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What You Need To Know About Incontinence After Prostatectomy

What You Need To Know About Incontinence After Prostatectomy

Prostatectomy is the surgical procedure to remove the prostate, and is a great source of stress for many men. Within the post-surgery period, you can experience prostate removal side effects like urinary incontinence. 

It is important to prepare yourself for the possibility of incontinence after prostatectomy. This potential side effect can complicate your life, so you should know what you are in for right from the get-go. 

Let's dive deep into prostatectomy recovery and the implication of incontinence after prostatectomy.

What Is Urinary Incontinence?

Urinary incontinence refers to the loss of the ability to control your urine. Such bladder control issues are common in men who've had to go through prostate surgery

There may be some variation in the types of incontinence men experience and the degree of severity. Some men have a little urine dribble, while others go through a complete loss of urine. 

You can experience two types of urinary incontinence after prostatectomy1

Stress Incontinence

The most common type of urinary incontinence is known as stress incontinence. It is not caused by mental stress but rather by the stresses put on the bladder from jumping, coughing, or sneezing. 

These physical activities will cause involuntary loss of urine. 

Urge Incontinence

The other urine incontinence after prostatectomy that you might experience is called urge incontinence. Urge incontinence, also known as overactive bladder, is when you get a sudden “urge” to urinate.

It may occur due to bladder spasms or contractions. The urge to urinate is so strong that many men end up urinating before making it to the bathroom on time.

Why Does Urinary Incontinence Happen After Prostate Removal?

To understand the relation between incontinence and prostate surgery, let’s learn how urine is excreted. 

What Is The Normal Urination Process?

Urine is emptied into your bladder from the kidneys, where it stays until you get the urge to urinate. Once you get the urge, the urine leaves your bladder and goes out through the tube called the urethra2

This happens when the muscles in the wall of the bladder contract and those surrounding the urethra relax. 

Male urinary tract

What Happens To A Man When He Has His Prostate Removed?

The prostate gland is what surrounds the urethra. If it becomes enlarged, it can obstruct the urethra from retaining and leaking urine properly at the right time. 

When you treat it with radiation, it can damage the bladder's nerves, disrupting the way it holds urine. Radiation can decrease the holding capacity of the bladder, causing muscle spasms that force urine leakage. You also have sphincters or valves that control the flow of urine from the bladder to the kidneys. If you have had to remove your prostate completely, chances are the surgeon also had to remove one of the sphincters. 

Removing one valve should not cause many problems, but it may cause some damage to the nerves in the area from where you urinate. 

Is It Normal To Get Urinary Incontinence After Prostatectomy?

Based on research3, approximately 6% to 8% of men develop urinary incontinence after prostatectomy. On the bright side, most men will regain complete control of their bladder in time. 

What Levels Of Incontinence Does A Person Experience During Their Recovery?

Recovery after prostate surgery takes time. You may be required to stay at the hospital for one night to monitor your health.  

After getting back home, here’s what you can expect for the post-surgical period. 

Stage 1 - one week after surgery 

The surgeons insert a urine catheter in your bladder as you experience a full bladder void in the first few days4. You will be given medication for pain management. 

The surgery area heals within 7-10 days of the surgery. After that, you will have the urine catheter removed. However, you will still experience heavy accidental incontinence. 

This is also the period where your doctor will let you know if you need to come back for further treatment or not. 

Stage 2 – one month after surgery

You can resume general activities 4-6 weeks after the surgery. However, doctors recommend staying away from strenuous activity. Most recoverees will take an off from work for 3-4 weeks.  

Your incontinence will be the heaviest during this period as your bladder is still recovering. Absorbent products should be used for 1-3 months post-surgery. 

You will also have to go for regular visits to the doctor. You should go see your doctor every three months to ensure the recovery process is going well. 

Stage 3 – three to five months after surgery

This is the stage of partial bladder void. Your incontinence level starts to improve. So you can begin increasing your activity levels. 

Ask your doctor if you can remove the restrictions from activities like driving or lifting things. 

