Urinary issues in males can be a common consequence of prostate cancer treatment, usually impairing the muscles and nerves that regulate urination. Several urinary issues may arise from different treatments. Depending on your medication or if you had urinary issues before the therapy, you’ll have a higher or lower likelihood of experiencing the side effects.
It is, therefore, best for a patient to consult a healthcare professional before beginning prostate cancer treatment to know about the potential side effects. Additionally, the patient should inform their healthcare specialist of any urinary issues after undergoing prostate cancer therapy to receive on-time treatment and appropriate lifestyle modifications for urinary dysfunction management.
The nature and seriousness of your issue will determine the treatment for urinary dysfunction. Although the resulting urinary dysfunction after prostate cancer treatment might seem incurable, treatment through surgery, pelvic floor exercises, medication, bladder retention, or lifestyle changes is possible.
What Is Urinary Dysfunction?
- Experiencing urinary incontinence, that is, the inability to hold urine. The individual’s bladder can leak little at unwanted times or empty involuntarily.
- Urinary discomfort or irritating voiding symptoms, such as increased urinary urgency, frequency, or painful micturition.
- Urinary retention, which is trouble voiding.
The common initial source of these problems is bladder blockage brought on by prostate enlargement. However, following treatment, the micturition problem is often brought by harm to the muscles and nerves involved in bladder control.
Common Types Of Urinary dysfunction Associated With Prostate Cancer Treatment
After having surgery for prostate cancer, you may suffer from accidental leakage of urine upon sneezing, coughing, or carrying heavy weight. The pressure or stress on the bladder results in stress incontinence. Men typically experience this post-prostate surgery.
Urge incontinence occurs when you feel the urge to urinate immediately, but you cannot hold it till you get to the bathroom. It also includes frequent urination and occurs mostly after prostate cancer radiation therapy.
Why Do Treatments For Prostate Cancer Lead To Urinary dysfunction?
To understand why prostate cancer treatments lead to urinary incontinence, you need to know how urine is stored in the bladder. The kidneys excrete the urine into the bladder, which remains there until you feel the urinary urge.
After the bladder’s capacity has reached half its limit, an impulse is generated, resulting in the bladder’s muscular wall being contracted. This way, the urine is forced out of the bladder and passes through the urethra, which relaxes simultaneously for the fluid to eliminate.
While the passageway to the urethral opening is straightforward in females, the male anatomy is different. In males, the prostate gland encircles the urethra. Urinary issues might result from an enlarged prostate gland, which can obstruct the urethral tract.
However, treatments for the prostate gland can also lead to urine or bladder dysfunction. Urine leakage may occur when the prostate is radioactively destroyed (using radioactive seed implants or an external beam) or surgically removed. Radiation exposure can reduce the bladder’s volume and result in contractions that compel urine to flow out.
Another treatment, radical prostatectomy, is a surgery that involves the complete removal of the prostate. There are valves outside the prostate that allow or stop urine excretion. One of them is excised along with the prostate gland during surgery.
The presence of one functioning valve is usually sufficient. But surgery can sometimes injure nearby nerves and muscles responsible for regulating bladder function. It can result in urinary dysfunction or incontinence in almost 6-8 percent of males.
How Is The Risk Of Developing Incontinence Minimized After Prostate Cancer Treatment?
To minimize the sphincter injury associated with prostate cancer treatment, surgeons attempt to preserve enough sphincter muscles around the urethra and the region surrounding the bladder during prostate removal.
Additionally, medical professionals have improved the procedure for prostate brachytherapy or implanting radioactive seeds, utilizing advanced computer projections that enable the seeds to kill the prostate cells while causing the least amount of bladder damage.
However, every male receiving surgery or radiation therapy for prostate cancer must remember that they’ll experience some degree of urinary dysfunction issues after treatment. With modern methods, some men will only experience brief issues with urination control, but many will eventually regain complete bladder control.
Let’s look at men’s urinary issues after undergoing particular prostate cancer treatment and their respective solutions and management.
