Treatments for Prostate Cancer can cause urinary incontinence, bowel and erectile dysfunction (or ED). The effects of prostate cancer range from different degrees of severity, where urinary incontinence can lead from dribbling to leakage. Erectile dysfunction is not necessarily caused by the disease itself, but the treatment that reduces sexual desire and poor erections, that affect sexual intercourse.
Urinary incontinence, or the loss of the ability to control urination, is common in men who have had surgery or radiation for prostate cancer. Because the prostate gland surrounds the tube (urethra) that flows the urine out of the bladder, the muscles become weaker and cannot hold the urine. Therefore, it can cause urination retention, urine leakage, a decrease in bladder capacity, or damage to the nerves that control functioning. This will only last a short period of time.
There are 2 types:
- Stress incontinence is the loss of urine with a cough, sneeze or laugh and is the most common type.
- Urge incontinence is frequent urination with episodes of leakage after radiation treatment.
Erectile dysfunction is the most common side effect of Prostate Cancer treatment. This is due to the delicate nature of nerves and blood vessels that control its functioning, and any trauma to the area can result in change.
There are 4 main components:
- Libido: Also known as the sex drive is most commonly affected by hormone therapy, or a decrease in your testosterone. This may affect the individual’s level of interest in sex.
- Mechanical ability: The ability to achieve a firm erection is most affected by surgery or radiation therapy.
- Orgasm/climax: This is a result of treatment due to low libido levels or orgasms that may cause initial discomfort.
- Ejaculation: This may be minimal after treatment, as the glands that produce the semen are removed and/or irradiated during treatment.
Preventative Measures Pre and Post treatment:
- Prevention or management of Erectile Function
- Erectile dysfunction can be prevented by preserving the nerves responsible for erection by the surgeon.
- Medications as tablets/injections to relax the muscles to allow blood flow into the penis to obtain an erection.
- External Mechanical Devices- to force blood into the penis using vacuum erection devices.
- Surgical implants to mimic natural functioning.
- Support groups- to talk with other men who are dealing with incontinence and participate in local support groups.
Prevention or management of urinary incontinence:-
- Urinary incontinence can be prevented by the surgeon preserving and protecting the muscles that controls urination.
- If incontinence in onset post surgery, it can be manage by pelvic floor strengthening exercises (Kegel’s exercise).
- With the advent of newer technologies like robotic surgery, the risk of incontinence can be reduced and prevented.
- The level of experience of the surgeon performing the surgery plays a paramount role in preventing post treatment complications.
Changes to make pre and post prostate cancer treatment:
- Exercise on a regular basis
- Eat a healthy diet
- Drink responsibly
- Try to lower your stress and fatigue
- Stop smoking
- Reduce caffeine intake and consumption of spicy food
- Counseling of patient and caregiver by experts
Coping within urinary incontinence and sexual dysfunction
Incontinence is more than a physical problem because it affects the individuals’ quality of life. When issues that affect personal life and are not managed well, it results in fear, anxiety, and anger and can lead to isolation. Treatment of prostate cancer can affect a man’s physical loss of erections and sexual desire because feeling embarrassed affects how the individual feels about his body and appearance (body image). This changes a man’s masculinity, self-identity, self-esteem, confidence and sense of sexuality. This, emotionally coping with the cancer diagnosis, and fatigue as a result of treatment, can affect wellbeing, feelings of self-worth, and his relationships.
We advise patients to prepare for the possibility of urinary incontinence and sexual dysfunction, even though it may be short-term problem, it will hinder the daily functioning! By proper education it is possible to manage the consequences of the treatment to improve overall quality of life.