Urinary & Bowel Side Effects

Urinary Side Effects

Incontinence is the loss of the ability to control urination. Any treatment that removes the prostate or destroys prostate tissue can affect urination. This is because the prostate is close to the bladder and it surrounds the urethra (the tube that allows urine to flow outside the body).
 
The most common types of incontinence in men with prostate cancer are:
  • Stress incontinence: the loss of urine while conducting activities that strain the bladder (for example, laughing, coughing or exercising).
  • Urge continence: strong, sudden urges to urinate.
Urinary incontinence is a relatively common side effect of radical prostatectomy. It is usually temporary, lasting a few weeks to a few months, but in a small number of men, incontinence may be permanent. Leakage of urine may occur without warning, or only with heavy lifting or sudden physical movement such as sneezing or laughing. Other urinary difficulties may occur with radiation therapy including: frequent urination, burning and pain, blood in the urine or an intense urge to urinate.
 
Management of urinary side effects

There are many strategies that can be used to help manage urinary side effects after prostate cancer treatment, including the following:
 
Lifestyle Changes: Some urinary symptoms can be relieved if you drink fewer liquids – especially before bed, avoid caffeine and alcohol and if you lose weight.
 
Kegel (Pelvic Floor) Exercises: Kegel exercises work by strengthening the pelvic floor muscles surrounding the urethra. These are the muscles that help you control urination. Making these muscles stronger can lessen incontinence. Click here to learn more about Kegel Exercises.
 
Medication: Some medications such as anticholinergic drugs (e.g., oxybutynin), can reduce bladder irritability and decrease bladder spasms. This, in turn, may relieve urinary urgency and frequency and some forms of incontinence.
 
Some men have trouble urinating because of a blockage in the urethra. These individuals usually have a very full bladder at all times, which may result in “overflow incontinence”- where the bladder can no longer hold any additional urine. These men may benefit from medications that improve bladder emptying.
 
Surgery: If lifestyle changes and medication do not improve urinary side effects, surgery may help. There are several different surgical options:
  • Eliminating blockage in the urethra- Sometimes scar tissue can build up in the urethra and cause it to narrow, restricting urine flow and making it difficult to empty the bladder fully. This can be repaired by cutting into the scar tissue or by stretching the urethra.
  • Urethral sling procedure- A surgically implanted sling compresses the urethra below the sphincter (the muscles used to control the flow of urine from the bladder).
  • Artificial urinary sphincter implant- A cuff is placed around the urethra to compress it. The cuff is inflated or deflated with a mechanical valve.
  • Bulking agents- Substances such as collagen can be injected into the bladder neck to reduce urinary leakage, although this is not very effective in men.
Bowel Side Effects

Radiation therapy to the prostate may affect the wall of the rectum and it can cause bowel inflammation, urgency to go to the toilet, diarrhea, cramps, blood in the stool and fecal incontinence (loss of regular control of the bowels). This is normally temporary but may be permanent in rare cases. New imaging techniques and more precise methods of delivering radiation have reduced the risk of these complications.
 
Radical prostatectomy surgery has a very small risk of injury to the rectum. A temporary colostomy (an opening in the abdomen for bowel movements to come through into a bag) may be necessary. This is usually short- term until the rectal injury site is healed.
 
Some medications such as hormone therapy may cause nausea, diarrhea and general gastrointestinal upset.
 
Management of bowel side effects

Management of bowel side effects may include dietary modifications, medication, bowel training, local remedies such as steroid suppositories, and in rare cases, surgery. 
 

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