Problems with our waterworks often result from diseases of the prostate, treatments, or simply the ageing process. These tend to fall into two categories – urgency and lack of control.
The muscles of the pelvic floor are kept firm and slightly tense to stop leakage of urine from the bladder or faeces from the bowel. Pelvic floor muscles can become weak and sag because of surgery, radiotherapy, being overweight, lack of exercise, poor posture, or just getting older. Weak muscles give you less control, and you may leak urine, especially with exercise or when you cough, sneeze or laugh. (This is called ‘stress incontinence’).
Pelvic floor exercises help strengthen these muscles and involve tucking your bottom in and pulling your pubic bone up in front and holding it there for a few seconds. This should be repeated 100+ times daily. Fast walking is also an excellent exercise. These exercises have also been shown to improve erectile function.
Although there is no firm evidence that doing pelvic floor exercises prior to treatment is beneficial, this can do no harm, and it may well help to get into the habit of routinely exercising the right muscles.
It must be emphasised that severe long-term incontinence is rare, and nearly all men recover continence after treatment within months. So do not despair.
The sphincter is a natural on/off valve associated with the urethra, which can become weakened or even damaged, usually during prostate surgery. In nearly all cases nowadays this strengthens over time (often with the help of pelvic floor exercises described on the previous page), and men usually gain full continence after 3–6 months or less. In up to 4% of cases, however, this can remain a problem after a year. If this is the case, there are two methods which are now used – a male sling (an implant for mild to moderate incontinence) and an operation to fit an artificial sphincter (for more severe cases).
The sling is made from polypropylene mesh and is implanted during a small operation, under general anaesthetic, through a small incision in the perineal area. It acts as a support for the urethra. A catheter may be needed for a short period, but normal urination should gradually be restored after this is removed.
There are two parts to fitting an artificial urinary sphincter, an operation done under full anaesthetic: the fitting of the sphincter, a cuff around the urethra, and an incision (like a hernia operation) in the groin to fit a pump attached to a small balloon in the scrotum. When the need to urinate is felt, a switch is pressed in the scrotum, which releases the urine, and after a few minutes the device self-closes. After the operation, the device cannot be used for six weeks, when it is activated by the nurse. Thereafter it alleviates the problem considerably.