Urinary Dysfunction After Prostate Cancer Surgery
Urinary issues following prostate cancer surgery (Radical Prostatectomy or RP) include:
- Urinary retention
- Leaking urine
Following surgery, some men may experience trouble urinating (urine retention). Scarring post-surgery can constrict the urethra, which results in urinary difficulty. However, it rarely happens after surgery.
It is a typical urinary issue following surgery for prostate cancer. After surgery, a catheter (a small tube) is placed inside the body. It is done to withdraw urine from your body. The catheter is removed after 1-2 weeks post-surgery.
Usually, males struggle to maintain appropriate bladder control after its removal. Moreover, surgery can harm the pelvic floor muscles, the urinary sphincter, and the nerves and muscles that regulate urination.
It takes time to recover from this condition. Hospitals offer absorbent incontinence pads to place in underpants. But when a patient has catheter removal, he might require some pads and a spare set of pants and trousers. Men frequently find loose, lightweight pants the most comfortable, and tight underwear can assist secure the pads in place.
Patients might experience less (a few droplets) or more when sneezing, coughing, or exercising. Some males also urinate during an erection or intercourse. The frequent leakage of urine might distress the patient, cause them to withdraw from social activities, and even cause skin irritation if proper hygiene is not ensured.
Solutions To Help With Urinary Leakage
You can take certain steps to aid yourself and use treatments and items helpful for urinary leakage post-prostate cancer treatment. The period of your prostate cancer surgery and the amount of leaking urine will determine which treatment options suit you. Patients must consult their physician before selecting appropriate products or treatments.
The following products and treatments are available that may be helpful:
Absorbent Pants and Pads
To absorb any leaks, wear absorbent pads underneath clothes or absorbent pants in place of underwear. Wearing fitted underwear with pads is comfortable for some. There are also options of urinary leakage underwear. In case of minimal leaking, trying female pads is better as they are small and lightweight.
Pads aren’t very apparent to others if worn discreetly. However, dark pants are recommended to make you feel self-assured if the pad leaks. Depending on your privileges, continence nurses or GPs may even provide complimentary pads. Otherwise, you can get them online or physically from pharmacists or supermarkets.
Pelvic Floor Exercises
These exercises strengthen your pelvic floor muscles, which aid in controlling when you urinate. Many medical professionals prefer to begin by teaching men behavioral skills to help them control their tendency to retain urine.
The muscles you squeeze to stop urinating midway are strengthened with Kegel exercises. You can combine these exercises with physical treatment for the pelvic floor with a biofeedback program to intensify your training of these muscles.
Men should continue performing Kegel exercises daily. Exercises for the pelvic floor can help you regain, maintain, or improve bladder and bowel control by strengthening the muscles at the bladder exit.
Stop urinating mid-flow or tense the muscles that prevent you from passing gas to locate the pelvic floor muscles. If you clench your pelvic floor muscles, the testicles will elevate, and the base of the penis will shift nearer to the abdomen.
Every day, try to perform 3–10 sets of 10 repetitions. Each set should alternate between rapid and extended muscle contractions (compression of the muscles). Perform this in front of the mirror. Avoid contracting your buttocks, thighs, or tummy muscles.
Long contractions: Gradually extend the length of the contraction until you can hold it for ten seconds. Between each contraction, take 10 seconds to relax. Muscles are quickly tightened and then relaxed during rapid contractions.
Sheaths or external catheters are attached to a thin tube that empties urine into a bag. The catheter is fixed on the penis, and the urine bag is strapped to the leg, hidden beneath garments. It must be emptied once filled.
Portable Urinals Or Bed Protectors
Bed protectors or portable urinals are helpful for patients who experience bed spills or frequent urination during the night. Large pads called bed protectors absorb any leaks, protecting your mattress and sheets. Washable, reusable, and disposable varieties are easily available.
Portable urinals allow urine collection in case there is no access to a toilet or when traveling long distances. They are practical to use with a big hole and a cap.
