Prostate cancer: Urinary incontinence
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Urinary incontinence, or the loss of the ability to control urination, is common in men who have undergone surgery or radiation for prostate cancer. You must prepare for this possibility and understand that, at least for a while, urinary incontinence can make life difficult for you.
There are different types of urinary incontinence and different degrees of severity. Some men may leak urine, while others may experience total leakage. Leakage of urine when coughing, sneezing, or laughing is called stress incontinence and is the most common type of urine leakage men experience after prostate surgery. On the other hand, the need to urinate frequently with episodes of leakage, called urge incontinence, is the type most commonly seen after radiation treatment. Doctors continue to improve prostate cancer treatments to reduce incontinence after surgery and radiation.
Why do prostate cancer treatments cause urinary incontinence?
It helps to know a little about how the bladder holds urine. When urine empties into the bladder from the kidneys, it is stored inside the bladder until you have the urge to urinate. The bladder is a hollow, muscular, globe-shaped organ. Urine leaves the bladder and leaves the body through a tube called the urethra. Urination occurs when the muscles in the bladder wall contract, forcing urine out of the bladder. At the same time, the muscles around the urethra relax and allow urine to flow. The prostate surrounds the urethra. Because an enlarged prostate gland can block the urethra, it can cause urine retention or other problems with urination.
The removal of the prostate by surgery or its destruction by radiation (either with an external beam or radioactive seed implants) can alter the way the bladder holds urine and can lead to urine leakage. Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can sometimes damage the nerves that help control how the bladder works.
Are there new techniques that reduce the probability of incontinence?
When removing the prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.
Still, at this point, any man who has radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With the newer techniques, some men will only have temporary trouble controlling their urine, and many will regain full bladder control over time.
