Prostate Cancer, Recovery & Expectations: Incontinence
The recovery after prostatectomy or the removal of the prostate is a dicey subject that thousands of men have to contend with every year. While a prostatectomy is, by any measure, a life-saving procedure, it does come with significant postoperative considerations. Over the years, we have improved techniques and technology that have allowed for the sparing of essential nerves in the area; however, even the best prostatectomy virtually guarantees some urinary incontinence for a time afterward. Many patients are happy to know that urinary incontinence eventually resolves in about 90 to 95% of patients. Urinary incontinence can be treated with elegant and practical solutions for the remaining patients.
Urinary Incontinence After Prostatectomy
The urinary incontinence experienced by virtually all men after their prostatectomy is related to the urinary valves or sphincters that each of us has. Before prostatectomy, we have two valves that regulate urine flow, but one of these valves must, as a matter of course, be removed along with the prostate; there is no surefire way to know if the remaining valve will have sufficient function and power to stop the flow of urine on its own. Herein lies the unpredictability of urinary function after surgery.
With that said, the return to continence after prostatectomy can take anywhere from a few weeks to a year and sometimes even more. However, we consider a year an appropriate cut-off point to begin conversations about surgical therapies to improve continence.
However, because the process is so long, patients often don’t recognize they are making progress and become frustrated. While this is normal, we encourage our patients to stay the course and acknowledge that while slow, their progress may be perfectly normal. Below, we will discuss the stages of continence after prostatectomy. Of course, not everyone will follow the same path, but this is generally what we like to see.
Initially, almost all patients will leak and require multiple pads daily. These absorbent pads help the patient continue their daily life without worrying about an embarrassing accident. Patients will be guided on how and when to change their pads and how to perform exercises, including Kegels, to strengthen the pelvic floor and bring about continence sooner.
Eventually, patients will get to the point where they sleep through the night without leakage. This is a significant step that gives patients lots of hope. Initially, they may not be able to get to the bathroom in time and will leak immediately after waking up. Once again, this is an ordinary course as continence improves.
At some point, relatively soon after, the patient should be able to hold their morning urine until they get to the toilet. During this stage, they will likely not hold the urine past this overnight period as daily activities will force them to leak.
Eventually, the patient will get through most of the day – let’s call it around 4 PM – before they leak. This late afternoon leakage results from tiredness and the appropriate muscles not having the stamina to get through the rest of the day.
Finally, the patient will eventually be able to make it through the entire day without leakage and find a dry pad by the end of it. During this stage, many patients wear a pad just in case they leak, thus avoiding any potential embarrassment or concern associated with their incontinence. We typically allow them to do so for a while as they gain confidence that they will no longer leak during the day. However, this security pad, as we call it, or crutch, can begin to work against the patient’s long-term goals. By leaning on this crutch all the time, patients may not place the appropriate emphasis on going to the toilet when needed and being diligent with their urinary habits. As such, eventually, we will strongly encourage patients to eliminate that final security pad and live without the backup plan.
What if I Haven’t Regained Continence?
Unfortunately, there are some patients who, for one reason or another, have not been able to regain their urinary continence, even after a year or more of diligent exercise and patiently waiting; for these patients, there are solutions, so they should not resign themselves to a life of wearing pads and worrying about leakage. Two surgeries, the artificial urinary sphincter and the male urinary sling, may help qualifying patients with the next steps. Both options are discussed elsewhere on our website, representing minimally invasive and highly effective solutions to the ongoing problem.
Our Comprehensive Postoperative Prostatectomy Program
After prostatectomy, most patients will experience some erectile dysfunction in addition to the urinary incontinence we discussed above. Dr. Natale has seen far too many patients go years or even decades suffering from these problems when there are solutions to help. As such, we have a team of three professionals and our dedicated staff at the office to help with post-op concerns. Dr. Natale, Gregg McKittrick, our pharmacist consultant, and Lis Mallers, our sex therapist, all work together to help patients through this trying time and get them back to erectile and urinary function as soon as possible. Of course, the first step is to contact us to learn more. Dr. Natale always looks forward to helping his patients and others comprehensively navigate the choppy waters of post-prostatectomy recovery.