Incontinence is minimal after you reach the 5 months mark. Once you have completed five months, you can move away from absorbent products and wearing regular undergarments. 

Stage 4 – six months after surgery

Your incontinence level should be either minimal or almost nothing except maybe dribbles from time to time. Very few men continue to experience incontinence past the 6 months mark. Nevertheless, some do experience it for a year or longer. 

If heavy incontinence continues to persist, get yourself checked by a doctor to see if you require incontinence treatment. There are surgical and non-surgical treatments to treat urinary incontinence after prostatectomy

Prostatectomy

How Long Does Incontinence Last After Prostatectomy?

There is no fixed time period for how long incontinence lasts. The severity and recovery time will be influenced by several factors like your age, weight, fitness level, and so on. Another important factor that doctors consider is the physical characteristic of the urethra itself. 

Even if you had a radical prostatectomy (complete prostate removal), you could become fully continent. 

The vast majority of men with urinary incontinence achieve full bladder control within 3 to 18 months5. They can start doing their usual routines without any padding after 3 months. This, however, applies only to those who already had normal urinary control before the procedure. 

These are usually men who have had good health their entire lives, with ages somewhere between 40-60 years old. In the case of others, the recovery time can vary. 

Are There Any Procedures That Reduce The Risk Of Urine Incontinence?

Given the complications incontinence adds to daily routines, doctors have tried to come up with ways to limit incontinence. Surgeons try to conduct the procedure in a way that saves as much bladder and sphincter muscles around the urethra as possible.

Robotic Prostate Surgery 

Doctors are also using advanced technology for radiation treatments now. Advanced computer projections are used to place the radioactive seed implants for prostate treatment. The placement allows the seeds to destroy the prostate while limiting the damage to the nerves around the urine passing area. 

This kind of surgery is slightly different from traditional prostate removal. Studies have also shown lower incontinence and quicker recovery rates with robotic prostatectomy6. This could be due to the greater maneuverability with the computer projection, allowing for more accurate dissection around the apex. 

How Long Does It Take To Recover From Robotic Prostate Surgery?

For most men, regaining full continence is a gradual process that can go on for several weeks to a few months. Within six months, those who had normal bladder control before the procedure regain it. 

They no longer need to wear pads as an absorbent. Some may prefer to continue wearing a liner just in case there is an accidental leak. 

Incontinence products

Which Absorbent Products Can You Use For Every Stage Of The Recovery?

Many men use absorbent products to avoid accidental leakage. These absorbent products are designed to absorb urine to protect your skin and clothes.

Accidental leakages are problematic and unsanitary due to the wetness and odor. Absorbents will keep you comfortable and clean, so you can go about your day stress-free.

Over 50% of members of the National Association for Continence (NAFC), a support group for incontinence patients, use absorbents7

Different products vary in their absorbent levels. Their absorbing capacity varies between 20-300 ml. 

Here are some of the absorbent products you can use for different stages of urine incontinence after prostatectomy

For Minimal Incontinence

Panty shields or panty liners have enough absorption capability for accidental dribbles. It is commonly used during the end of the recovery stage when you do not need heavy absorbents but require a safety net. 

For Light Incontinence

Since urine loss may be more here, close-fitting pads are more appropriate for this level of incontinence. Close-fitting pads or absorbent guards are typically attached to undergarments. You can just put them on and wear your usual clothing on top.

For Heavy Incontinence

Heavy urine loss requires bulkier absorbents like adult diapers or full-length pads. The bulkiest absorbent are adult briefs which are secured in place with self-adhesive tape. You can also buy absorbent pads designed for protecting bed mattresses at night. 

You should remember that these absorbent products are in no way a cure-all remedy for urinary incontinence. They are simply there to provide to help you with urine loss and for hygienic purposes. 

Long-term use or dependency on these pads can make it harder for you to achieve full continence. It leads to better acceptance of your incontinence condition, which can demotivate you from seeking treatment. 

Recovery Stage Summary Table

Here's a summary of the different stages of incontinence after prostatectomy.

