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Male Sexuality and Cancer

Managing Incontinence and Leaking of Urine

What is urinary incontinence?

Urinary incontinence is the accidental release of urine.

It’s common for you to lose some bladder control after treatments for cancer of the pelvis (e.g., radiation, surgery). This can be embarrassing and disrupt daily activities. Even if you have good bladder control during the day, you might still have incontinence when you sneeze, cough, or laugh (stress incontinence).

What causes stress incontinence?

Stress incontinence happens when the muscle that holds the bladder’s outlet closed isn’t strong enough to hold back the urine.

How is incontinence treated?

There are treatments for incontinence and ways to help you manage it at home.

How long does incontinence last?

After pelvic surgery (e.g., for prostate cancer), many men have incontinence for at least 3 months. It’s usually better after 6 months. Incontinence usually gets worse later in the day because the muscles in the pelvic floor get tired.

What is pelvic floor physiotherapy?

Pelvic floor muscle strength is an important part of bladder control. Strong pelvic muscles can help decrease incontinence, help the bladder hold urine when you feel the urge, and make harder erections.

Pelvic floor physiotherapy means exercises you can do to strengthen your pelvic floor. When the muscles in the pelvic floor are tightened, it should feel like you’re tightening the same muscles you use to stop the flow of urine or to pass gas. It feels like you’re lifting the scrotum up and inward. When the muscles are relaxed, it should feel you’re relaxing like when you pass urine.

To do pelvic floor exercises:

  • Empty your bladder and get into a sitting position.
  • Tighten your pelvic floor muscles as strongly as you can, then let go. It should feel like you’re lifting or pulling that area up. Don’t tighten the muscles in your stomach or buttocks and don’t hold your breath while you do the tightening.
  • Hold the tightening for 3 seconds, 5 seconds, or 10 seconds. Hold it only as long as you can fully hold it. It’s better to do a few really good tightening exercises than many that aren’t fully tightened.
  • Repeat this 10 times. The more you practice, the more muscle strength you’ll build up. If you keep doing the exercises, eventually you’ll be able to hold for 10 seconds.
  • Try to practice these exercises during the day. You can do the exercises while sitting, standing, lying down, or walking. Your muscles will get stronger if you do the exercises 3 to 5 times every day.

If you do pelvic floor exercises regularly, incontinence may get better after a couple of months. If symptoms don’t get better, talk to your doctor.

How do I manage incontinence and sex?

Some couples struggle with urine leaking during sex. These ideas might help:

  • lay a towel out on the bed before sex—if urine leaks, the towel will absorb it
  • keep a warm, wet cloth near you for easy clean up if needed
  • remember that urine doesn’t have any germs in it, so it isn’t harmful if it leaks while having sex
  • try having sex in the shower or bath
  • use an erection ring (like the kind used with a vacuum erection device to help prevent leaking
Picture of a vacuum device for erection problems 

Even when men have good control of the bladders during the day, they might still leak urine when they become aroused or have an orgasm.

What if my incontinence isn’t getting better?

Some men with severe stress incontinence might need surgery. Your doctor might want you to wait until after your cancer treatments to have surgery. Many doctors recommend waiting at least 1 year before having surgery for incontinence.

Your doctor will tell you what surgery is best for you. There are different types of surgery for incontinence:​​​​

  • artificial sphincter
  • urethral bulking
  • bulbourethral sling: a sling is put under the urethra to support it and is attached to muscle or the pubic bone
  • electrical stimulation ​

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