Urinary incontinence (leaking urine) is a common side effect for men after prostate cancer surgery (radical prostatectomy). For some men, lifestyle changes, bladder retraining and pelvic floor muscle exercises will help to reduce or stop the leaking within six to 12 months after surgery. But if not, there are products and treatments available to help. Here Specialist Nurse, Sophie answers some common questions about ways you can manage your incontinence so you can get on with life.
Even if you’ve been told you may leak urine after surgery it can still be quite a shock when it happens. Wearing absorbent pads or underwear can stop you wetting your clothes. They are often very discrete and no one would know that you’re wearing them.
They can be reusable and washed with your usual laundry or disposable to stick into your underwear. They come in many different sizes and shapes and hold different amounts of urine. You can also get absorbent pants to wear instead of your underwear.
Some hospitals and GP surgeries will prescribe free pads. But this will depend on the area and you might have to pay for them yourself. Your GP, nurse or incontinence team should be able to tell you whether this is the case in your area.
If not, you can buy pads from supermarkets or chemists, or order directly from the manufacturer – some may send you an initial sample for free. Some websites, such as the Incontinence Supermarket, sell pads VAT free, so shop around to get the best deal.
Changing and disposing absorbent pads or pants can be inconvenient, especially if you’re out and about and there are no toilets or bins nearby. You may find that devices such as body-worn urinals, urinary sheaths or penile clamps are more useful to you.
Urinary sheaths (also called external catheters) look like condoms with a tube attached to the end, which drain urine into a bag. The sheath fits tightly over the penis and you can strap the bag to your leg (under your clothes) and empty when you need to. They are a good option if you are in a wheelchair, or if you have an active lifestyle and like to go out for long periods of time.
Body-worn urinals are similar to sheaths in that they collect the urine from your penis and drain it into a bag that you empty when it’s full. You fix them in place with either straps or specially designed underwear. They are best used when you are standing and walking around. Sitting down changes the position of the device and can make them leak.
Penile clamps are small devices that you put on your penis. They work by pressing on your penis and squeezing the urethra (the tube you urinate through) shut so that no urine can leak out. They can be a bit uncomfortable and you should only use them during the day for short periods, and open them at least every two hours. They aren’t usually recommended by health professionals, as they reduce the blood flow to the penis so can be unsafe if they are put on too tightly or for too long.
As with pads, you may be able to get these products, from your hospitals or GP but this will depend on the area and you might have to pay for them yourself. Ask your GP, nurse or incontinence team about this. You can buy these devices from the producers or specialist websites but not from supermarkets or chemists.
If you suddenly and urgently need the toilet during the night, you might find hand-held urinals useful. These are containers with a lid that can be used if you can’t reach the toilet in time or if there isn’t a toilet nearby. You can keep them by your bed and empty it in the morning.
Absorbent pads or pants can stop you wetting the bed if you leak urine in your sleep. You can also get washable or disposable underpads that go on under your sheets, or you could use waterproof bedding to protect your sheets and mattress.
Underpads, waterproof bedding and hand-held urinals are not usually available on the NHS and you can’t buy them from supermarkets. But you can order then from chemists or buy them directly from the producers.
If you drive a lot then absorbent pads and pants, urinary sheaths and penile clamps can be useful. And if you are worried about being caught in traffic jams, keep a hand-held urinal or an empty plastic bottle with a lid next to you in the car. You can carry wet wipes with you too, to wipe up any drops.
Depending on how long you’ve been leaking, you may be able to have a male sling or an artificial urinary sphincter fitted. You will have a number of tests before you are offered them and you’ll need an operation to put these in. They work in slightly different ways.
A male sling is a piece of mesh material that is placed under the urethra (the tube you urinate through) near the bladder. It presses gently on the urethra to keep it closed, and helps to support the surrounding tissues of the bladder. This stops you from leaking urine. It should be tight enough to stop urine leaking out, but loose enough to let you urinate when you want to. Find out more about male slings.
An artificial urinary sphincter is a small device that consists of a fluid-filled cuff that fits around your urethra, a balloon in front of your bladder and a pump in your scrotum (the skin around your testicles). The cuff presses the urethra closed so that you don't leak urine. To urinate, you squeeze the pump in your scrotum – this moves the fluid out of the cuff and into the balloon, opening your urethra. See how it works in our short animation.
You will usually only be able to have a male sling or an artificial urinary sphincter if you are still leaking urine 12 months after your treatment.
If you leak a mild amount (one to two pads a day) or a moderate amount (three to five pads a day), the male sling may be suitable. It doesn’t work very well for men who leak a large amount of urine (more than five pads a day), so you won’t usually be offered a sling if you leak a lot.
If you’ve had radiotherapy as well as surgery to remove your prostate, you probably won’t be able to have a male sling. Radiation damages the tissues around your bladder and urethra, and this stops the sling from working as well as it should.
If you leak a moderate amount (three to five pads a day) or a large amount (more than five pads a day) of urine, you may be able to have an artificial urinary sphincter.
Once the wounds from the operation to put in the sling or artificial urinary sphincter have healed, you should be able to go back to your usual activities, including doing sport and having sex. If you have a sling, you might find that you leak a bit and have to wear a light pad if you do strenuous exercise such as heavy lifting.
Speak to your GP, specialist nurse or continence team about what products or treatments could be right for you, and whether the NHS will cover the cost of products in your area.
If you want more information on the different types of continence products and where to get them, visit the Continence Product Advisor website.