Post prostate surgery, many patients experience urination and bowel problems.
Many men experience urinary problems as a side effect post prostate surgery. Following urinary problems may arise after prostate surgery.
- Leaking urine
- Frequent urination
- Difficulty urinating
This is the commonly observed problem in the patients after prostate surgery. Upon waking up after surgery, patients find a small tube known as catheter for draining out urine from the body. In many patients, there is no bladder control after removal of catheter for the first time. This happens as a result of damage to the muscles and nerves responsible for controlling urination. Absorbent incontinence pads can be given to the patients to put in their under garments. With time, leaking urine problem gets improved. After six months of surgery, an improvement is seen in most of the patients. In some cases, leaking may continue for one year or more post surgery.
Treatment for urine leaking is based on the quantity of urine leakage and how recent the surgery has taken place.
- Absorbent pads and pants
Absorbent pads and pants need to be used by patients post surgery. These help in soaking leaks.
- Pelvic floor muscle exercises
For strengthening the pelvic floor muscles, exercise is very helpful. It also helps in increasing the control on urination.
- Urinary sheaths (external catheters)
External catheters or urinary sheaths have a tube attached to one end for draining urine into a bag. These sheaths or catheters fit tightly over the penis and the patient can strap the bags under the clothes.
- Artificial urinary sphincter
An artificial urinary sphincter involves a surgery with a small device which consists of a balloon in front of bladder, a fluid-filled cuff which fits around urethra and a pump in the scrotum (skin around the testicles) as shown in the figure below.
This device helps in control over urination. It has been reported in the medical literature that over 27% men with an artificial urinary sphincter did not need incontinence pads and over 52% required only one pad each day. An operation is required to fit this device. This operation is carried out using general anesthesia. There are some risks in fitting an artificial urinary sphincter. These include infections or breaking of device. In some men, it is not possible to proceed with these devices.
- Internal male sling
An internal male sling is a tiny piece of material which presses gently on urethra of the patient to keep it closed. It helps in leak stoppage. An operation is carried out to fit this sling using general anesthesia It needs to be tight enough to stop the leakage and at the same time it needs to be loose enough to help the patients urinate whenever required. This sling is shown in the figure.
An internal sling is offered in patients of prostate cancer if they leak moderate amount of urine one year after treatment. Up to 75% of men with an internal sling do not require pads and do not leak as per the studies. In patients with heavy leakage of urine and previous radiotherapy exposure, sling may not be useful. There can be side effects post surgery such as pain and infection. In some men, urine retention is observed after operation.
- Adjustable balloons
Around urethra of the patients, two small fluid-filled balloons are placed by surgical method. Leakage of urine is stopped by pressing the balloons on the urethra. Stoppage of leakage do not hamper normal urination in this process.
Each of these balloons contain fluid and is linked to a port placed in scrotum of the patients. These ports can be used by surgeon for making the balloons bigger or smaller as required. Balloons can be used as an optional treatment in patients leaking urine after six months of prostate cancer treatment.
After prostate surgery it is common to observe difficulties in urination. This is a result of scarring which makes narrowing of urethra.
There are treatments for frequent urination along with self help techniques.
(1) Bladder retraining
In this training, the patient can hold on the urination for longer and can control urination.
Over time, this can help you hold on for longer and control when you urinate. Speak to your specialist continence nurse or physiotherapist for more information.
Anti-cholinergics help in reducing urination frequency, leakage and urgency of urination.
(3)Percutaneous posterior tibial nerve stimulation (PTNS)
This is a relatively new treatment which helps in urination and urine leakage becomes less frequent.
A low electrical current is applied to the nerves responsible for controlling the urination. This helps in emptying of bladder before getting full.
(4) Botulinum toxin (BOTOX)
Injecting BOTOX into the bladder wall helps in stopping the bladder squeezing out urine. This happens before bladder is full. This is a new treatment method for urinary frequency and urgency. This treatment is available at specialized hospitals.
(5) Urine retention
Retention of urine is difficulty in emptying the bladder in proper manner after radiotherapy. Due to radiotherapy, prostate swells and block the urethra which leads to urine retention. This makes narrowing of urethra known as stricture.
(6) Chronic urine retention
In some men, emptying of bladder in proper manner is not possible even if they urinate a little. This is chronic urine retention.
Signs of chronic urine retention include:
- Urine leakage at night
- Swollen feeling in abdomen
- Feeling of not emptying the bladder completely
Treatments for chronic urine retention
- Use of catheter for drainage of urine from the bladder
- Alpha blockers or 5-alpha reductase inhibitors
- Widening of urethra or opening of the bladder by surgery
(7) Acute urine retention
Sudden and painful urination occurs which is known as acute urine retention. Consultation with the surgeon is recommended in such cases. Usually a catheter is used to drain in this case.
Bowel problems post prostate surgery
In the first few weeks after prostate surgery, the bowel changes can be seen in the patients. This is a result of adjustment of body with the abdominal space which gets increased due to loss of prostate. For problems associated with bowel, use of anti-diarrheal agents is useful. High-fiber foods, fresh fruits and vegetables and supplements and are recommended to patients after surgery. This helps in reducing problems associated with bowel and helps in faster recovery.
To conclude with, it is very essential for the patients to inform the surgeon regarding any unusual symptoms post prostate surgery.
Dealing with problems associated with urination bowel is not easy and can be frustrating at times. With various treatment methods and healthy diet, patients can recover faster after surgery.
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