home: information: prostate cancer: management
Banner Ad
The Prostate Cancer Charity Home Page

Urinary continence and prostate cancer

The information on this page comes from our Tool Kit fact sheet on urinary continence and prostate cancer. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download and print a PDF version of this fact sheet.

This page is for men who have been diagnosed with prostate cancer and are concerned about problems passing urine. It describes how prostate cancer and its treatment can affect your control of your bladder (continence). It describes treatments for urinary problems and incontinence that may be associated with prostate cancer and lists sources of help and support. Each hospital or specialist team will do things slightly differently so use this page as a general guide to what to expect and ask your doctor or specialist team for more details about treatment and help available to you.

What is urinary incontinence?

Urinary incontinence is the uncontrolled leakage of urine. This can range from just a few drops leaking out before or after passing urine, to not being able to control when you pass urine at all. Not all men with prostate cancer will experience incontinence. However if you are affected there are a range of treatments or lifestyle changes that may help reduce or even get rid of the problem.

Back to the Top

How does the bladder work?

The genitourinary systemOur kidneys produce urine continuously during the day and night, although this slows down overnight. This urine flows slowly down the tubes connecting the kidneys to the bladder. We tend to produce around one and a half litres of urine over a 24-hour period, although this depends on how much we eat, drink and sweat.

The bladder is a muscle shaped like a balloon and is supported by the pelvic floor muscles. As the bladder fills with urine, the bladder muscles relax to allow it to expand gently. Urine is kept inside the bladder by the muscles around the neck of the bladder. Another muscle, called the sphincter, surrounds the tube that you pass urine through (the urethra) and seals it tightly so there are no leaks. As the bladder becomes full, signals are sent to the brain telling us that we will need to pass urine soon. This gives us time to find a convenient place to go.

When we are ready to pass urine, the sphincter and pelvic floor muscles relax and the bladder muscle contracts. This allows urine to flow out through the urethra and out of the body. How often you need to go to the toilet will depend on many things, but on average most people need to pass urine from four to eight times a day and up to once a night.

Back to the Top

What causes urinary incontinence?

Most urinary problems are either due to problems with storing urine or problems with emptying the bladder. Urinary incontinence in men can be caused by:

  • prostate problems such as BPH (Benign Prostatic Hyperplasia)
  • prostate cancer
  • treatment for prostate cancer
  • urine infection
  • other conditions including stroke, Parkinson’s disease, Multiple Sclerosis and spinal cord injury.

You may have problems emptying your bladder if your bladder muscle is weak and cannot squeeze the urine out. Alternatively you may not be able to empty your bladder because of a narrowing of the urethra. This is most commonly due to prostate problems including prostate cancer.

Problems with storing urine may be caused by problems with the bladder, sphincter or pelvic floor muscles. The bladder muscle may be jumpy or overactive and empty too quickly or with no warning. If the sphincter or pelvic floor muscles are weak, this may allow urine to escape, especially during exercise or when coughing or sneezing. These problems can be caused by treatment for prostate cancer.

Back to the Top

How does prostate cancer affect continence?

Prostate cancer may affect continence in a number of ways. Most men with early prostate cancer have no symptoms at all; however the prostate cancer may at some stage press on the urethra causing it to narrow and slow the flow of urine. This can cause symptoms including:

  • a weak urinary flow
  • a delay in starting to pass urine (hesitancy)
  • straining or taking a long time to finish
  • frequent urination (more than eight times a day)
  • getting up frequently at night to pass urine
  • needing to rush to the toilet (urgency)
  • dribbling urine
  • a feeling that your bladder has not emptied properly

These symptoms can commonly be caused by other prostate problems, such as Benign Prostatic Hyperplasia (BPH) so it’s important to see your doctor to talk about your symptoms. Call our confidential Helpline for more information.

If the narrowing is severe, it may stop you from being able to pass urine at all (acute retention) or you may be able to pass some urine but leave increasingly large amounts of urine behind in the bladder (chronic retention). If you are unable to pass urine you should seek medical help immediately. The treatments for urine retention are discussed further on in this fact sheet.

