One of the most common and frustrating side effects of prostate surgery is urinary incontinence. It affects about half of all patients who undergo surgery, interfering with social, work and sexual life. The most common type of incontinence patients will experience is stress incontinence (postprostatetecomy incontinence), where leakage occurs whenever the individual exerts physical energy, such as laughing, coughing and lifting heavy objects. Other urinary symptoms may include sudden urges to urinate, frequent urination, slow urinary stream and difficulty emptying the bladder.
The good news is that bladder functional usually improves gradually. The American Cancer Society (ACS) recently released the guidelines below to help prostate cancer survivors improve their quality of life and transition back into everyday life. Primary care physicians are recommended to:
- Maintain an active discussion with all prostate cancer survivors about their urinary function, as many men are often reluctant to talk about their bladder problems. Talk about difficulty emptying the bladder, whether incontinence pads are being used, the amount of leakage occurred and how often the patient uses the bathroom.
- Refer patients with post-surgery incontinence to a physical therapist for pelvic floor rehabilitation. Kegel exercises are one of the common treatments for stress incontinence, and can be very effective if done correctly and consistently.
- Suggest timed voiding for those experiencing urge incontinence, frequent urination and nocturia. Timed voiding involves using the bathroom on a regular schedule. Patients can also try anticholeric medications, such as oxybutynin.
- Refer those with a slow stream to try alpha-blockers or go to a urologist with more experience.
- Refer patients with constant leakage to a urologist for further evaluation (eg, urodynamic testing, cystoscopy). Treatment options for these men may include male urethral sling procedure or artificial urinary sphincter placement.
In addition to guidelines on improving urinary function, the report also provided suggestions on how to help prostate cancer survivors manage distress and depression, improve sexual intimacy, exercise right and eat well. Click here to read more.