Five Ways to Improve Your Continence Faster After a Prostatectomy

When my patients are diagnosed with high-grade prostate cancer, they are often and rightly concerned about the urinary incontinence that affects almost every patient at least in the several weeks to several months after their procedure. Why this happens revolves around simple anatomy. Every man has an external urinary sphincter that helps stop the flow of urine when a man is not trying to urinate. This structure is supplemented by the internal urinary sphincter within the prostate. However, during radical prostatectomy, we remove this secondary assistive sphincter along with the prostate, and there’s no way to tell beforehand if the external urinary sphincter will be up to the task of stopping urine on its own.

In most patients, this change requires some adjustment time and results in leakage and inability to hold urine in the early days after surgery. Fortunately, about 90% of patients regain continence within the first year after surgery. Many of these men can return to normal urination within several weeks.

That said, any (even temporary) urinary incontinence can be a significant drag on a patient’s social life, as they are concerned about the embarrassment of leakage or need to always be near a bathroom, just in case they have the urge to urinate. Patients rightly want to leave their pads or Depends behind as quickly as possible. Following are a few ways to get back on track faster and return to a normal urinary lifestyle as soon as possible.

Do your Kegels. Kegels are essential for strengthening the pelvic floor and improving the musculature, which allows you to maintain proper urine flow and retention. Kegels are a straightforward exercise requiring no skill or equipment. You must remember to do them according to your postoperative plan. For some patients needing additional help, pelvic floor physical therapy may also be an option, so speak to my office, and we will discuss whether this can benefit you in your recovery.

Improve your diet and hydration habits by eating lean, healthy meats, vegetables, and whole fruits. Prioritize proper hydration because, while counterintuitive from a urination standpoint, healthy hydration habits make a big difference in pressure on the abdomen and keeping your bladder and urinary tract as healthy as possible. If you must modify your hydration habits, don’t limit your water intake; consume your fluids more strategically. For example, you can avoid drinking an hour or so before a significant event, so you are less concerned about leakage. Remember, dehydration can be problematic and cause bladder irritation up to and including overactive bladder, which can worsen the symptoms you’re already experiencing.

Try hold and double voiding techniques. If you are experiencing severe incontinence, you can try to hold your urine. This may include getting to the bathroom but waiting an extra 10 seconds and holding your urine before urinating. There is also what’s known as the double voiding technique, where you wait a few minutes after urinating and try again. These can increase the strength of the pelvic muscles that control your urination and more fully empty your bladder, respectively.

Cialis may help. If you’ve had a prostatectomy, you will also experience erectile dysfunction to some degree. For most, a PDE-5 inhibitor like Viagra/sildenafil or Cialis/Tadalafil may help restore erectile function. However, chronic low-dose Cialis may also speed up urinary continence. We will discuss whether Cialis/Tadalafil is a good option for you.

Don’t shun the pads; pads or adult diapers are essential stepping stones for returning to continence. Many patients are embarrassed or somehow ashamed to use them, but they offer protection, especially in the early days when you have less urinary control. Don’t try to go at it without your pads, as you may create more anxiety, stress, and embarrassment unnecessarily. Embrace that you need them and work as hard as possible to minimize their use.

The Bottom Line

Fortunately, for most patients, urinary incontinence is temporary, and in those patients, there are ways to speed up the return to normal, predictable urination. For the 10% or so of patients who do not regain their continence after prostatectomy, there are elegant surgical options, including a male urethral sling that supports the urethra and addresses urinary leakage and mild to moderate incontinence. An artificial urinary sphincter is an excellent option for patients with more severe urinary incontinence. Both are simple surgical procedures that contribute immeasurably to the quality of life after prostatectomy.

Don’t delay in speaking to Dr. Natale if you’re having issues with urinary continence after your prostatectomy. Fortunately, modern technology has made it easier to regain continence, and we are here to ensure you live life to the fullest with minimal interruption from urinary problems.

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