Back to the Top

Treatment for prostate cancer

The following treatments for prostate cancer may also cause incontinence.

Surgery (radical prostatectomy)

Surgery removes the whole prostate gland. This may cause weakness in the pelvic floor muscles and the sphincter. After surgery, you may experience symptoms ranging from occasional drops of urine escaping when you exercise, cough or sneeze (stress incontinence) through to an inability to control your urine at all. Symptoms tend to improve over time and many men will notice an improvement after six months to a year. A small number of men will have more serious long-term incontinence problems after radical prostatectomy.

External beam radiotherapy

Radiotherapy can cause changes to the wall of the bladder, which may irritate or shrink the bladder. During radiotherapy, you may find that you need to go to the toilet more often and with less warning. You may notice that you need to pass urine more often at night. Some men may also have a burning feeling and occasional bleeding when they pass urine. For some men these symptoms may continue after radiotherapy treatment is finished.

In some cases, radiotherapy may cause a narrowing in the tube (urethra) that urine passes through. This is called a stricture and may cause a weak stream of urine. Occasionally this may lead to an inability to empty the bladder properly (chronic retention) or an inability to pass urine at all (acute retention).

In rare cases radiotherapy can cause long-term incontinence. This is more likely if you have previously had prostate surgery such as Trans Urethral Resection of the Prostate (TURP) or radical prostatectomy.

Brachytherapy

Brachytherapy can cause a swelling of both the prostate gland and the urethra after treatment. This can cause a weak stream and urine retention as described above. During and after treatment you may need to pass urine more often and with less warning. Some men may also have a burning feeling.

If you have an enlarged prostate or problems passing urine before treatment you may not be suitable for brachytherapy as it may make the symptoms worse. Some centres may offer you hormones to shrink the prostate or a TURP to reduce the blockage before brachytherapy treatment.

Urinary incontinence is rare in men treated with brachytherapy, but you may be at greater risk if you have previously had surgery to treat urinary problems.

High Intensity Focused Ultrasound (HIFU)

HIFU may cause a narrowing of the urethra (stricture) and stress incontinence. Men may experience a range of symptoms including poor stream, leakage when they cough or sneeze, frequent urination and urgency (when there is little warning that you need to pass urine).

Cryotherapy

Cryotherapy may cause incontinence, particularly leakage when coughing or sneezing. If you are considering treatment for prostate cancer you should discuss the possible side effects with your doctor. You may also like to read our Treatment fact sheets.

Back to the Top

What can I do to improve my continence?

There are a number of basic lifestyle changes that may help your urinary problems. These include:

  • maintaining a healthy weight
  • avoiding constipation
  • drinking plenty of liquids (2 litres or 3-4 pints per day), but avoiding or reducing liquids that may irritate the bladder such as caffeine based drinks (tea, coffee and cola), other fizzy drinks and alcohol.
  • doing pelvic floor muscle exercises.

Back to the Top

Pelvic floor muscle exercises

Pelvic floor muscle exercises (also known as Kegel exercises) can help many men regain control of their bladders. The exercises work by strengthening the muscles that control urination. You can also do these exercises to help prevent future incontinence, particularly if you know that you are going to have prostate cancer treatment in the near future.

Finding the right muscle

Sit, stand or lie down. Relax your thighs, buttocks and stomach. Tighten your pelvic floor muscles as if you are trying to stop passing urine or wind. You should feel a lifting sensation inside and a tightening of the muscles around the entrance to your back passage (anus). You should not be tensing your thighs, buttocks or stomach. You can also check if you are using the correct muscles by placing your finger tips on the skin behind the scrotum. You will feel the muscles lift up away from your fingers when you are using them correctly.

Do not try to stop and start your stream whilst passing urine, this may irritate the bladder and may cause problems with emptying your bladder.

