One in SEVEN men will be diagnosed with prostate cancer and experiencing bladder leakage post treatment is a common side effect.
When we came across the Prostate Cancer Centre in Calgary who provide patient-focused support for men and their families, guiding them through the entire process, from initial consultation, treatment and after care - we asked them to share their knowledge, which they generously agreed to.
In this post, we ask David Bateman from the Prostate Cancer Centre in Calgary a few questions about the prostate cancer diagnostic process, why incontinence can happen after treatment and what you can do to mange bladder leaks.
Hi David. Thanks for taking the time to share your expert knowledge with us today. Are you able to provide a brief introduction about yourself as well as the Prostate Cancer Centre?
I am the proud clinical director of Calgary's Prostate Cancer Centre. We are located In Calgary Alberta, Canada’s third largest city, in a building shared with Calgary's most pre-eminent urologists. As a not-for-profit, we offer a one stop service for men diagnosed with prostate cancer.
We have two “Man Vans", that visit urban and rural areas to do mobile testing of PSA’s (blood test screening for prostate cancer). To date we have tested over 30,000 men. We see hundreds of men in our clinics and firmly believe in aftercare support, so we have comprehensive follow up appointments with our patients at 3 and 9 months and 2, 3 and 4 years.
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.
At Calgary's Prostate Cancer Centre, a patient is referred by a family doctor and seen within 10 days of referral by an urologist. They are either asked to follow up after a certain time or referred for a biopsy, which we do at the center as well.
What are the different treatment options for prostate cancer?
There are a huge range of prostate cancer treatment routes, and individual factors like age, grade and stage of cancer, general health and feelings about side effects need to be considered.
The treatment approach is a collaborative decision between health professional and individual, and 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 prostate).
What is incontinence?
Incontinence is involuntary leakage of urine out of the bladder. This is usually the result of damage to the sphincter muscle found within the bladder which controls the flow of urine.
What are the common causes of incontinence?
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 treatments are 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 when they present with prostate cancer 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.
Getting bladder control back - what are your recommendations?
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 pads 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 (more on this below). The one year mark gives a man a pretty good idea of where they will be for the remainder of their life in regards to bladder control.
Pelvic floor exercises
Pelvic floor or Kegel exercises are the most important therapy to regain bladder control. Many men can stop the stream of urine when urinating, but find it difficult to flex this muscle when just sitting or standing.
In order 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 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 breath normally.
While sitting, standing or lying down with knees bent:
1. Squeeze your pelvic muscles.
2. Hold and count slowly; one…and two…and three.
3. Completely relax the muscles and count slowly; one…and two…and three.
4. Complete 10 repetitions, five times per day
For a good comprehensive video on pelvic exercises, check out:
Incontinence pads and underwear
Finding the right incontinence product is usually by trial and error. Incontinence products include: absorbent briefs, both disposable and washable; disposable absorbent pads; and incontinence clamps. For longer term issues, washable briefs may be more cost efficient. For mild cases, an incontinence pad inserted into the underwear and held in place with an adhesive strip might work. For more severe incontinence, a larger pad and/or absorbent brief may be what you need. 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.
Incontinence pads and disposable briefs are usually available at pharmacies and supermarkets. For other male incontinence products, try a medical supply store or the internet. The above is just a general overview of some incontinence issues that face men post-prostatectomy.
For more information about prostate cancer, therapies and research visit:
Confitex would like to thank David for generously taking the time to share his expert knowledge and recommendations with us!