Recovery Stage

Incontinence Level

Absorbent Product

First week

Full Bladder Void

NA (Urine Catheters)

First month

High Incontinence

Adult briefs or diapers

Three to five months

Slightly High To Light Incontinence

Close-fitting pads

Six months and above

Minimal Incontinence

Panty liners

What Treatments Exist To Improve Incontinence During Recovery Stage

What Treatments Exist To Improve Incontinence During Recovery Stage?

If moderate leakage is making you feel discomfort, you can ask your healthcare providers for treatment options. 

They will start you off with non-surgical treatment options, such as:

Kegels

First are exercises that train your bladder muscles to hold the urine successfully — kegel exercises are excellent for that purpose.

They strengthen your pelvic floor muscles, which speeds up the recovery process. These muscles are also the ones you use to stop yourself from urinating. So strengthening them with regular Kegel exercises will really help in controlling urine flow. 

Biofeedback Programs

It is common to combine these exercises with biofeedback programs. Biofeedback monitors can help you understand if the Kegel exercises are working well or not. 

Behavior Modification

Behavior modification is changing certain habits that contribute to frequent involuntary urination. This would mean cutting out caffeine, alcohol, spicy foods and avoiding drinks before bedtime. 

Weight loss is also known to improve continence, so change to a healthier diet during your recovery period8

Surgeries That Treat Urine Incontinence After Prostate Surgery

If none of these non-invasive treatments prove to be effective, your next best bet is to go for surgery. 

There are three types of surgery for treating urinary incontinence after prostate removal

Urethral Sling

A sling is essentially a synthetic mesh tape implanted in the urethra to suspend and compress it. The urethral compression from the sling improves your bladder control. 

Neuromuscular Electric Stimulation

In this treatment, the surgeon will insert a probe into the anus. A current is passed through the probe. Since it is below the pain threshold, it only causes a contraction. 

You will then be asked to squeeze your muscles when the current is on. The stimulation works your muscles to strengthen and retain weakened urinary muscles for better bladder control. 

Urethral Sphincter

An artificial sphincter is used by those who have severe urinary incontinence or experienced damage to their sphincter muscles. 

This patient-controlled device helps close the way out from the bladder using an inflatable cuff. A balloon device regulates the pressure of the cuff, and a pump regulates the inflation.

Final Thoughts

It is a trying time when you have to have your prostate removal or surgery done. You can, however, reduce the mental and physical toll by being prepared to deal with urine incontinence after prostatectomy

Apart from keeping yourself informed about the pre-surgery and post-surgery procedures, you also need a good support system. Look for a forum like the NAFC message board. These forums are a great place to share your experiences with others suffering from urine incontinence.

Prostatectomy FAQ

Bonus: Prostatectomy FAQ

After prostate surgery, how long will I have incontinence?

The majority of men who lose bladder control suffer symptoms for 6 months to a year after prostate surgery. However, a tiny number of men may continue to have issues after the first year.

Is incontinence after prostate surgery normal?

Urinary incontinence affects about 6-8 percent of men who have had their prostate surgically removed. The good news is that after time, most men will restore bladder control.

Does radiation treatment for prostate cancer cause incontinence?

After prostate removal, some men require radiation therapy. Some of the normal tissues around the urinary sphincter, urethra, and bladder may be exposed during radiation therapy, producing discomfort and incontinence afterward. This usually goes away after a few months of radiation therapy, but if it doesn't, the extra treatments listed below may help.

After prostate surgery, what causes incontinence?

Prostate removal surgery might cause urinary incontinence as a side effect. The urethra is surrounded by the prostate, which is placed directly below the bladder. The nerves and muscles of the bladder, urethra, and the sphincter, which controls the passage of urine from the bladder, can occasionally be damaged when it is removed or treated with radiation. Urinary incontinence can arise as a result of this.

Incontinence after prostate surgery: How bad is it?

The severity of incontinence varies from person to person, ranging from complete incontinence to minor dribbles. And, as you progress through your rehabilitation and any other bladder or pelvic floor therapies you may be doing, the amount you leak will likely decrease.

