Ask the prostate cancer expert

Ask the prostate cancer expert

One man in seven will be diagnosed with prostate cancer in his lifetime, and although it can usually be treated, it’s not uncommon for men to end up living with some degree of

urinary incontinence

afterwards.

David Bateman from the Prostate Cancer Centre in Calgary, Canada, answers our queries about the diagnostic process, why incontinence can happen after treatment and what you can do to manage bladder leaks.

What typically happens during the process of a prostate check-up?
When you get a prostate check, the doctor will ask about your family history and whether you’ve experienced any changes in your urination. Two tests will be performed.

The first test will be a digital rectal exam (DRE). The doctor will insert a lubricated finger (gloved) inside your rectum while you are either bending over or lying on your side and feel for any abnormalities on your prostate.

The second test is a PSA blood test. PSA is a prostate specific protein which can increase when you have prostate cancer – but you can have high PSA without prostate cancer and vice versa, which means that both tests are necessary.

What are the treatment options for prostate cancer?
There are a range of prostate cancer treatment routes, and individual factors including your age, the grade and stage of your cancer, your general health and your feelings about side effects need to be considered.

The treatment approach is a collaborative decision between health professional and individual. In Canada it can include brachy (radioactive implants), external beam radiation therapy, radical surgery (cancer removal), cryosurgery (liquid nitrogen treatment) and active surveillance (regular check-ups to see if cancer is spreading from the prostate), but this may vary depending on where you live.

What is incontinence?
Incontinence is involuntary leakage of urine from the bladder. It is usually caused by damage to the sphincter muscle within the bladder, which controls the flow of urine.

What are the common causes of incontinence?
Some common causes of incontinence include prostate cancer treatments, diabetes, multiple sclerosis, Parkinson’s disease and pelvic surgeries. In relation to prostate cancer therapy, incontinence can occur days to months after radiation treatment due to nerve damage. During surgical removal of the prostate, muscles are cut and then re-attached. This treatment also causes nerve damage which leads to incontinence while the muscle is healing. Essentially, the reason incontinence results from prostate surgery is because the muscle that controls the bladder opening is cut. The tube that carries urine from the bladder runs directly through the prostate gland. The point where the bladder and urethra join is called the bladder neck sphincter and this opens to let urine flow through and closes to prevent leaking. Prostate surgery can damage this bladder neck sphincter, which can result in incontinence. Radiation treatments can also decrease bladder capacity, which can result in leakage due to overflow.

Do people expect incontinence to be an issue or does this surprise them?
Most are aware that they will have a few months of issues, but no one expects that they may have lifelong issues. Although we say that some men will have ongoing leakage, no one ever thinks they’ll be in that group.

What are your recommendations for getting bladder control back?
All men are different, get better at different rates, and have different comfort levels. Bladder control is one issue many men will face after a prostatectomy and getting that control back after surgery is an important step to recovery. To address this, men need to do pelvic floor exercises and wear protection for leakage. The average man can go through two to four pads in a 24-hour period for anywhere from a few weeks to many months post-surgery (more on this below). The one-year mark gives a man a pretty good idea of where he will be for the remainder of his life in regards to

bladder control.

What are

pelvic floor exercises

and how do you do them?
Pelvic floor or kegel exercises are the most important therapy to regain bladder control. Just like any other muscle in the body, the pelvic floor needs a regular workout to get stronger.

To find this muscle, try the following:

1. Empty your bladder before exercising

2. Find a quiet place where you can relax without interruption

3. To locate your pelvic floor muscles it is best to sit down

4. Try to squeeze the muscles that prevent you from passing gas

5. Then squeeze the muscle that stops you from going pee

6. Do not tighten your abdominal and buttocks muscles

7. Do not hold your breath as you exercise, just breathe normally

Many men can stop the stream of urine when urinating, but find it difficult to flex this muscle when just sitting or standing.

To do kegel exercises:

To regain pelvic floor strength, complete 10 repetitions of the following sequence five times a day while sitting, standing or lying down with knees bent:

1. Squeeze your pelvic floor muscles as described above

2. Hold and count slowly; one… and two… and three

3. Completely relax the muscles and count slowly; one… and two… and three

For a good comprehensive video on pelvic floor exercises for men, check out:

What protection is available in the meantime?
Finding the right incontinence product is usually by trial and error. Immediately post-surgery you are likely to need heavy single-use incontinence pads, but as you begin to regain control

washable absorbent underwear are a more cost-efficient, discreet and comfortable option.

Sometimes the choice of a product may be related to activities such as golf or yoga, in which case washable briefs may be the answer. It may take some experimentation before finding a type of incontinence product that works and feels comfortable.

Confitex would like to thank David for generously taking the time to share his expert knowledge and recommendations with us. For more information about prostate cancer, therapies and research visit www.prostatecancercentre.ca

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