Male incontinence can be treated with a non-invasive treatment called a penile clamp that doesn’t include any medicines or surgery. To stop urine flow, the clamp is inserted around the penis. This external clamp applies gentle pressure to obstruct urine flow via the urethra.
Penile clamps are found successful for males with urinary incontinence. A penile clamp is for daytime use and brief periods only. It is a must to remove it once after two hours to allow blood regulation through the penis. However, they are uncomfortable and may decrease the blood supply to the penis if care is not ensured (clamp left long enough or tightened too much). Hence, health specialists usually do not recommend them.
Patients must seek the following treatments if they do not recover with the help of the solutions mentioned above and experience continuous leaking for six months to a year post-surgery. These treatments consist of the following:
- Internal sling
- AUS (Artificial Urinary Sphincter)
- Adjustable balloons
Solifenacin (Vesicare), Tolterodine (Detrol), and similar anticholinergic drugs aid in treating the signs and symptoms of bladder irritation and help keep the urethra closed or relax your bladder in case of continuous urinary leakage if other therapies are not effective for you. However, side effects from medicines are possible. You can discuss this with your physician before taking them.
Bulbourethral Or Internal Sling
A sling can be used to deal with different urinary incontinence. The urethra is suspended and compressed using a sling, providing the urethral compression required to establish bladder control. It can be created using the patient’s tissue or synthetic material.
Approximately 70% of men who undergo prostatectomy benefit from the sling, albeit only about half of them reported being fully dry after four years. Fewer men reported being entirely dry after four years, with only 30% reporting dryness after radiation therapy.
A sling is a tiny mesh piece pressed onto the urethra to keep the urinary sphincter closed, preventing urine leakage. It is a surgical procedure that involves general anesthesia administration. It must not be too tight to restrict urine flow while passing urine and not too loose to allow leakage.
Those who require 2-3 absorbent pads per day after a year of prostate cancer treatment and get a mild or moderate amount of leakage might require an internal sling. However, it is ineffective for those who underwent radiation therapy or have excessive urine leakage.
There may be side effects of an internal sling, as with other treatments, which include:
- Pain: it can be painful for a few months after getting internal sling surgery
- Infection: one in eight men may require sling removal due to an infection.
- Urinary retention: following surgery, some men experience difficulty while urinating. This side effect is very rare.
You can learn more about the potential side effects from your doctor.
Artificial Urinary Sphincter (AUS)
More than 70% to 80% of individuals are cured or have significant improvements because of an artificial sphincter, a patient-operated device.
An operation with the administration of general anesthesia is necessary to insert this compact device that comprises of:
- A cuff that encloses the urethra and is filled with fluid to prevent urine leakage
- A balloon placed anterior to the bladder for control pressure
- A pump placed in the scrotum
The fluid leaves the cuff and enters the balloon upon squeezing the pump placed in the scrotum. Upon emptying, it stops squeezing the urethra to shut and allows urine to travel through and excrete out. After a while, the fluid returns to the cuff and shuts back the urethra. Consequently, you get control over leakage. It is suitable for men with excessive continuous leaking until six months following prostate cancer surgery.
An artificial urinary sphincter implant carries some risks:
- Device failure
Its side effects are common in radiotherapy patients. Some men may require device removal, while others may require additional surgery to correct issues.
It involves two little fluid-filled balloons that are positioned around the urethra. Patients with adjustable balloons can urinate upon urge due to the pressure the fluid-filled balloons put on the urethra. The balloon size is adjustable whenever required using a “port” implanted in your scrotum.
Men experiencing urine leakage for more than six months following prostate cancer surgery can opt for adjustable balloons. However, those who underwent radiotherapy are not suitable for this treatment. Side effects associated with adjustable balloons include:
- Possibility of the balloons budging or deflating.
In such conditions, removing the balloons is necessary to avoid adverse reactions.
