Understanding Post-Prostatectomy Urinary Incontinence
Urinary incontinence is a very common challenge for men after a prostatectomy, initially affecting up to 98% of patients. This high rate stems from several factors related to the surgery:
- Loss of the Internal Sphincter: A radical prostatectomy involves removing the proximal urethra, which contains the internal sphincter. This crucial component for bladder control is compromised, reducing urethral closure pressure.
- External Sphincter or Nerve Damage: The external sphincter (a striated muscle) or its nerves can be damaged during surgery, directly impacting your voluntary control over urination.
- Bladder Support Issues: With the prostate removed, the bladder can descend onto the pelvic floor muscles, ligaments, and fascial connections. This altered support can negatively affect the mechanisms that keep the urethra closed.
- Bladder Overactivity: The bladder itself can become overactive, with up to 48% of men reporting urgency after surgery.
While the internal sphincter is lost, the external sphincter muscle remains intact and is under voluntary control. This muscle is an integral part of your pelvic floor musculature, working closely with your core and as such, wth the right treatment, it can be retrained and strengthened. When your core muscles contract, there’s a natural co-contraction of your pelvic floor muscles, including this essential sphincter.
This interconnectedness is vital: if your core and pelvic floor muscles are weak, the external sphincter’s function can be significantly affected. Together, these muscle groups provide crucial stability and support for your pelvic organs, playing a key role in maintaining continence.
Weakness in these areas can lead to:
- Reduced support for your pelvic organs, potentially affecting their position and function.
- Decreased ability to maintain continence, especially during activities that increase abdominal pressure like coughing, sneezing, or lifting.
- Potential overcompensation by other muscles, which can lead to further dysfunction.
The good news is that for most men, continence can be achieved within a year with correct management. For example, approximately 90% of men regain continence 6 months after a laparoscopic robotic prostatectomy, with only minimal further improvement typically seen after that.
Since the external sphincter muscles remain under voluntary control, they become the primary focus of rehabilitation. Strengthening exercises for both the core and pelvic floor muscles are a cornerstone of these programs, and use of our RTUS has given excellent results. The exercises we give aim to improve the coordination and strength of these vital muscle groups, significantly enhancing sphincter function and overall bladder control.
However, a proper assessment and a tailored exercise program are essential. Some individuals might have overactive pelvic floor muscles that require relaxation techniques rather than strengthening. Our Real-Time Ultrasound (RTUS) is used to accurately diagnose weakness, poor timing, or overactivity of the pelvic floor and core. This allows us to ensure the correct muscles are being engaged and to provide a precise, individualised course of treatment for your recovery.