urinate), there are medications that can help. Some of these relax the bladder and increase the amount of urine it can hold. Your doctor will explain to you which medication is right for you and its side effects.
There are currently no effective medications for `Stress Incontinence` (the type of urine leakage when coughing or sneezing).
Can this condition be cured with surgery?
Yes. If your stress incontinence persists after 6 to 12 months, your doctor may recommend surgery. There are two main types of surgery.
1. Urethral Sling: This involves making a small incision in the perineal area between your scrotum and anus and using something like synthetic mesh tape to lift the urethra up. This works well for people with mild to moderate stress incontinence.
2. Artificial Urinary Sphincter (AUS): This is used for people with severe stress incontinence. This is essentially an artificial device that works in place of your dysfunctional valve. It has three parts:
- An inflatable cuff placed around the urethra: This keeps the urethra closed and stops urine leakage.
- A small pump inside the scrotum: This is what opens and closes the belt.
- A balloon that controls intra-abdominal pressure: This keeps the pressure in the system constant.
After this surgery, when you need to urinate, you have to press the pump in your scrotum. Then the band opens and urine comes out. When you're done urinating, the band automatically closes again.
When should I see the doctor?
If you have these symptoms after prostate surgery, be sure to talk to your doctor.
It can be embarrassing and difficult to talk about this. But you are not alone. Many people who have this surgery go through this experience. Your doctor is there to help you. So, instead of dwelling on it and suffering, tell him about it.
Take-Home Message
- Loss of urinary control after prostate surgery is common and is often temporary.
- There are two main types: `Stress Incontinence` (urine leakage when coughing, lifting a heavy object) and `Urge Incontinence` (urgent need to urinate).
- Kegel exercises are a very important treatment method, but they must be done correctly and under medical advice.
- There are many highly effective treatments for this, including exercise, medication, and surgery.
- Don't be ashamed of this and don't suffer alone, but definitely talk to your doctor and get advice.
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