Urinary incontinence, or the loss of the ability to control urination, is common in men that have had surgery or radiation for prostate cancer. You should prepare for this possibility and understand that for a while at least urinary incontinence may complicate your life.
It is also important to know that doctors continue to improve treatment for prostate cancer to lessen the chance of getting incontinence after surgery or radiation.

Problems can include:
• Leaking urine – this can range from just a few drops leaking out to urine leaking out
in a steady slow flow throughout the day
• Leaking or dribbling urine when you sneeze, cough or exercise (stress incontinence)
• Passing urine more often (more than eight times a day)
• Getting up a lot at night to pass urine
• A sudden urge to go to the toilet (urgency)
• Needing to go to the toilet urgently and sometimes leaking before you get there (urge incontinence)
• Problems emptying

Why do prostate cancer treatments cause urinary incontinence?
To understand why urinary incontinence is common after prostate cancer treatment, 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.

What are some new techniques that reduce the chance of becoming incontinent?
When removing the prostate, surgeons try to save as much of the area around the bladder valves as possible, thus limiting damage to the valves. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder valves.

Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some degree of urinary incontinence. With the newer techniques, many men will have only temporary problems controlling their urine, and many others will eventually regain full control of their bladder.

What can be done to treat urinary incontinence after prostate cancer treatment?
There are several treatments for urinary incontinence. Many doctors prefer to start with behavioral techniques that train men to control their ability to hold in their urine. A popular set of exercises, called “Kegel exercises,” strengthens the muscles you squeeze when trying to stop urinating mid-stream. These exercises can be combined with biofeedback programs that help you train these muscles even better.

Another treatment option is to inject collagen to “bulk up” the weakened area around the bladder. The problem with this treatment is that it is only effective for a few months and most men need repeated injections. It is also expensive. Newer injectable bulking agents may lessen the need for repeat injections, but still need more research.

Your doctor can also perform a surgery that has been helpful in some men. It involves placing rubber rings around the tip of the bladder to help hold urine.

You may see advertisements for drugs to treat urinary incontinence and “overactive bladder.” As the latter name suggests, these drugs treat an “overactive” bladder — not a bladder where the valves have been damaged — and usually do not work for incontinence following prostate cancer treatment.