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Why Am I Leaking After Prostate Surgery?

Hi friends! This week we’re going to talk about individuals with prostates because they have pelvic floors, too! The functioning of their pelvic floors can be impacted by prostate disorders like benign prostatic hyperplasia (BPH), also known as an enlarged prostate, and prostate cancer.

A radical prostatectomy is a common procedure that is used to treat prostate cancer. This surgery involves removal of the prostate and its cancerous tissue. With advanced in medicine, the procedure is usually performed either as a laparoscopic surgery or a robotic-assisted surgery.


While this surgery often has great outcomes for removing cancer, it often causes stress in incontinence (leaking with activities like sneezing, coughing, bending, lifting, position changes, and exercise) after surgery. Stress incontinence is the most common side effect after radical prostatectomy with up to 90% of patients experiencing it (Rahnama, 2021; Milios, 2019)


There are some risk factors that increase the risk of developing incontinence after radical prostatectomy including: (Schifano, 2021)

  • Age

  • Higher body mass index (BMI)

  • Diabetes

  • History of another prostate surgery (e.g. TURP)


Studies have also found that patients who had a laparoscopic surgery are more likely to develop incontinence versus patients who had a robotic-assisted surgery; however, there are still high rates of urinary incontinence in patients with both procedures (Rahnama, 2021)


While you can likely expect urinary incontinence after a radical prostatectomy surgery, there is hope to regain continence. After surgery your provider may have you complete a 24 hour pad test to determine the severity of your incontinence (Schifano, 2021; Milios, 2019). This involves weighing the pads used in a 24 hour period and classifies the severity (mild, moderate, or severe) based on the weight of pads.


Pelvic floor muscle training is the first treatment choice of incontinence (Rahnama, 2021). Pelvic floor muscle exercises may be given to your by your provider, or they may recommend you see a specially trained physical or occupational therapist. Many times, individuals have difficulty performing pelvic floor muscle exercises correctly without some assistance; however, we understand access to a provider with this training may be limited in your area.

You can ask your provider for a referral to a pelvic floor physical therapist or find a pelvic PT near you on our website.


In the long haul, regardless of participation in a pelvic floor muscle training program, many individuals see an improvement in urinary incontinence over time. For this reason, some researchers and providers do not recommend pelvic floor training as a conservative treatment option. However, many studies do show that men who participate in guided pelvic floor muscle training before and/or after surgery regain continence sooner than those who do not receive treatment (Milios, 2019; Haga, 2017). If you could regain continence months earlier, wouldn’t it be worth it?


Pelvic floor muscles exercises can be started BEFORE surgery. One study found individuals who performed exercises starting five weeks before surgery had a significantly lower chance of being incontinent 3 months after surgery (Schifano, 2021). However, by 6 months after surgery there was no difference in those who did the exercises versus those who did not.


A medication called Duloxetin may also be recommended as a conservative treatment option, however, it often has severe digestive and central nervous system side effects (Rahnama, 2021). Bulking agents have been used as a treatment option but they are not recommended due to complications such as embolization, migration, absorption, allergic or fibrotic reactions (Rahnama, 2021).


If conservative therapy fails, there are surgical treatment options like the placement of an artificial urinary sphincter; however, these are saved as a last resort since many times conservative treatment options are successful (Rahnama, 2021; Schifano, 2021).


As always, this does information is not medical advice and does not replace evaluation and treatment by a licensed healthcare provider.


To learn more about your pelvic floor muscles, check out these great resources:

For providers, check out our online courses to help your male clients. Consider joining our Ambassador Program and most of our courses are included with your membership!


Written by Emily Reul, PT, DPT


References

  1. Haga N, et al. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy. Fukushima J Med Sci. 2017;63(2):46-56.

  2. Milios JE, Ackland TR, Green DJ. Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urology. 2019;19:116.

  3. Rahnama MS, Marcelissen T, Geavlete B, Tutolo M, Husch Tanja. Current management of post-radical prostatectomy urinary incontinence. Frontiers in Surgery. 2021;8:1-10. doi: 10.3389/fsurg.2021.647656

  4. Schifano N, Capogrosso P, Tutolo M, Deho Fredrico, Montorsi F, Salonia A. How to prevent and manage post-prostatectomy incontinence: a review. World J Mens Health. 2021;39(4):581-597.

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