The aim of this page is to provide tips and information to help overcome continence problems resulting from surgical or radiation procedures on the prostate or bladder exit. Incontinence, or stress incontinence, may become a problem whether or not prostate cancer is involved. Medical procedures that may cause continence difficulties include:

-- a TURP (Transurethral Resection of Prostate) which is essentially a removal of Prostate tissue near the bladder exit in order to improve flow during urination;

-- any Prostatectomy surgery where the prostate is removed completely and the urethra is reattached directly to the bladder;

-- a TURB (which is similar to the TURP, except the Bladder is named because the Prostate has already been removed; this procedure is sometimes needed if scar tissue develops from a prior procedure and interferes with urine flow;

-- any of several Radiation treatments targeting prostate cancer.

Once I started reading about these medical procedures, incontinence became my next biggest concern after wanting the operation to be a success. Other possible side effects were of far less concern.

Speaking to many others in my situation, the fear of persistent incontinence had been equally high on their list of worries. Consequently possible incontinence is indeed a big deal to folks.

Warning. Here are some very personal experiences and opinions. Your situation will likely differ and you should consult your health care professionals for what is best for you.

It is well established that Kegel exercises give improved control.

I did not wait until after the operation to start exercising. I learned how to do them beforehand from my medical specialists and by reading books and articles on the internet, and I started practicing.

Before having the TURP procedure, I was told NOT to do these exercises while any catheter was still in place. Made good sense.

The nurse removing the catheter at the hospital provided a pad to place inside my undershorts for the trip home. While loose boxer undershorts were best with the catheter, I had brought briefs to wear while I needed a pad. Keeps it snugly in place.

Once home, I switched to a simple home-modified version of another pad. (See how to make this inexpensive pad at the end of this page.)

I found that a small amount of leakage, a few drops, might happen within seconds of finishing regular urination. But I was mostly in full control afterwards until the next time I felt a need to use the washroom. During those early days it was important not to delay, but proceed immediately. If away from home, it was a good idea to know exactly where the closest public washroom was located.

I had bought a package of Depends for home use. These are sort of like stretchy underpants, with fairly bulky pads built in. I wore them only for sleep at night -- over my regular underpants and home-modified pad during the first couple of weeks, as a safety precaution. They proved unnecessary but they gave a lot of peace of mind for sleep.

Also handy is a package of disposable general purpose pads. Mine were blue in colour and measured 17 1/2 by 24 inches. These items were intended for use on baby change tables or where ever a waterproof plastic pad covered with an absorbent layer might be useful. One such was placed on the car seat for that first trip home after surgery. Just a precaution, and was not needed. During the first couple of weeks at home (with or without a catheter still in) I placed one on any chair I was using. Turned out never to be needed, but also gave peace of mind if I dozed off. (And the leftovers from the package can protect your driveway while changing the oil in your car or lawnmower or ... )

Also from the pharmacy I bought a couple of larger pads, which have a water resistant layer covered with a fairly thick absorbent layer. These waterproof sheet protectors were 30 by 34 inches, made of cloth, and were machine wash and dry. One of these was placed on the recliner I slept in while the catheter was still in, and for one week afterwards. By then I was pretty confident that I had enough control to sleep in my bed. There the large pad was placed under the lower sheet, and did not interfere with sleep. Again, having it there to protect the bedding just gives reassurance and more restful sleep.

As for the Kegel exercises, I made a decision not do them for the first couple of days after catheter removal just to let the body recover a bit from any stretching effect.

Many sources of information suggest that Kegel exercises start with a session of perhaps four or five repetitions, taking several seconds to contract the muscles, followed by several seconds to relax the muscles. There should be four or five sessions a day (depending on which source I listened to). Eventually I was supposed to be able to do as many as 5 sessions of 10 repetitions daily, each of 10 seconds contracting and 10 seconds back down. Once successfully at this point, more sessions per day could be considered.

I found during the early days that I did better if I did not exercise too much or too often.

It was important that an exercise session began soon after emptying the bladder. Then I would do perhaps 4 Kegels in a session, repeated only 3 or 4 times that day. Yes I could have done more and longer repetitions, but if I got too tired during a session, the next couple of hours found me feeling a need to go to the washroom every 15 or 20 minutes. Then no more Kegels that day.

There is another Kegel variant, where several immediate contractions and releases are done in a quick session. Such is supposed to calm the bladder if there is a feeling of contractions. Done too soon after the operation, this exercise variant usually resulted in another of those 2-hour periods of wanting to go frequently, before my system went back to normal.

My thought was to build up the duration and number of exercise sessions gradually. This was not a race or ego trip. I wanted success for the long term.

After my TURP operation, I found that good bladder control was not a big problem. I was lucky, but still did my practice exercises and improved control by using a Kegel contraction whenever about to do a potentially stressful activity, like stooping down or lifting.

