Incontinence can be a complication of prostate surgery done for
either benign or a malignant disease. To understand why urinary
incontinence is common after prostate surgery, it is important to
know a little bit about how the bladder holds urine.
When urine is emptied into the bladder from
the kidneys, it is kept inside the body by a couple of valves that
stay closed until you “tell” them to open when you urinate. The
prostate gland, which surrounds the tube that allows urine to flow
outside the body, also helps to hold back urine until given the
OK.
Removing the prostate through surgery or
destroying it through radiation -- either with an external
beam or with radioactive seed implants -- disrupts the way your
bladder holds urine and can result in urine leakage.
There are three types of incontinence seen following prostate
surgery, stress incontinence, total (dripping faucet)
incontinence, and detrusor instability (caused by bladder muscle
and nerve instability seen following many types of pelvic
surgery). Both stress incontinence and total incontinence are
caused by injury to the urethral sphincter muscle during surgery.
The prostate itself also contributes a great deal to continence in
males, as it contains a large amount of smooth muscle that helps
control urinary flow. Many times patients will have transient
forms of any of these types of incontinence that will resolve with
time or conservative measures.
Stress incontinence occurs when the patient coughs, sneezes,
or lifts a heavy object with straining to put the "stress" of
the increased abdominal pressure on the bladder and overcoming
the holding pressure of the urethral muscles.
Total incontinence is caused by severe damage to the pelvic
muscles so that urine is constantly leaking like a dripping
faucet.
Damage to the nerve and muscle fibers of the bladder itself,
causing "spasms", urgency, and urge incontinence (the need to
rush to the bathroom at a moment's notice) cause Detrusor
instability.