Osteoporosis (thinning of the bones) also is a problem because it can lead to decreased mobility, reduced quality of life, and debilitating falls. As treatments for prostate cancer improve, these complications will become less common. For now, however, men should be aware that there are effective ways to alleviate these problems.
Incontinence and Prostate Cancer Treatment
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). As a result, some degree of incontinence (inability to control bladder function) is common immediately after treatment.
For example, urge incontinence (the strong and sudden need to urinate, followed by a bladder contraction and involuntary loss of urine) is common for a few days after catheter removal in men who have undergone TURP for the treatment of BPH. In the initial period after radical prostatectomy for prostate cancer, men typically experience stress incontinence, in which urine leakage occurs during moments of physical strain (such as sneezing, coughing, or lifting heavy objects).
Recovering bladder control can be a slow process and may take up to six months. Fortunately, severe incontinence occurs in less than 1 percent of men after surgery for BPH and in fewer than 3 percent of men following radical prostatectomy or radiation therapy for prostate cancer.
Several approaches can be taken to improve bladder control. These include lifestyle measures, Kegel exercises, collagen injections, and implantation of an artificial sphincter. In addition, the use of absorbent products, penile clamps, external collection devices, catheters and medications also can help men cope with incontinence resulting from treatment.
Lifestyle Measures and Incontinence
Simple changes in diet and behavior can be helpful. Excess weight increases pressure on the bladder and worsens incontinence. Weight loss through calorie restriction and increased physical activity will help ease the problem.
Because constipation also can worsen symptoms, it is important to eat high-fiber foods, such as leafy green vegetables, fruits, whole grains and legumes. Caffeine and alcohol increase urinary frequency and therefore should be limited. If nighttime urination is a problem, avoid consuming liquids during the last few hours before bed.
Kegel Exercises and Incontinence
These exercises are performed by squeezing and relaxing the pelvic floor muscles that surround the urethra and support the bladder. To locate the pelvic floor muscles, try slowing or stopping your urine flow midstream as you urinate. Strengthening these muscles may improve bladder control after radical prostatectomy.
In one study, 19 percent of men who performed regular Kegel exercises had regained urinary continence by one month, and 95 percent of the men were continent by six months. Among men who did not do the exercises, 8 percent were continent by one month, and 65 percent were continent by six months.
Kegel exercises involve contracting the pelvic floor muscles for three seconds and then releasing them for another three seconds. Although there is no standard routine for performing Kegel exercises, a good starting point is 45 repetitions a day. Try dividing the 45 repetitions into three sets of 15. Do each set in a different position: sitting, standing, and lying down.
Collagen Injections and Incontinence
If urinary incontinence persists, collagen can be injected around the bladder neck to add bulk and provide increased resistance to urine leakage during times of physical strain. Repeat injections often are needed because collagen is a naturally occurring protein and is gradually broken down by the body.
Artificial Sphincter Implantation and Incontinence
In this procedure, a doughnut-shaped rubber cuff is positioned around the urethra. The cuff is filled with fluid and connected by a thin tube to a bulb implanted in the scrotum. The bulb, in turn, is connected to a reservoir implanted within the abdomen. The fluid in the cuff creates pressure around the urethra to hold urine inside the bladder.
When a man feels the urge to urinate, he squeezes the bulb. This transfers fluid from the cuff to the reservoir and deflates the cuff for three minutes so that urine can drain through the urethra. Afterward, the cuff automatically refills with fluid and urine flow is again impeded.
Absorbent Products and Incontinence
Wearing absorbent pads or undergarments is the most common way to manage incontinence. These products are often used right after surgery and are effective for managing all degrees of incontinence, ranging from mild to severe.
Penile Clamps and Incontinence
An option for severe incontinence, these devices compress the penis to prevent urine from leaking. Penile clamps are not recommended immediately after treatment because they interfere with the development of the muscle control needed to regain urinary continence.
External Collection Devices and Incontinence
These condom-like devices can be pulled over the penis and held in place with adhesive Velcro straps or elastic bands. A tube drains urine from the device into a bag secured on the leg. Collection devices are often used with a penile clamp and should not be used immediately after surgery.
Catheters and Incontinence
A Foley catheter is a small tube that is inserted through the urethra to allow urine to flow continuously from the bladder into a bag. This option is not recommended for long-term use because it can cause irritation, infection, and, possibly, loss of bladder muscle control.
Medications and Incontinence
Although medication can help control mild to moderate incontinence, it is not effective for severe cases. Drugs such as oxybutynin (Ditropan) and tolterodine (Detrol) may reduce urge incontinence by decreasing involuntary bladder contractions. Nasal decongestants, like pseudoephedrine, or the antidepressant imipramine (Tofranil) can reduce stress incontinence by increasing smooth muscle tone in the bladder neck.
Because pseudoephedrine is a stimulant that can increase heart rate and blood pressure, it should only be used under a doctor's supervision. The drug may cause nervousness, restlessness and insomnia and may have adverse effects in people with asthma or cardiovascular (heart) disease.