Urinary Dysfunction After Prostate Cancer Radiotherapy
Radiotherapy like brachytherapy and external beam radiation (EBRT) can result in urinary issues, such as:
- Radiation cystitis (bladder discomfort)
- Urinary frequency (urge for frequent urination)
- Urge incontinence (urinary urgency)
- Urine retention (trouble while urinating)
Radiation rarely causes urine leakage. But, patients who undergo an enlarged prostate treatment or Transurethral Resection of the Prostate (TURP) have higher chances of developing it.
Radiation cystitis is the medical term for inflammation in the urethra and bladder lining after radiation therapy. Its signs include:
- Burning sensation after urination
- Frequent urination during the day as well as at night
- Urine with blood in it
- Having trouble urinating
Its symptoms appear soon after the first therapy and usually resolve once it completes. However, some men experience its symptoms for a few months. Others don’t experience any symptoms following their last course of medication.
Solutions To Help With Radiation Cystitis
Treatments and self-care solutions can resolve radiation cystitis.
- Adequate water intake, at least 1.5-2 liters per day.
- Avoid carbonated drinks, alcohol, caffeine drinks, tea, soda, etc., as they cause bladder irritation.
- Cranberry juice might help in some cases. But those who take Warfarin (blood thinner) must avoid it.
Patients with severe radiation cystitis are given bladder wash treatment using Cystistat. This liquid medication covers and shields the bladder lining, soothing it from irritation. The liquid medication is inserted into the bladder through a tiny catheter passing up the penis. The patient is then asked to use the restroom to relieve his bladder.
Urinary Urgency and Frequency
After radiation therapy, some men might experience urgency, frequency, or nocturia for a few months. Occasionally, they will experience urge incontinence. It occurs when bladder muscles spasm or twitch uncontrollably, which forces urine out.
Solutions To Help With Urinary Urgency and Frequency
- Cutting back on water intake, drinking two hours before bedtime
- Steering clear of beverages that irritate the bladder
Numerous drugs can expand the bladder volume and lessen urinary frequency. Newer drugs might become accessible soon to help prevent other types of urinary dysfunction. Anticholinergic medications can assist in reducing leakage, urgency, and frequency. For patients with anticholinergic medicine intolerance, Mirabegron (Betmiga) is recommended.
Bladder retraining helps patients with urinary urgency and frequency. It allows the body to control and retain urine for longer periods. For details regarding bladder retaining, consult your physiotherapist or specialized continence nurse.
Percutaneous Posterior Tibial Nerve Stimulation (PTNS)
PTNS treats urinary frequency and leakage. A needle is inserted under your skin, just above your ankle. Then, a minimal current is applied through the needle to stimulate the nerves that regulate urine. It prevents the bladder from leaking before it is filled.
PTNS treatment is given once weekly for 12 weeks, each lasting around 30 minutes. PTNS has no side effects except skin soreness at the needle insertion area.
Sacral Nerve Stimulation (SNS)
It involves the surgical placement of one end of a wire electrode over the sacral nerve, with the other end attached to a stimulation box. Mild electric pulses from the SNS device stimulate the sacral nerve, which results in regaining bladder control. It helps decrease urine leakage and urinary frequency. SNS, or Sacral Neuromodulation (SNM), is an advanced treatment available in a few hospitals.
The SNS device has the size of a coin, and insertion requires two surgeries with local anesthesia administration. The initial procedure involves temporarily placing a stimulator box outside the patient’s body to check if SNS works for him. If the treatment is successful, the device is permanently inserted in the body during the second procedure. Otherwise, it is removed.
Side effects of SNS implant include:
- Device malfunction
- Discomfort in the implant area
SNS is not appropriate for all patients. Physicians can decide if you should opt for SNS or not.
BOTOX Or Botulinum Toxin
The bladder’s ability to expel urine before it is full can be prevented by injecting BOTOX into the bladder’s wall. It is a relatively modern treatment for frequent and urgent urination, and not all hospitals offer it.
