How do you stop urine leakage after prostate surgery?
Leaking urine after any surgery to the prostate is fairly common, especially in the first 1-2 weeks post-op. A prostatectomy, where the prostate is removed, impacts the nerves and muscles, both of which can take time to heal. Therefore, leaking often persists for several weeks to months. However, specific strengthening, improving your breathing strategies, using good body mechanics, optimizing bowel health, and paying attention to your overall body composition can all help support your recovery. By improving the strength of your pelvic floor and decreasing the strain on the urinary system overall, you can reduce or eliminate your urinary leakage.
Is leaking after prostate surgery common?
Prostate procedures are actually very common in men, with a reported 80+% of needing to undergo at least one type of prostate surgery or procedure in their lifetime. These procedures range from small needle biopsies (taking tissue samples) to full removal (prostatectomy) and many things in between.
An extremely common side effect of surgery to the prostate is an inability to hold back urine, or “urinary incontinence.” In fact, almost 100% of men will have incontinence upon catheter removal immediately post-op.
Then, while the majority do recover, it can take months and for some, the problem can persist for years. As men, we mostly go through our adult lives without the concern of urinary leakage, so this change can feel extremely unsettling.
Fortunately, while we can’t control everything, there are things you can do to improve the speed of recovery and overall success with regaining bladder control after prostate surgery.
Normal urine storage and urination
Understanding how the system works under normal conditions can help the understanding of what can go awry after surgery. To get a sense of the anatomy first, picture two kidneys at the top with tubes coming down to the bladder (ureters). The bladder is the main storage organ and has a valve at the bottom (Valve 1). Then, there is another tube that passes from the bladder to the outside of the body (urethra) that passes through the prostate and then finally the pelvic floor muscles (Valve 2). Here is a breakdown of how that system works in action to help us urinate:
The kidneys continuously make urine, with some variation on speed depending on circumstances like hydration, time of day, and hormones.
As the kidneys produce urine, it is sent via the ureters directly to the bladder for storage.
The valve at the base of the bladder, “Valve 1” stays closed during the storage phase
As the bladder fills and stretches it sends signals up to the brain to say “I’m getting pretty full down here.”
Brain says back “Okay, start opening that Valve 1!” At the same time, the brain says “Hey, Valve 2 (the pelvic floor muscles), close up and hold that urine back until he tell us we’re in the right spot.”
Once you’ve made it to a restroom, are able to consciously relax Valve 2 which then allows the urine to empty.
After the bladder has emptied, it is no longer being stretched, which then signals your system to close Valve 1 again and return to storage mode. As Valve 1 takes back over, Valve 2 can stay relaxed.
Why does urine leakage happen after prostate surgery?
The prostate is an organ that surrounds the urethra (pee tube) immediately under the bladder and Valve 1. When a surgery, procedure, or even radiation affects the prostate it often either damages part of Valve 1 or the nerves that help control it. Therefore, the body no longer has full control of Valve 1 to help keep the urine in during storage.
The good news is that Valve 2 can help, but up until this point, it has only been conditioned for short-term use. It’s like asking a sprinter or middle distance runner to suddenly step up for marathons with no additional training.
But, just like we can make a plan to help the runner be more successful for long distances, we can also train Valve 2 to help compensate for a missing prostate and compromised Valve 1.
Pelvic floor strengthening to improve urinary continence
Specifically coached, prescribed, and progressed exercises are a major portion of the work to be done. Many men are told “Just do some Kegels and you’ll be okay. Most men dry up within 2 years.” I don’t know about you, but leaking urine for 2 years sounds….unacceptable - especially if I know it can be much shorter than that!
If Valve 2 now has to carry the load start to finish it is going to need endurance training, strength, and quick reactions. The most up-to-date training philosophy involves doing pelvic floor muscle training (ie. Kegels) that involve both fast contractions (reaction speed and strength) and slow contractions (endurance) instead of just endless maximal squeezes.
Additional training specificity can be helpful too. If you were working on a training program for our runner who was going from sprinting to a marathon, we’d also want to consider what conditions the marathon was being run in. There may be different details to attend to if it was on a track vs. a trail run for instance.
Similarly, depending on your unique activities and goals, we need to do activity-specific training for your body. Your pelvic floor may need to respond differently playing pickleball vs. doing deadlifts vs. standing against the current while fishing vs. hauling hay bales vs. playing ball with your grandkids.
When you stop to reflect how different each person is in their habits going into surgery and their goals coming out of surgery, it becomes very clear that a “just do your kegels” approach is not going to give you the most personalized and therefore best shot at success.
What Else Can Affect Urinary Leakage After Prostate Surgery?
Retraining Valve 2 is part of the process of regaining control over urinary leaking after a prostate surgery or procedure, but it also isn’t the only thing that can be done. Learning to coordinate your breathing, abdominal muscles, and pelvic floor muscles while lifting, moving, or even just rolling over in bed can make a huge difference even BEFORE the muscles or nerves are fully healed.
Incontinence can be looked at as a simple equation: When the pressure in the bladder exceeds the pressure of the pelvic floor, leakage will happen. So, focusing on strengthening the pelvic floor muscles can be a good strategy, but when you look at the whole equation and also address the bladder, you’re setting yourself up for a lot more success. Here are three additional things that can impact your incontinence:
Bowel health: When there is a back up of stool in the system, it takes up space from the bladder and makes leakage even more likely. Having regular, easy, and complete bowel movements on the other hand takes the extra pressure off of the bladder and therefore can improve bladder control. There are many ways to improve your bowel health including fiber intake, hydration, supplements, hands-on techniques, positioning for toileting, and/or muscle coordination.
Intra-abdominal pressure: Intra-abdominal pressure (IAP) is a normal part of being human and is just a fancy way of saying the pressure that is in the closed system of our abdomen. It is dynamic and variable based on the activities we are doing and how we are doing them. By looking at both the activities and the performance of them including breathing techniques, body mechanics, and muscle coordination, you can minimize excess pressure in the system. Bonus: improving your pressure system can also minimize your risk for hernias.
Visceral fat/adipose tissue: Having increased visceral fat/adipose tissue can also work against the bladder, similar to intra-abdominal pressure. Exercise and nutritional interventions are the most tried and true methods to change body composition and set you up for a better, healthier recovery.
Geting support to improve your continence and fully recover after your prostate surgery
You’ve already got a lot on your plate, and it can be overwhelming to sift through information on the internet or try to create your training plan on your own. Seeking out the guidance from a men’s health specialist who can take out the guesswork and give you a clear and specific plan can be a gamechanger. If you’re ready to get started now, Dr. Nathan is accepting new patients and can give you tools and tips for success no matter what stage of pre-hab or recovery you are at. Schedule your first appointment now and ditch the diapers for good!
