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Treatments for incontinence after prostate surgery

With Douglas Dewire, M.D., Urologist at Columbia St. Mary’s

Posted: Sept. 1, 2007

Incontinence is one of the most common side effects of prostate cancer treatment. There are three main types of incontinence that can affect men after prostate cancer treatment: stress incontinence, urge incontinence and total incontinence.

Stress incontinence is when urine leaks during activities such as jogging, lifting or coughing. This type of leaking often occurs after the prostate is removed through a prostatectomy, which can result in weakened pelvic muscles or a compromised bladder neck.

Stress incontinence is sometimes treated with exercise to tighten the pelvic muscles. However, if there is a significant amount of leakage, surgery is available. The simplest approach involves injecting a gel to bulk up the urethra so it pinches together and provides additional bladder control. Another option is a sling procedure, where a piece of tissue is wrapped from one side of the pelvis, underneath the urethra and bladder, to the other side of the pelvis so it compresses the urethra to where it joins the bladder.

Urge incontinence is characterized by the uncontrollable urge to urinate. The condition is often a side effect of radiation therapy and can occur when a bit of radiation gets to the bladder and causes irritation. Although less common, the condition can also be a side effect of a prostatectomy. Medication to soothe the bladder muscle is usually prescribed to treat urge incontinence. But, in more severe cases, an InterStim device can be implanted to help control nerves and stimulate the bladder. The InterStim device sends mild electrical impulses to the sacral nerve, which influences the bladder and surrounding muscles. The electrical impulses are able to control or eliminate some symptoms of incontinence.

A third type is total incontinence, which is when there is continuous leaking of urine. This condition occurs when the bladder and the pathway to the urethra are continuously open. Patients who undergo both a prostatectomy and radiation therapy are more likely to experience total incontinence.

One option to treat total incontinence is a surgical procedure that implants an artificial urinary sphincter. The inflatable ring completely circles the urethra and is attached to tubing and a pump. In its resting state the cuff compresses the urethra so the patient doesn’t leak, but when the patient’s bladder is full, the patient can squeeze the pump so the urethra opens to allow urination.

Columbia St. Mary’s Incontinence Center offers patients the best care and an array of treatment options. Although incontinence can be embarrassing and uncomfortable, there are many effective treatment options. Incontinence is not something anyone should have to live with.

Douglas Dewire, M.D.
Urologist
Columbia St. Mary’s
414-326-1745

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