The exercises

Once you have found the correct muscles, and know what it feels like when you tense them, you can do the following exercises.

1. Tense the muscles so you feel a lifting sensation and hold this lift for as long as you can (up to ten seconds). Do not hold your breath whilst doing this. Then relax the muscles. You should have a definite feeling of letting go. Wait four seconds then repeat the ‘lift’. You should aim to lift then relax up to ten times.

2. Repeat the same lift of the muscles, tighten as quickly as possible and let go quickly. Try to do up to ten short fast lifts.

Practice your pelvic floor exercises three times each day.

Try to include the exercises as part of your daily routine. As you get better at doing them, you can try to increase the time you hold the contractions. See how many you can do before your muscles start to feel tired. Also, increase the number of short, fast lifts you do. You will need to practice pelvic floor exercise regularly and it may take some time before you notice an improvement.

It is important that you are doing the exercises correctly. If you are not sure what you are doing, ask your continence advisor or GP for help.

Back to the Top

What if I leak urine when I stand, cough or sneeze?

If you leak urine when you stand, cough or sneeze, pelvic floor exercises may help. Try to tighten your pelvic floor muscles before you stand, cough or sneeze and also before lifting anything.

If you have had a prostatectomy, doing pelvic floor muscle exercises soon after the surgery may help you to regain control of your bladder more quickly 1. Ask your doctor or specialist nurse for advice.

You should also try to reduce the amount of pressure on the pelvic floor muscles by:

  • avoiding constipation as this may result in straining during bowel movements.
  • getting medical advice for hayfever, asthma or bronchitis to reduce sneezing and coughing.
  • stopping smoking as this can cause coughing
  • trying to keep your weight within the normal range for your height
  • avoiding heavy lifting.

If the problem persists then ask to be referred to a continence advisor or specialist physiotherapist who may be able to offer more specialist help. They may suggest biofeedback, which is a technique that is used alongside pelvic floor muscle exercises. It measures your muscle contractions as you do the exercises. This helps to make sure you are squeezing the right muscles and can check how well you are squeezing them.

In some cases, the problem persists despite the options described here. You should discuss this with your specialist team. Surgical treatments are usually offered as a last resort for treating long-term incontinence. This is because any type of surgery has its own risk, and because further disruption to the urinary system can cause other problems. Success rates for the different surgeries vary.

The following surgery is possible:

Artificial urinary sphincter

This is an implant that closes the urethra in order to stop the flow of urine. An inflatable band is placed around the urethra. This is inflated by a balloon that is inserted behind the pelvic bone. A switch located in the scrotum controls the inflation. When you need to pass urine, the band is deflated. When you have finished the band is inflated, shutting off the urethra and preventing leaks.

Bulking agents

These can be injected into the area around the urethra. This helps the body keep the urethra and bladder opening closed and may help prevent small leaks. This is a fairly new treatment and more research is needed to support its widespread use.

Back to the Top

What if I pass urine frequently and with little warning?

Frequency and urgency may be symptoms of an unstable bladder. This is when the bladder muscle contracts uncontrollably or too early. It may also be a result of damage to the bladder wall after radiotherapy. If you notice that your urine is cloudy or smelly, or stings when you urinate, you may have a urine infection. If you have these symptoms, consult your GP.

If you experience frequency and urgency there are a number of things you can do to reduce or relieve your symptoms:

  • avoid drinks that irritate the bladder such as caffeine and alcohol.
  • aim to drink three to four pints of fluid each day. Do not reduce your fluid intake as this can make urine more concentrated, irritate the bladder and make symptoms worse.
  • pelvic floor muscle exercises may help although further research is needed.
  • bladder retraining.

Bladder Retraining

A normal bladder should be able to hold between half a pint and a whole pint (250-500 ml) before it needs to be emptied. Most people first feel that they need to go to the toilet when the bladder is about half full. They are then usually able to hold on until the bladder is fuller and there is a convenient place to go.

