Male incontinence guidelines

Improving bothersome incontinence following prostate surgery

Who is the leaflet for? What is its aim?

After prostate cancer surgery some men can experience incontinence.

• Stress incontinence is leakage with coughing or sneezing, reported by around 15% of men.
• Urge incontinence is leakage associated with an uncontrollable urge to pass urine, which is reported by 7% of men.

Similar figures are reported at six years after surgery. Only a quarter of men with severe leakage after prostate cancer surgery undergo surgical treatment for their leakage.

Treatment solutions

There are different options available to you to help you to manage your incontinence, including:

• Containment products
• Physiotherapy
• Surgery

Containment products

There is a choice of products available:

• Pads: These are triangular shaped and fit into snug fitting pants. They come in a range of thickness from a liner to a pad which can absorb 600ml of urine.
• Absorbent pants: Wearever is one of the makes available and has products which are washable and absorb from 150ml to 600ml of urine.
• Clamps: These ‘clamp’ over the penis to stop the flow of urine and can be particularly helpful for periods of a few hours – during a game of golf, a flight or a special occasion, for example. Dribble Stop and Pacey Cuff are two examples of available clamps.
• Penile sheath into a leg bag or Afex system into a leg bag: These are free draining systems to collect the urine into a bag.
• Flow director: If the direction of urine flow is a problem then this small device can help direct the flow of urine into the toilet.

Physiotherapy

Men are encouraged to do a mixture of power contractions of the pelvic floor, endurance contractions or long holds and then they must use the muscles functionally whenever exerting themselves with either a cough, sneeze or lifting, pushing or pulling. See the booklet by the CSP ‘Pelvic Floor Muscle Exercises (for men)’ available from pelvic floor muscle exercises men (opens in a new tab) for further instruction or contact your local men’s health physiotherapy service.

A physiotherapist will teach you to locate and work your pelvic floor muscles correctly. They will give you a personalised exercise programme following an assessment.

Needing to rush to the toilet or needing the toilet frequently may also be a problem. If you are suffering with urge incontinence, bladder training advice may be found in the leaflet available at Urgency and urge incontinence It may be beneficial for you to complete a fluid volume chart prior to your appointment (see under ‘Books and booklets’ below.).

If you live in Cambridgeshire you may self-refer to the physiotherapy department.

Surgical solutions

Solutions for stress incontinence

• male sling is a mesh tape passed under the urethra mimicking the supportive ligaments
• artificial urinary sphincter – this is 3-piece silicone device that all sits internally and closes the urethra involving a pump system

Solutions for urge incontinence

• medications (anticholinergics or mirabegron)
• botox injections into the bladder
• sacral nerve stimulation is a pacemaker that stimulates the sacral nerves

Where to seek help?

There are a number of sources of help available which include:

General advice

• NHS Choices – NHS Choices (opens in a new tab)
• Prostate Cancer UK (PCUK) – Prostate cancer UK (opens in a new tab)

Services available

• Urology nurses at Addenbrooke’s – 01223 257049
• Self-referral link to physiotherapy for Cambridgeshire patients –Self referral service
• REACT
• Maggies cancer services Cambridge – 01223 249220 [drop in or join a group session to gain knowledge and support after prostate surgery]
• Pro-active Peterborough Oncology CNS Team – 01733 677476
• Ipswich – Fiona Lennard, physiotherapist, Ipswich Hospital – 01473 703522
• Bedford – Milena Testori, physiotherapist, North wing Bedford Hospital – 01234 409232

Books and booklets

• Prostate Recovery Map 2 by Craig Allingham
• The Prostate Playbook by Craig Allingham
• CSP pelvic-floor exercises for men (opens in a new tab)
• Urgency and urge incontinence
• Fluid volume chart (opens in a new tab)

Products

• The Squeezy App (opens in a new tab)
• Pads – all supermarkets or Tena
• Wearever pants (opens in a new tab)
• Dribble stop clamp (opens in a new tab)
• Pacey cuff (opens in a new tab)
• Afex (opens in a new tab)

The questionnaire attached may be useful to complete if seeing a practitioner for medical help. ICIQ Questionnaire – if seeing a practitioner please complete and take with you.

Today’s date:

Many people leak urine some of the time. We are trying to find out how many people leak urine and how much this bothers them. We would be grateful if you could answer the following questions, thinking about how you have been, on average, over the PAST FOUR WEEKS.

1 Please write in your date of birth:

DAY MONTH YEAR

2 How often do you leak urine?

(Tick one box)

0 ☐ Never

1 ☐ About once a week or less often

2 ☐ Two or three times a week

3 ☐ About once a day

4 ☐ Several times a day

5 ☐ All the time

3 We would like to know how much urine you think leaks.

How much urine do you usually leak

(Tick one box)

0 ☐ None

2 ☐ A small amount

4 ☐ A moderate amount

6 ☐ A large amount

4 Overall, how much does leaking urine interfere with your everyday life?

Please ring a number between 0 (not at all) and 10 (a great deal)

0 1 2 3 4 5 6 7 8 9 10

ICIQ score: (add the scores from question 3,4 & 5 to arrive at your ICIQ score)

5 When does urine leak?

(Please tick all that apply to you)

☐ Never – urine does not leak

☐ Leaks before you can get to the toilet

☐ Leaks when you cough or sneeze

☐ Leaks when you are asleep

☐ Leaks when you are physically active/exercising

☐ Leaks when you have finished urinating and are dressed

☐ Leaks for no obvious reason

☐ Leaks all the time

Thank you very much for answering these questions.