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Urinary incontinence
Because surgery or radiation therapy may irritate the urethra or bladder or damage the urinary sphincter muscles that contract to prevent urine from flowing out of the bladder, some degree of incontinence is common immediately after treatment.
A number of methods can be used to reduce incontinence:
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Lifestyle measures: Simple changes in behavior can be helpful. A high-calorie diet and lack of exercise can lead to obesity, which increases pressure on the bladder and exacerbates incontinence. Because constipation can also worsen symptoms, it is important to eat high-fiber foods, such as leafy green vegetables, fruits, whole grains, and legumes. Caffeine and alcohol consumption should be limited since they increase frequency of urination. If nighttime urination is a problem, avoid consuming liquids several hours before bedtime.
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Kegel exercises: Kegel exercises are performed by squeezing and relaxing the pelvic floor muscles that support the bladder and surround the urethra. By strengthening these muscles, bladder control may improve. To locate the pelvic floor muscles, try slowing or stopping the flow of urine midstream.
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Collagen injections: Collagen can be injected around the bladder neck to add bulk and provide increased resistance to urine flow during times of physical strain. However, repeat injections often are needed because collagen is a naturally occurring protein and is broken down by the body.
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Artificial sphincter implantation: In this procedure, a doughnut-shaped rubber cuff is implanted around the urethra. The cuff is filled with fluid and is connected by a thin tube to a bulb implanted in the scrotum. In turn, the bulb is connected to a reservoir within the abdomen. The fluid in the cuff creates pressure around the urethra to hold urine inside the bladder. When the urge to urinate is felt, squeezing the bulb transfers fluid from the cuff to the reservoir and deflates the cuff for three minutes so urine can drain through the urethra. Afterward, the cuff automatically refills with fluid and urine flow is again impeded.
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Absorbent products: Wearing absorbent pads or undergarments is the most common way to manage incontinence. Typically used right after surgery, these products are effective for minor to severe incontinence.
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Penile clamps: These devices, which compress the penis to prevent urine from leaking, are an option for severe incontinence. Penile clamps are not recommended immediately after treatment because they prevent the development of muscle control that is needed to regain urinary continence.
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External collection devices: These condom-like devices can be pulled over the penis and held in place with adhesive, Velcro straps, or elastic bands. A tube drains fluid from the device to a bag secured on the leg. Often used with a penile clamp, these devices should not be used immediately after surgery, because muscle control needed for bladder control will not develop.
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Catheters: A Foley catheter is a small tube that is inserted through the urethra and allows urine to flow continuously from the bladder into a bag after prostate treatment. This option is not recommended for long-term use because it can cause irritation, infection, and, possibly, lack of muscle control.
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Medications: Medication can be used to control mild to moderate incontinence but is not effective for severe cases. Medication such as oxybutynin (Ditropan), tolterodine (Detrol), and propantheline (Pro-Banthine) may reduce urge incontinence by decreasing involuntary bladder contractions. Nasal decongestants, like pseudoephedrine, or the antidepressant imipramine (Tofranil) can reduce stress incontinence by increasing muscle tone in the bladder neck. Because pseudoephedrine is a stimulant that can increase heart rate and blood pressure, it should be used only under a doctor's supervision. The drug also may cause nervousness, restlessness, and insomnia and may have adverse effects in people with asthma or cardiovascular disease.
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