Bladder retraining aims to help you to hold back or ignore the strong feelings of wanting to go to the toilet when the bladder is not full. This helps you to regain control over your bladder by reducing the number of times you need to pass urine and helping you hold on longer. If you leak urine because you cannot get to the toilet in time, bladder retraining may also reduce or stop this. The following steps may help you:

1. Keep a record of how often you go to the toilet. You may also want to record how much urine you pass each time. You should keep this record for at least three days.

2. Using this information, work out on average how often you go to the toilet. If this is every half an hour, then set your first target for going every three-quarters of an hour.

3. Slowly increase the time between going to the toilet.

When you get an urge to empty your bladder try doing a long slow contraction of your pelvic floor muscles. Sitting on a hard surface may help as this gives support to the pelvic floor muscles. You could also try distracting yourself with a book or the television.

It can take time to retrain your bladder. Sometimes you may find that you can only hold on for an extra few minutes. Keep a record whilst you are doing this so that you can see your progress. Some people find it easier to do bladder retraining with the help and support of a continence advisor.

In some cases, drug treatment may be effective. There are drugs (called anti-cholinergics) available which relax the muscle wall of the bladder. This can reduce frequency, urgency and leaks, although the tablets can take up to a few weeks to work. These tablets can cause side effects including a dry mouth, headaches, constipation and dizziness. If the drug you are prescribed does not agree with you, you can discuss alternatives with your specialist team.

In rare cases, surgery may be needed. This involves adding a piece of bowel to the bladder to increase its size and make it more stable. Another, relatively new, treatment involves injecting botox into the wall of the bladder to reduce contractions. Results so far have been promising 2.

Back to the Top

What if I get up to pass urine many times at night?

If you are bothered by having to get up to the toilet frequently at night, try cutting down on any drinks in the last two hours before you go to bed, particularly any alcohol, coffee or tea.

Bladder retraining may help, but will only be effective at night when any daytime problem has been dealt with.

If you have swollen legs, you may find that you pass more urine at night. This is because the body reabsorbs the fluid held in your legs when you lie down. Try putting your legs up whenever you can during the day. If this does not work, consult your specialist team. They may suggest a diuretic pill, to stimulate urine production during the day.

Back to the Top

What if I dribble after I finish passing urine?

Losing a few drops of urine after you have finished passing urine is common in men of all ages, but is more likely to happen if the pelvic floor muscles are weak. Many men find that even after waiting and shaking the penis, a very small amount of urine will leak out afterwards. This may happen if the urethra has not emptied completely and a small pool of urine gets left behind.

Pelvic FloorAfter you have finished passing urine try contracting your pelvic floor muscles once for several seconds. This will push the urine out of the urethra and help to stop the dribbling.

Alternatively, after you have finished passing urine wait a few seconds and then use your fingertips to press gently behind the scrotum. Move your fingers forward toward the base of the penis under the scrotum and keep pressing gently. This should push the urine further along the urethra. You can then shake the last few drops out in the normal way.

What if I am not emptying my bladder properly?

If you are not emptying your bladder properly, you may find that you still feel full after passing urine. You may also notice that your stream is weak. Sometimes this can lead to urine infections. It is important that you let your specialist team know if you are having these problems.

If your bladder is not emptying because of a narrowing of the urethra, your doctor may prescribe tablets called alpha-blockers which can help to relax the muscles around the prostate or the neck of the bladder. Sometimes the problem can be resolved by a small operation. This works by either stretching the narrowing or by removing some excess prostate tissue, depending on the cause of the problem.

If you do not want an operation or your doctor does not recommend the tablets or operation, you may be shown how to self catheterise. This involves passing a fine, hollow tube up through the penis into the bladder to drain the urine. Your specialist nurse will show you how to do this and advise how often it is necessary to do it.

Back to the Top

Are there any symptoms I should look out for?