Urinary retention develops in some males following radiotherapy, especially brachytherapy. It commonly occurs in patients with an enlarged prostate. Radiotherapy can result in prostate swelling, which clogs or constricts the urethra, developing urethral stricture. A small percentage of men develop urinary retention and undergo cryotherapy, radical prostatectomy, or HIFU.
There are two types of urinary retention:
- Acute urinary retention
- Chronic urinary retention
Acute Urinary Retention
It requires immediate medical attention as the patient cannot urinate in this condition. Contact your healthcare specialist immediately to receive an early diagnosis and treatment. Ensure they know your prostate cancer treatment history, particularly if you had RP (radical prostatectomy).
Treatment For Acute Urinary Retention
The patient’s bladder might be drained using a catheter.
Chronic Urinary Retention
It involves little but not complete emptying of the bladder. Typical early warning signs include:
- Abdominal or stomach bloating
- Urine leaks during the night
- Scant urinary flow
- Feeling an incomplete bladder emptying
Let your doctor or nurse know if you experience any of these symptoms. Although chronic urinary incontinence is typically painless, the urine pressure may gradually weaken and strain the bladder muscles. It might result in your bladder holding onto urine after you urinate. With time, the condition can lead to kidney issues, urinary tract infections, blood in the urine, bladder stones, etc.
Treatments For Chronic Urinary Retention
- Medications (5-alpha-reductase inhibitors or alpha-blockers) for prostate shrinking.
- Bladder emptying using a catheter
- Surgery to expand the bladder opening or the urethra
Medicines that increase urine flow are frequently utilized because radiation therapy-related urinary symptoms result from tissue irritation. Males are normally administered alpha-blockers like Terazosin (Hytrin), Tamsulosin (Flomax), etc., after radiation therapy for a minimum of a few weeks and then slowly stop as their symptoms resolve.
Urinary Dysfunction After Cryotherapy
Patients who undergo cryotherapy after radiotherapy may sometimes develop urinary dysfunction, which includes:
- Urinary retention
- Urinary leakage
- The urethra or the aperture of the bladder may also constrict due to cryotherapy. It results in a complete inability to urinate or scanty urine flow.
- The prostate may expand or swell following cryotherapy. The patient will face trouble urinating for 1-2 weeks.
A catheter is inserted to expel urine from the bladder until the swelling subsides.
Some males who receive cryotherapy may occasionally leak urine. If you have previously received radiation, this is more likely. Leaking pee can be controlled in several ways, as mentioned above.
Urinary Dysfunction After High Intensity Focused Ultrasound (HIFU)
Patients receiving various prostate cancer treatments may develop urinary issues after HIFU. Potential urinary issues include:
- Urinary leakage
- Urinary retention
- Urinary infections
- Urethral constriction
- Prostate enlargement or swelling for 1-2 weeks
The patient will have a catheter to discharge urine from the bladder.
Stress incontinence is common in men who receive HIFU treatment for prostate cancer treatment, especially if they received radiotherapy as well.
As mentioned above, various treatments and self-care solutions for resolving urinary leakage exist.
Males might develop a urinary infection following HIFU.
Antibiotic treatment is the best cure for the infection.
This therapy involves changing one’s actions, including:
- Consuming an adequate amount of fluids.
- Abstaining from alcohol, caffeine, spicy meals, etc.
- Avoiding liquid intake just before sleeping
- People are urged to urinate frequently rather than waiting till the last moment.
- Some people could experience better urinary continence after lowering their body weight.
- Replacing any prescription drugs that affect incontinence is another aspect of supportive care.
- Exercising regularly besides treatment.
- Consulting with physicians, concerned professionals, urologists, etc.
- Ensuring regular follow-ups.
It might be difficult to treat prostate cancer while dealing with the side effects of urinary dysfunction. Ask your doctor about the potential adverse effects of radiation, surgery, cryotherapy, and HIFU. Consult your urologist about alternatives if you experience urinary dysfunction following prostate cancer treatment. The support services mentioned above and treatments can help resolve urinary dysfunction in patients.