Urinary incontinence is a frequent side effect of prostate cancer treatments, particularly major radical prostatectomy surgery. Although focal therapy for prostate cancer generally reduces the risk of urine incontinence, some men may still experience temporary urinary control issues. Fortunately, various strategies can help improve bladder control and enhance quality of life following prostate cancer treatment.

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Why Does Urinary Incontinence Occur?

Prostate cancer treatments affect urinary function in different ways, depending on the approach used:

Surgery (Radical Prostatectomy)

Radical prostatectomy involves the removal of the entire prostate gland, which can weaken the urinary sphincter control. This weakening may result in stress urinary incontinence, where urine leaks during activities such as coughing, sneezing, or lifting heavy objects. The severity of urine incontinence varies, with some men recovering within months, while others may experience long-term challenges.

Radiation Therapy

Radiation therapy, commonly used for prostate cancer, can irritate the bladder lining, leading to urine urgency, frequent urination, and urge incontinence (due to sudden, strong urge to urinate without control) causing urine leakage. Over time, the cumulative radiation may also cause scarring, which can affect bladder function.

Focal Therapy

Focal therapy for prostate cancer, which targets cancerous areas while sparing surrounding structures, minimizes the risk of incontinence. However, temporary mild leakage may still occur in some cases when the body heals from treatment.

Strategies to Reduce Urinary Incontinence

There are several ways to manage and reduce urinary incontinence after prostate cancer treatment. These strategies range from exercises to medical interventions and lifestyle modifications.

(a) Pelvic Floor Muscle Exercises (Kegel Exercises)

One of the most effective ways to improve bladder control is by strengthening the pelvic floor muscles through Kegel exercises for men. These exercises help support the bladder and urethra, reducing incontinence over time.

A structured Kegel routine includes:

• Contracting the pelvic muscles (as if trying to stop urine flow) for 5-10 seconds.
• Relaxing for the same duration before repeating the contraction.
• Performing three sets of 10-15 repetitions daily.
• Starting exercises before surgery (if applicable) to promote faster recovery and better urinary control post-treatment.

(b) Bladder Training

Bladder training is another non-invasive method to help regain urinary control. This technique involves:

• Delaying urination when the urge arises, gradually increasing the time between bathroom visits.
• Maintaining a bathroom schedule, even if there is no strong urge to urinate.
• Avoiding bladder irritants, such as caffeine, alcohol, carbonated drinks, and spicy foods, which can worsen urgency.

(c) Medications and Medical Interventions

Certain medications can aid in managing urinary urgency and frequency. These include:

• Anti-cholinergics: These drugs reduce overactive bladder symptoms and help improve control.
• Alpha-blockers: These medications help relax the bladder neck muscles, making urination easier.
• Collagen injections: These are sometimes used to bulk up the urethral tissue, providing better control and reducing leakage.

For men with persistent incontinence, medical procedures such as Botox injections into the bladder can also help reduce overactive bladder symptoms.

(d) Surgical Options for Severe Cases

For individuals with severe or persistent urinary incontinence, surgical options may be necessary. These include:

• Artificial Urinary Sphincter (AUS): A small device is implanted around the male urethra, allowing controlled urine release.
• Male Sling Procedure: A mesh-like sling is placed under the male urethra to provide support and prevent leakage.

(e) Lifestyle Modifications

Beyond medical and exercise interventions, lifestyle changes can significantly impact urinary continence. Implementing the following habits can help improve bladder control:

• Maintaining a Healthy Weight

Excess weight increases abdominal pressure on the bladder, potentially worsening incontinence. Maintaining a healthy body weight through proper diet and exercise can reduce this pressure and improve urinary function.

• Hydration Balance

Drinking sufficient water is crucial, but excessive intake can lead to frequent urination. Conversely, dehydration can cause concentrated urine, which irritates the bladder and increases urgency. Striking a balance in hydration is essential to prevent worsening symptoms.

• Avoiding Constipation

Chronic constipation can increase pressure on the bladder and weaken pelvic floor muscles, worsening incontinence. Consuming a fiber-rich diet, staying hydrated, and engaging in regular physical activity can help prevent constipation and support bladder health.

• Quitting Smoking

Smoking has been linked to bladder irritation and chronic coughing, which can strain pelvic floor muscles and contribute to stress incontinence. Quitting smoking not only benefits bladder control but also improves overall health.

• Using Absorbent Pads or Protective Garments

For men experiencing leakage, absorbent pads or protective undergarments provide confidence and comfort while undergoing treatment or lifestyle adjustments.

• Psychological and Emotional Well-being

Urinary incontinence can significantly impact self-esteem, mental health, and social interactions. Seeking prostate cancer support groups, counseling, or speaking with healthcare professionals about concerns can improve emotional well-being. Men should be encouraged to discuss urine incontinence openly with their doctors to find the best management strategies.

This article has been fact-checked by Dr Chong Kian Tai, urologist at Surgi-TEN Specialists, Farrer Park Hospital, Singapore.