After prostate surgery, does incontinence go away on its own? 

Urinary incontinence usually goes away in about a year for most guys. Pelvic floor exercises, commonly known as kegels, are exercises that assist strengthen the muscles in the base of the pelvis between the pubic bone and can help speed up the recovery process.

How can I reduce incontinence after prostate surgery?

After prostate surgery, if you want to stop incontinence, kegels could be the answer. Kegels are a prominent therapeutic option for incontinence after prostate surgery, as previously indicated. The pelvic floor muscles, among other things, help govern bladder and bowel function, and if they become weak, they will no longer be able to execute their job properly.

Kegels must be performed on a daily basis to increase muscular function. The good news is that they can be done almost anywhere, at any time, and in a variety of ways (sitting, standing, lying down, etc.). Click here for a step-by-step tutorial to doing a men's kegel.)

Biofeedback can occasionally be used to check if you're doing a kegel correctly. Additionally, electrical stimulation can be utilized to retrain muscles to contract.

If my incontinence doesn't go away after a year, what are the options for me?

While kegels and behavioral therapy are successful for most men with mild to moderate leakage, they may not be enough for some. Fortunately, there are still some treatment options available for bladder leaks following prostate surgery.

When bladder leaks persist for more than a year following surgery, further surgery may be required. A urethral sling operation or an artificial urinary sphincter are two options. A synthetic mesh tape is inserted to support the urethra during a urethral sling surgery. This method has been shown to improve men's leaking by up to 80%, and some men have totally stopped leaking.

Patients who have more severe urine incontinence that is not improving or who have had a lot of damage to the sphincter muscle following prostate surgery may benefit from an artificial urinary sphincter. A mechanical ring that helps close the exit from the bladder is known as an artificial urinary sphincter.

These operations, like all surgeries, have benefits and drawbacks as well as the possibility of problems. Make sure to talk to your doctor about these choices.

What is the procedure for a robotic-assisted prostatectomy?

It's similar to a traditional laparoscopic prostatectomy, although it's less intrusive. The surgeon, however, uses four precision-guided robotic arms to cut and remove the prostate from a dedicated console in the operating room.

A small video camera is introduced through a keyhole-sized incision to provide surgeons with magnified, three-dimensional views of the prostate location. Doctors can see the nerve bundles and muscles that surround the prostate with this wide view. The robotic arms, which can rotate 360 degrees, are inserted through a series of keyhole incisions, allowing surgical tools to move with greater precision, flexibility, and range of motion than in a traditional laparoscopy. 

Under general anesthesia, the surgery normally takes 2 to 3 hours. Patients who have had a prostatectomy normally stay one night in the hospital and are discharged as soon as their laboratory tests are normal, their discomfort is under control, and they are able to retain liquids.

Patients are discharged with a specific catheter, which is removed 5-7 days following the operation during an outpatient appointment.

Why does robotic-assisted surgery result in less blood loss?

The use of robotics in surgery allows for a more precise and less disruptive dissection, which aids in the control of potential bleeding sources. The pressure created by the gas used to inflate the abdomen during surgery also reduces blood loss, giving surgeons a better and more expansive view of the operating area around the prostate.

References

1. Continence After Your Prostate Robotics Surgery, n.d.

2. Incontinence After Prostate Surgery, n.d.

3. Incontinence After Prostate Surgery, n.d.

4. Prostatectomy, n.d.

5. Continence After Your Prostate Robotics Surgery, n.d.

6. Hoyland, K., Vasdev, N., Abrof, A., & Boustead, G. (2014). Post-radical prostatectomy incontinence: etiology and preventionReviews in urology16(4), 181–188.

7. Andip P Vasavada, 2021

8. Subak, L. L., Whitcomb, E., Shen, H., Saxton, J., Vittinghoff, E., & Brown, J. S. (2005). Weight loss: a novel and effective treatment for urinary incontinenceThe Journal of urology174(1), 190–195. 

Disclaimer: The information presented here is purely for educational purposes and should not be used in place of the advice of your doctor or physician.