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Prostate Cancer

Urinary incontinence

Short-term urinary incontinence is very common after radical prostatectomy. However, for most men, this usually clears up within three to six months of the operation. About two in every 10 men have long-term problems requiring the use of pads.” (NHS Choices 2016). 

“Around 2 out of 100 men (2%) have major problems with incontinence after one year of their surgery." Cancer Research UK July 2016

Newer surgical procedures and treatments such as Robot- assisted laparoscopic radical prostatectomy, and HIFU are reported to cause less erectile dysfunction and incontinence than radical surgery. Occasionally urinary incontinence follows other treatments such as radiotherapy or transurethral resection. Some of the men interviewed who had had a radical prostatectomy described the practical problems that they had encountered after their surgery. Also, men who had been treated with brachytherapy described their urinary symptoms after treatment.

 

Explains that he needed pads after surgery but things are mostly back to normal now.

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Age at interview: 55
Sex: Male
Age at diagnosis: 54
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Obviously the muscles on the bladder were not working that well at that time but they were reasonable as I tended to drip. So I was given different male pads to take home with me. But you were only given enough pads for a short period of time, then you've got to buy the pads yourself, the male pads are very hard to get as many chemists do not stock them. And I'd advise anybody to make sure that their local chemist or pharmaceutical outlet got them in for you as our local chemist only had one pack, so it is advisable. The pads are not uncomfortable to wear but it is a little bit annoying that you feel a drip now and again. 

I haven't worn pads now for the last 4 or 5, about the last 4 months. I get a drip now and again but it's mostly if I've got my legs, if I put my legs wide apart you can't, it does make you drip slightly but basically if you just do the normal day to day things you're alright. And I'm doing quite a physical job [as a builder].

 

Comments on an idea he had to avoid some of the embarrassing problems with incontinence.

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Age at interview: 70
Sex: Male
Age at diagnosis: 67
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The other problem that we have, not every man, but a lot of prostate cancer patients, particularly those are incontinent, if you go on a journey you've got to plan it via toilets, the comfort stops. This is something I brought up with the SAPCA (Scottish Association of Prostate Cancer Support Groups) recently. We're currently looking at the possibility of cards, that you can carry, like a donor card that if you really are caught out you can go into a shop, ask if you can use their toilet because it's quite embarrassing, it's embarrassing may be for other people. I don't know, but there is a need for something like that. They're small things but they're things that do irritate prostate cancer patients, that there's no provision there to help them in these particular aspects.

 

Explains how his confidence is returning after initial urinary problems following Brachytherapy.

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Age at interview: 59
Sex: Male
Age at diagnosis: 59
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After the Brachytherapy, although at no time did I suffer any embarrassment I felt that the opportunity to be embarrassed was there. So this, you know I phoned the doctor up because extremely uncomfortable and very painful and I've since seen the doctor and this is one of the side effects that certain people experience. I experienced this pain in the bladder and trouble passing water and passing water far too often to get involved in doing anything else and this obviously leads to a lack of confidence and you don't feel like leaving home. But this has improved dramatically over the last week and it's nearly, I wouldn't say it's nearly back to normal that's probably right but it's on it's way and this is one of the symptoms that you may get. And the doctors aren't worried so far be it for me to be worried because I don't have their experience and I'm sure they're right. And my confidence is gradually returning and I can go out of the house and travel about now and it's getting back to normal.

 

Describes how Detrusitol helped prevent urinary symptoms interfering with his life after...

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Age at interview: 68
Sex: Male
Age at diagnosis: 66
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Temporary incontinence due to male cystitis in my case necessitated pads available from the District Nurse for one week & my operation having taken place in September '99 I still had a few urinary symptoms eight months after the operation, that is very urgent frequency together with a very occasional accident and nocturia once or twice at night. I sought further advice from my urologist who prescribed Detrusitol [tolterodine] this gave me the ability to control the frequency which had begun to interfere with travel by train.

 
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He was totally incontinent for the first six months after his prostatectomy. Then the problem...

