After surgery to remove the prostate gland (radical prostatectomy) you might have problems with your bladder including leakage and difficulty passing urine.
When you wake up from your operation you have a tube into your bladder (catheter) to drain urine. You have this in place for a couple of weeks and then you go back to hospital to have the catheter removed.
You're likely to have some urine leakage when the catheter is taken out. It’s a good idea to have a supply of incontinence pads at home and to take a couple with you to hospital. You can buy these at supermarkets and pharmacies.
Leaking urine could affect what you do and where you go in the weeks after your operation. How this affects you can vary. Some men have dribbling of urine, while others could leak larger amounts. You might notice this is worse when you cough or sneeze and is called stress incontinence. Or you might leak urine when you have an erection or orgasm.
It’s hard to say how long it will take for you to get back your bladder control. This varies between men and depends on the type of surgery you had and whether you had any problems before or during your operation. Most people get better within 3 to 6 months of their operation. But for some, it takes 1 or 2 years. A small number of people might need further surgery to get back bladder control.
Some people have permanent urinary problems following surgery.
What you can do to help
Pelvic floor exercises
Pelvic floor exercises target and strengthen the muscles that control your bladder. Your doctor or specialist nurse will talk you through what to do. Research has shown that pelvic floor exercises can help you stop or reduce urine leakage.
If you have not had information about pelvic floor exercises, ask your specialist nurse. Or ask to see a physiotherapist that can talk you through them.
You can find out more about how to do pelvic floor exercises on the NHS website.
Drink plenty of fluids
Don’t cut down on your fluids, drink at least 2 litres a day. You can drink plenty during the day, but it might help to limit fluids 2 hours before bedtime. Drinking plenty helps your bladder regain its tone.
Incontinence pads and sheets
You might need to wear pads when you first start going out. There are different types of pads. You might be able to get some pads for free on the NHS, although this may depend on the service in your area. Some GP practices have a continence nurse you can see.
It can also help to visit places where you know there are toilets. Or you can telephone beforehand to find out about toilets and how easy they are to get to.
You might find it useful to get some incontinence sheets for your bed. This might not be necessary, but could be reassuring when you first have your catheter removed. You could try a urinary sheath. The sheath looks a bit like a condom with a hole at the end. It fits on your penis and is connected to a tube and bag. Any leaked urine can drain into the bag. This might be particularly useful at night to help you sleep better.
'Just can’t wait' card
You can get a card to show to staff in shops or pubs etc. It allows you to use their toilets, without them asking awkward questions. You can get the cards from Disability Rights UK or the Bladder and Bowel Community. They also have a map of all the public toilets in the UK.
You could get a key to disabled toilets if you need to access them quickly. You buy the RADAR key from Disability Rights UK. But this should only be used by people who need quick access to a disabled toilet due to a disability or medical condition.
- Plan your trips out.
- Find out where the toilets are.
- Take extra pads and spare underwear.
- Organise a ‘Just can’t wait card’ or key for disabled toilets if you need it.
- Do your pelvic floor exercises regularly.
When to get further help
Your doctor can refer you to a specialist incontinence clinic if urine leakage becomes a long term problem. Staff there can help you with further muscle exercises and bladder training.
Bladder training encourages your bladder to hold larger amounts of urine for longer periods of time. You keep a diary of when you go to the toilet and gradually increase the time between each visit.
Artificial urinary sphincter
Your doctor might suggest that you have surgery to fit an artificial urinary valve (sphincter) if you leak a lot of urine. This is usually only recommended if your urinary leakage is severe. And other measures, such as pelvic floor exercises and bladder training, do not help. A small number of men who have had their prostate removed (prostatectomy) need to have this operation.
During the operation your doctor puts an inflatable ring around the urethra. This is the tube that carries the urine from the bladder to the outside of the body (urethra). The ring attaches to a small pump in your scrotum that you use to deflate the ring when you want to pass urine.
This device could reduce the amount of urine leakage or stop it altogether. But there is a risk that the operation might not help you.
Difficulty passing urine
You might have problems passing urine, although this is quite unusual following surgery. This is due to a narrowing of the tube from the bladder to the penis. This is called a urethral stricture. You might find it difficult to pass urine, or you might not be able to pass urine at all.
Let your doctor or nurse know if you have any problems passing urine.
A doctor stretches the narrow area during a short operation. They might slide a thin rod into the urethra to widen it. Or they may use a thin flexible tube with a light and camera on the end. They can see the narrowed area and put a tiny knife down the tube to cut away tissue and open up the urethra. You have these operations under local or general anaesthetic.
You might need to have this operation repeated if the urethra gets narrower again.
Talk to your GP about help with your urinary problems. Community continence advisers can visit you at home. Or you could ask to be referred to a specialist incontinence clinic.
You can phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9 am to 5 pm, Monday to Friday. They will be happy to answer any questions.
If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.