Prostate clinic > Some practical advice
REGAINING CONTINENCE
You will probably need to wear a small incontinence pad for a few weeks after a radical prostatectomy. These will be supplied by the team looking after you, and further supplies are available from your GP or can be bought from chemists. After this, if you have had an open or laparoscopic radical prostatectomy, you may find that pelvic floor exercises will help you to regain your continence control.
First you need to become aware of your pelvic floor muscles. Do this in two stages. While passing urine, contract the muscles up and inwards to stop the flow. Then let go. It does not matter if the flow does not stop altogether. The important thing is recognizing the muscles you are using. Once you have done this, there is no need to keep stopping and starting the urine flow. Secondly, tighten the rest of your pelvic floor muscles by pulling up the muscles around your rectum as if to control an attack of diarrhoea.
You should use all of these muscles at the same time when performing pelvic floor exercises. Draw them up and hold them for a count of five, and repeat until you have done five contractions. Try to do this exercise once each hour every day. Do 20 short, sharp contractions every day as well. Try to keep your stomach, thigh and buttock muscles relaxed so that you use only your pelvic floor muscles.
You will probably need to do the regular exercises for several weeks before you notice any improvement. To help you remember to do your exercises, try to schedule each set of contractions to accompany a certain daily task to build them into your routine.
After starting the exercise programme, you may notice a mild aching sensation as the muscles get tired. The ache should disappear within a few days, but you can take a rest from the exercises for a day or two if you wish. However, if you are at all concerned, you should consult your doctor.
SELF-CATHETERIZATION
Occasionally (in up to 8% of cases), narrowing of the bladder neck occurs after radical prostatectomy. This can cause a reduction in the urinary flow and occasionally even complete retention of urine. This problem is simply treated by gently dilating the bladder neck under light sedation, which is sometimes followed by a period of self-catheterization for a few weeks (this involves passing a small slippery tube through the narrowed area on a daily or less frequent basis). These simple measures nearly always resolve the problem, although they sometimes need to be repeated.
RADIOTHERAPY FOR PROSTATE CANCER
Many men opt for radiotherapy for the treatment of their prostate cancer. In general, either external beam radiotherapy or brachytherapy are well tolerated. However, the bowel disturbance that accompanies external beam radiotherapy, particularly towards the end of the treatment, can be troublesome. A low-residue diet can help, as can the use of medicines such as codeine phosphate, immodium or lomotil. Rectal bleeding can also occur following treatment and sometimes needs to be treated with Predsol steroid enemas or even laser therapy.
Brachytherapy seldom causes rectal problems but may result in difficulty in passing urine as a result of the swelling of the prostate that follows the insertion of the radioactive seeds. These usually settle eventually, but may persist for some months. Most patients undergoing brachytherapy are prescribed an alpha-blocker, such as Flomaxtra (tamsulosin) or Xatral (alfuzosin), for some time after the implants have been inserted. Occasionally the difficulty in passing urine can be so severe that a catheter is required. In this situation you should consult your doctor urgently.
SEXUAL PROBLEMS AFTER TREATMENT
Some treatments for prostate cancer and BPH can leave you with reduced or absent erections (often called erectile dysfunction), although orgasm is usually unaffected. Several drugs to help overcome this problem are now available. The best known is Viagra (sildenafil), but newer drugs, such as Cialis (tadalafil) and Levitra (vardenafil), can also be helpful. Some surgeons are suggesting that they be tried soon after the operation, but they may not work fully until about 6-9 months later. These drugs are, however, not suitable for everyone; for example, if you have angina or had a recent heart attack. In such cases, a number of other options such as silicone implants, inflatable penile prostheses, penile injections of prostaglandin and vacuum pumps can be considered.
Talk to your doctor if you experience loss of erections after treatment. He will be able to advise you about the appropriate options, and give you further information about the pros and cons; do not buy Viagra on the black market - always go through your doctor.
OTHER CONSIDERATIONS
A question that is sometimes posed is: how will my partner be affected? Nobody can ‘catch’ prostate cancer from you, but your partner will certainly be affected if impotence is the result. Frank discussion is vital before and after the operation, particularly if you go for a radical prostatectomy, and your partner must understand the implications as well as you. Emotional support for a partner and family is just as important as for the sufferer himself, and this is something to which the Prostate Research Campaign UK is firmly committed. In this situation good information is vital, so make sure your partner is as well informed as you are about all facets of prostate treatment.
Some patients ask: should I tell my family and friends I have, or have had, a prostate problem? It is up to you, of course, but why should there be a need for secrecy and shame? In fact, many men feel much better about the problem once they have shared it with their partner and/or close friend. Remember, that if you have or have had prostate cancer your first-degree relatives have roughly double the risk of developing the disease themselves and should therefore be put on their guard. It could also be argued that spreading the word about prostate disease can only help to raise the awareness that is required to help prevent prostate problems ruining people’s lives by encouraging them to see a doctor earlier.