You should see your GP if:

  • your urine is cloudy, foul smelling or if it stings when you pass urine, especially if you also have a fever
  • your testicles become swollen or painful
  • you see blood in your urine
  • your incontinence suddenly gets worse
  • you are unable to pass urine (if this happens you should go straight to an Accident & Emergency department)

Back to the Top

What other help is available?

There are a number of places that you can turn to for help and advice. Your GP will be able to offer advice and put you in touch with your local NHS continence service. Alternatively, you can usually refer yourself to your local continence service. The Continence Foundation has a list of all the services in the UK. Call 0845 345 0165 or visit www.continence-foundation.org.uk.

Continence services are run by specialist nurses and physiotherapists. They will be able to help assess your incontinence and advise you on treatment options. They will also be able to give you support and advice on products that can help you cope with incontinence.

Products

The Continence Foundation has a directory of products, where you can find detailed information about different products such as penile sheaths and urinals. It also includes a list of manufacturers and suppliers. PromoCon (Promoting Continence and Product Awareness) is an organisation that provides information about continence products and services.

Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks. Your NHS continence service may be able to provide you with free disposable pads but this is based on an assessment of your needs. There is usually a limit to the number of pads they can provide.

Sheaths look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing. You can buy long underwear with a built-in pocket to hold the bag. Your continence advisor or district nurse will help to make sure that you get a good fitting sheath. Sheaths are available from chemists with a prescription from your doctor.

Catheters are tubes inserted up through the urethra and into the bladder to allow urine to drain out of the body into a bag. You can then empty the bag when it is convenient for you. You can get a catheter by prescription from your specialist team.

Other products such as reusable bedpads and urinals are also available. Talk to your continence advisor or contact PromoCon or the Continence Foundation for more information.

Back to the Top

Personal support

Continence problems can affect your self-esteem, your dignity and your independence. If you are having any difficulty managing your continence, talk to your specialist team or contact your continence service for help and advice. Some continence services also run local support groups.

Many men find that acknowledging their continence problem and seeking advice on managing it can help them feel that they are more in control and help to build self confidence.

A personal experience
‘The continence nurse was supportive and reassuring. She made me feel very comfortable and gave me helpful advice on a personal basis’

Incontinence can have both an emotional and practical impact. A few practical steps may help to make things easier:

  • Plan ahead when you go out - find out where public toilets are before you leave home.
  • Pack a bag to make sure you have any extra pads, undergarments or handwipes you may need. Some men also find it useful to carry a container in the back of the car.
  • Get a ‘Just can’t wait’ or ‘urgent’ card to show to staff in shops, restaurants and other public places. The card allows you to use their toilets without them asking awkward questions. You can get the cards from Incontact and the Continence Foundation.
  • If you know you will need to go to the toilet in the night, leave a light on in case you are in a hurry.

Links

The following organisations provide further information relevant to this page:

The Continence Foundation
www.continence-foundation.org.uk
The Continence Foundation has written information on continence and a specialist helpline service.

InContact
www.incontact.org
InContact provide support and information to people with continence problems and their carers.

PromoCon (Promoting Continence and Product Awareness)
www.promocon.co.uk
PromoCon provide impartial advice on continence products to members of the public and to health professionals.

Back to the Top

Reviewed by:

  • Declan Cahill, Consultant Urologist, Guy's Hospital
  • Elaine Hazell, Urology Continence Nurse Specialist, Guys Hospital
  • Julia Herbert, Specialist Continence Physiotherapist,Bolton PCT & Independent practitioner
  • Lyn Kirkwood, Nurse Consultant, Weston Area Health Trust, Weston-Super-Mare
  • The Prostate Cancer Charity Support & Information Specialist Nurses
  • The Prostate Cancer Charity Information Volunteers

Written and edited by:

The Prostate Cancer Charity Information Team

References used in the production of this page.

1. Filocamo MT, Li Mardi V, Del Popolo G et al . Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. European Urology 2005; 48 (5): 734-8

2. Duthie J, Wilson DI, Herbison GP et al. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database of Systematic Reviews 2007 Issue 4.