Bladder Control Issues After Prostate Cancer Are Common -- And The VA Can Help
- The VA has lots of options for helping you manage incontinence after prostate cancer treatment.
- Bladder control issues are common after surgery for prostate cancer and can cause a patient distress and embarrassment.
- These problems range from mild to severe and can emerge immediately after treatment or develop gradually.
- Incontinence rates vary, with 10-15% of men experiencing significant leakage six months post-surgery but decreasing over time.
- Treatments vary depending on the severity of the problem. They include pelvic floor exercises, biofeedback, male sling procedures, and artificial urinary sphincters.
But these are common issues that men face and there’s no reason to feel ashamed, says Dr. Isla P. Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System.
Read MoreHow common is incontinence after prostate surgery?
Incontinence after prostate cancer surgery refers to the loss of bladder control, leading to involuntary leakage of urine.Surgical treatments, particularly radical prostatectomy — a surgical procedure to remove the prostate gland and surrounding tissues — can lead to urinary incontinence as a result of the removal of the internal urethral sphincter and potential damage to the external urethral sphincter, nerves, blood supply, and supporting structures.
- 10-15% of men face significant bladder leakage six months post-treatment (with surgery), dropping below 10% in three years.
- 30-50% report increased urinary symptoms after prostatectomy, but less with nerve-sparing methods.
- Urinary incontinence is much more common after surgery compared with radiation
“It can be very mild, meaning that when you lift something heavy or you cough really hard, you might lose a little bit of urine or it can be severe where it’s a constant drip and you really feel like you have no control over your bladder anymore and require diapers or pads,” notes Dr. Garraway.
Dr. Garraway adds that symptoms of the bladder are often temporary and manageable with the right treatment approaches. Recognizing the signs and seeking help when they occur usually leads to effective solutions.
Related: For Veterans Facing Prostate Cancer, The VA’s Health System Does Away With Disparities
What are the treatments for incontinence?
“So initially, most people after surgery can expect some degree of urinary incontinence. They have to retrain their bladder,” Dr. Garraway says.
To manage bladder problems after prostate cancer treatment your doctor may recommend trying several approaches that help improve urinary control. Choice of treatment depends on your specific condition, severity of symptoms, and overall health.
- Pelvic Floor Exercises: Regular exercises that strengthen the pelvic floor muscles, which support the bladder and urethra to improve bladder control. Most men will see some improvements in bladder control within 3 to 6 months. However, the time frame can vary widely depending on factors like the initial strength of the pelvic floor muscles and any other underlying health conditions.
- Biofeedback and Electrical Stimulation: By providing real-time information about muscle activity, biofeedback helps you gain better control over their pelvic floor muscles. Electrical stimulation can also be used to strengthen these muscles. Most patients will do one or two sessions a week, usually with a physical therapist or at their urologist’s office.
- Male Sling Procedure: This is a surgical approach that improves urinary control by placing a synthetic mesh sling around the urethra, effectively supporting it like a hammock. Your doctor will make a small incision in the perineal area and place the sling that exerts gentle pressure on the urethra. This helps prevent urine leakage during activities that increase abdominal pressure, such as coughing or lifting. It’s especially beneficial for treating leakage that occurs as a result of physical activity. It’s less invasive compared to other surgical options, offering a quicker recovery and fewer potential complications, making it a good choice for mild to moderate incontinence.
- Artificial Urinary Sphincter: This is a surgical option that involves implanting a device consisting of a cuff, which is placed around the urethra, and a pump, which is placed in the scrotum. The device is designed to mimic the natural function of a healthy urinary sphincter, allowing for manual control over urination. By manually operating the pump, the user can open the cuff when it’s time to urinate and allow it to close automatically afterwards, thereby restoring normal urination control and significantly reducing or eliminating leakage. Doctors recommend this procedure for men with severe urinary incontinence who have not responded to other treatments.
Will the VA cover the cost of treatment for incontinence after prostate cancer surgery?
Va hospitals have wide array of in-house specialty services for prostate cancer, but subspecialties such as urology can vary by location.
The VA Health Care system provides a wide array of in-house specialty services for prostate cancer, but subspecialties such as urology can vary by location.
If your local VA does not have the services you need on site, they will refer you to a community urologist that they are contracted with. The VA will cover the costs of your tests and treatments, and will continue to monitor your care at other facilities.
Typically, the VA does cover the cost of treating bladder issues that arise after prostate cancer, as long as the condition is service-connected. This is true, even if the care is provided outside the VA system, so long as your receive the proper approval.
However, the type and extent of coverage may vary depending on your specific situation and the treatment option you choose. You should work with your care team make sure you understand all of your options as you move forward with your care.
Questions for your doctor
It’s a good idea to discuss the risk of incontinence after prostate cancer treatment so you can make informed decisions. Some questions to consider asking:
- Can I expect to experience these symptoms as a result of my treatment?
- Which treatment type causes incontinence more frequently, surgery or radiation?
- If so, how long will they last and what are my options to help manage them?
- What else can I do to help avoid or manage these symptoms?
- Are there any new or experimental treatments I should consider?
Watch: Dr. Matthew Rettig discusses how the VA improves chances of survival in prostate cancer
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