- Urinary incontinence (UI) is a common complication of prostate surgery.
- UI often goes hand-in-hand with erectile dysfunction after prostate surgery.
- Nearly 10 percent of all men will receive a prostate cancer diagnosis in their lifetime.
- Doctors may treat prostate issues like cancer with surgery or radiation.
- There are a number of treatment options available for post-prostatectomy UI and ED.
If you’ve undergone prostate surgery, chances are good that you’re familiar with the urinary incontinence (UI) that often follows a prostatectomy. UI is a common complication of prostate surgery and radiation treatment and often goes hand-in-hand with erectile dysfunction (ED).
In this article, we’ll discuss the anatomy of the prostate, the relationship between UI and ED, the causes of urinary incontinence following prostate surgery, and treatment options for UI (some of which can also help ED).
What Does the Prostate Do, Exactly?
The prostate is an important part of the male reproductive system. This small gland, located under the bladder, works with the testicles and other glands to make seminal fluid (fluid that helps carry sperm out of the body). It also plays an important role in ejaculatory function. The prostate forces seminal fluid into the urethra to and out of the body during ejaculation.
What are Common Prostate-related Health Concerns?
As men age, their prostate glands continue to grow. A prostate grown too large, however, can create health issues. In fact, most men who live beyond “a certain age” will eventually have prostate problems.
Common prostate-related health issues include:
- Benign prostatic hypertrophy (BPH), or enlargement of the prostate
- Prostatitis (inflammation of the prostate)
- Prostate cancer
How Do I Know if I Have Prostate Issues?
Prostate conditions can either be symptomatic or asymptomatic. If the issue is symptomatic, there are noticeable symptoms to suggest that something is wrong. On the other hand, your issue may be asymptomatic if there are no detectable signs or symptoms of prostate issues. Doctors can determine if prostate issues are occurring by a simple blood test called prostate-specific antigen (PSA).
Doctors may request a blood draw to test levels of PSA to detect things like prostate cancer, but it’s not always a straightforward process. There is no set normal level of PSA that indicates cancer is definitively present, meaning prostate cancer can occur in men who have low PSA levels as well as higher levels. Other issues like prostatitis or a urinary tract infection (UTI) can also cause PSA levels to increase.
How Do I Treat My Prostate-related Health Concerns?
Depending on what’s wrong, you may have several options to treat your prostate concerns, including:
- Surveillance (watching how your symptoms change over time)
- Internal radiation therapy (referred to as brachytherapy)
- External beam radiation therapy
- Systemic therapies like chemotherapy
- Prostate surgeries like prostatectomy
Prostate surgery and radiation therapy are commonly used to treat prostate issues, but they come with side effects. urinary incontinence is one of those side effects.
What is urinary incontinence?
Urinary incontinence is loss of bladder control and one of the main side effects of prostate surgery or radiation therapy. While other factors, like obesity, diabetes, and even asthma, can cause UI, it is most common after prostate surgery or radiation treatment. When radiation is used to treat prostate issues, or surgery is conducted to remove the prostate gland, the surrounding nerves and muscles that affect the bladder may be affected. This is due to how close the prostate gland is to the urethra and the bladder.
You may be wondering, how many men are affected. This depends on which procedure was used to treat the prostate problem. With surgery, only a small percentage of men (6 to 8 percent) will experience UI. This can include anything from light leaks of urine to full loss of bladder control. Symptoms can last anywhere from 6 months to 1 year following surgery. Though symptoms are usually temporary, some men may experience urinary incontinence longer than 1 year after surgery.
The Connection Between Urinary Incontinence and Erectile Dysfunction
Men who have prostate surgery or radiation may also experience erectile dysfunction (ED) after prostate surgery. This is because the prostate also plays a role in your erectile functioning. Men’s recovery times will vary depending on the type of surgery they had (e.g. nerve-sparing prostatectomy or radiation therapy).
With nerve-sparing prostatectomy, as the name suggests, doctors try to spare the nerves around the prostate gland. Close to half of men who undergo this treatment get back to their original erectile functioning within one year of surgery. More than half of men should get back to original function within two years of their surgery.
Recovery from erectile dysfunction is more challenging after radiation therapy. With brachytherapy, 25 to 50 percent of men will regain their original erectile function. The odds are slightly better with men who undergo external beam radiation therapy, with about 50 percent of men getting back to their old functioning. Sadly, the chances of improvement decline over time.
If you need prostate treatment, seek care from a doctor that specializes in this issue to increase the chances of having better erectile functioning in the long run.
What Treatments are Available for Urinary Incontinence or Erectile Dysfunction?
Because prostate surgery and radiation affect both UI and ED, they share similar treatments. If you experience both ED and urinary incontinence after prostate treatment, your doctor might ask you which is more concerning to you. From there, they will determine the best course of treatment.
Common treatments for urinary incontinence that may also help with erectile dysfunction include:
- Pelvic floor exercises
- Urethral sling procedure (like the Mini-Jupette sling) with inflatable penile prosthesis
- Storage or barrier devices like an indwelling catheter
- Urethral bulking agents
- Anticholinergics and beta3 agonists
Fortunately, these treatments have been shown to improve patient outcomes as well as their quality of life. For instance, in a study of men with the Mini Jupette sling, 80 percent of men in the study no longer had incontinence at 6 months out.
Urinary incontinence and erectile dysfunction can negatively affect your quality of life. If you are concerned about your prostate function or erectile dysfunction, don’t wait. Talk to a healthcare professional about treatment options to see what works best for you.
One More Note
ED and UI can also be caused by other factors besides surgery or radiation, like obesity or diabetes. If you also have any of these concerns, know that your doctor will want to address them as well. They might refer you to other specialists to address those health concerns at the same time to improve your chances of successful recovery.
eDrugstore Can Help
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Kwynn holds a Master of Public Health and is currently pursuing a PhD in Social Work. Her research examines the intersections of health, technology, and gender-based violence.