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I was incontinent from October to the following April, totally urinary incontinent and that of course was a problem easily overcome but it has to be rather in the forefront of your mind because the sort of nappy type pads that I wore had a 40 minute life span. One had to change them in 40 minutes so one had to park the car so if you were going to go shopping you'd be back again into the car within 40 minutes. When I got better [from surgery], I went back to seeing patients, one had to make certain that no interview of a patient lasted more than 40 minutes, 40 minutes almost precisely, and then I had to go and change my pads. If I was lecturing, anything of this sort, I mean I couldn't lecture for more than 40 minutes. I had to find an excuse to disappear. I couldn't go to a cocktail party, you know, if one was going to go to a cinema or anything of that sort, everything had to be worked out in 40 minutes' I was still very pleased I'd had the surgery. I mean I would never have not had the surgery because of it. It was a nuisance but I was beginning to make long term plans about how one was going to deal with this nuisance. It did seem at the time it would be difficult to continue in medicine with such a short sort of urinary span. And a very nice former consultant who I knew, who had exactly the same problem and was left totally incontinent, had heard about this on the grapevine and came round to have a chat. And he said, 'It's really very easy. The whole question is sun' and he said, 'What you've got to do is retire' and he said, 'You buy a house in Spain where you have a lovely patio and you sit in the sun and you're never more than 10 minutes away from the loo.' And he said, 'In the winter you go out to Australia or New Zealand and you spend your winter out there and you just come back to England at Christmas time.' Well, that actually struck me that he must have done very well when he was a consultant but I didn't see my financial resources running to a house in Spain and three or four months of the year in Australia. So I said it was very kind of him to come but I might have to find more simple ways round it. And then suddenly it started to get better.

Did you find it hard to get the pads or was it quite easy?

It was quite easy. They used to arrive by post in a great bundle. I'd got the address of where I'd had the pads when I was in hospital, I wrote to them and I just had a regular, steady order.

Men who suffer from incontinence have various options, including special pelvic floor exercises, pads, catheters, urinary sheaths, medical therapies and surgical intervention. Surgery includes the ‘male sling’ and the artificial urinary sphincter. The insertion of an artificial urinary sphincter is an established operation with high patient satisfaction. During this operation an inflatable cuff is placed around the urethra and a pump is inserted (usually situated in the scrotum). Once the artificial sphincter is in place, a man can use the pump to empty (deflate) and fill (inflate) the cuff. Squeezing the pump moves fluid from the cuff to the balloon. When the cuff is empty, the urethra opens so that a man can urinate. The cuff will re-inflate on its own. Surgical intervention is usually considered 1-2 years after prostatectomy.

 

After surgery John experienced some incontinence. Two years later he still had problems so had a...

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Age at interview: 57
Sex: Male
Age at diagnosis: 54
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The two principal side effects were firstly, incontinence I had to wear incontinence pads, I was wearing quite large pads, and getting through a couple a day, two or three a day to begin with,  things improved over the course of the first six months I suppose, I was doing pelvic floor exercise, perhaps not as consistently as I might have done but they helped, but then it’s, it reached a plateau, I was, after that point I was going back to the hospital every six months, for a check up which consisted of a PSA test and a chat about my condition generally, and after the first two or three perhaps of those assessments I had... the guy I saw had been trained and was operating on male slings which reduce incontinence and he thought that I was an ideal candidate for that, so I had a test for that, which was basically to see the capacity of my bladder and the amount of leakage, and they decided that because I wasn’t too severely incontinent that I was a good candidate for that so I was put forward for that second operation, which took place just about two years after my prostatectomy. I had the operation under, I had the choice of local anaesthetic or a general anaesthetic, and I chose a local because I don’t like anaesthetics very much, the operation was quite straightforward, quite quick, I went home the following day. It was incredibly uncomfortable, the operation is basically you’re, you’re cut open, right underneath, right underneath the bit you sit on, which made it very difficult, when I got home, very difficult to get comfortable, difficult at night, difficult when you are sitting down, and difficult walking, the first couple of weeks were pretty uncomfortable, it was, I would say it was, that the operation was worth doing because the incontinence was reduced, but I had rather hoped that I’d be completely free and in control of, that aspect and free of having to wear pads, but it wasn’t, things were a lot better, I wear one smaller pad now, and I don’t have to worry so much about it, I don’t have to worry about making sure that I’m within reach of a loo so I can change my pad when I go out in the evening or anything like that, so from that point of view it’s been very beneficial, not as good as I would have hoped.

 

 

John explains that his incontinence may still improve as his 'male sling' gets stronger. He finds...

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Age at interview: 57
Sex: Male
Age at diagnosis: 54
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And have you been told that that will get better, or will that be the level of incontinence?
 
It [urinary incontinence] may still get better, because the, the way the male sling works it’s, I believe it’s attached to the pelvic bone at either side, and then it just flops underneath the bladder, but in the course of putting it, or in the course of fitting it, there is scar, operation surgery damage which creates scar tissue and the scar tissue actually [lights go out] strengthens the sling so that over the course of time the sling actually gets stronger.
 
The sling gets stronger?
 
The sling gets stronger, so there is hope, I’ve been told that over, perhaps the first year, there, there is certainly a possibility that things will get better, and I’m trying to help myself a bit more now and doing pelvic floor exercises which definitely do help and I notice that if I go a day or two without doing the exercises, then things get worse. So I really should be doing them several times a day, and I should be drinking less coffee than I do, but I like coffee and like to have a pint sometimes in the evening, and one puts up with the consequences.

 

 
Last reviewed July 2017.
Last updated July 2017.
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