And yes, these practice exercises are going to be a permanent routine in my life. Stopping the routine practice exercises would allow muscles to get flabby and problems could then likely return.

I did experience some instances of stress incontinence, where a sudden bending or cough or sneeze or similar sudden stress caused a few drops of leakage. Thanks to the Kegel exercises, I immediately reacted by clamping down and stopping it. It was then a good idea to go to the washroom reasonably soon. If this happened away from home, I was okay for a further 20 minutes or more.

Soon after the TURP operation, and before I learned I had cancer and needed the prostatectomy, I was very much in control. I had dropped use of the formal pad and from habit kept only the five folded sheets of toilet paper, which were very rarely needed -- mainly only if a drop or two of urine was not fully outside immediately after normal urination.

Because of the Kegels before the prostatectomy, I was hopeful, but still a little worried about future incontinence.

The difference from the TURP was the far longer time the catheter would be left in -- about 15 days -- a lot of time to stretch things. Plus, the operation might have reduced the strength and capability of the sphincter muscle.

Because of the considered seriousness of the prostatectomy, I received an appointment with a continence nurse specialist at St. Joseph's Hospital before the catheter was removed. She reviewed all the information about exercises and had a number of tips on improving control. Included was advice to remove caffeine from my diet (tea, coffee, and chocolate) and reduce strongly acidic drinks like cranberry juice and carbonated drinks and alcohol. She was right, any of the above that tempted me resulted in one of those nasty 2-hour periods of feeling the need to go every 15 minutes, before settling down again.

Get your rest. One important factor that no one mentioned was rest and sleep. If you are overly tired through lack of sleep or too much exercise or too much food and/or alcohol, your next sleep may be more akin to being unconscious. That is not a good situation for bladder control if you cannot wake up easily.

A further tip for strengthening control was useful after I had already gained good control. If I needed to go to the washroom, rather than going immediately I would deliberately wait another 15 minutes or so. After a few weeks, I had no more control concerns.

Stool Softeners. The specialist said it was also important to have regular bowel movements, as constipation could stimulate the strong feeling of a need to urinate. Stool softeners were an option, to be taken only as needed.

Personally, I found that stool softener pill use was unpredictable in results, too much or too little. My surgeon advocated increased fruit in the diet instead.

Besides some whole fruit daily, I tried drinking a small amount of bottled prune juice that to me tasted awful, nothing like good prunes. So I tried a package of prunes. Several brands on the shelf. Hmmm? Decided on a package of Mariani Premium Pitted Prunes. Wow, these tasted really good. A bit of experimentation found one or two prunes taken with breakfast gave near perfect daily regularity. And my wife, who hated prunes, tried one and admitted they were not the strong tasting rubbery ones of her youth; so she likes them now.

Much the same advice about foods to avoid was given by another continence nurse specialist that gave a presentation to the Prostate Support & Awareness Group (PSA Group). [More about them on the Support Groups page here.] This lady said that human temptation is normal, and that one (only) of the bad food items listed might be okay in moderation on a given day. She also recommended cranberry juice to reduce the chance of urinary tract infections [which definitely reduce continence control]. The experiences of other members of the PSA Group confirmed that many were able to enjoy a small amount of real coffee or the other "bad" items without incontinence issues. But they mostly did so only after their personal control had been well established.

One food item that has mixed opinions is cranberry juice. It is fairly acidic and many folks without prostate issues drink a daily glass in the hope of reducing urinary tract infections. While some say it is useless for this purpose, others say that their experiences with urinary tract infections were reduced very significantly. Cranberry juice had always been one of my favourites, but I also did not want its acidity to cause any strain on continence control, especially during the weeks soon after surgery. In our home we changed to a low calorie type, and usually dilute it with water to the point that we can take several such glasses daily to get the equivalent of about one glass of full-strength cranberry juice. So far no problems of any type.

There are many pad variants on the market, including a guard designed for men. I found such products bulky, downright uncomfortable, and expensive.

One of the books or websites, I forget which, had suggested the use of relatively inexpensive diapers designed for newborns. They are small enough to make a very effective pad without discomfort.

After checking what was available, I tried a package of Huggies Newborn Gentle Care. They are for babies up to 10 pounds, and other brands in this size should work also. As bought, they would be very uncomfortable as a pad. With simple modification, they are comfortable and effective when worn inside a snug pair of briefs. The exact modification for someone else (or a different brand) might vary, so adapt the following procedure as necessary.

These diapers have a hook and loop fastener at the top. Per the picture, trim off this fastener on each side and reduce the plastic overhang on each side to about half an inch wide, from the top to about half way down. Below that, trim off all the plastic excess (beyond the pad stuffing) down to, and around the bottom. Excess plastic can be very irritating; removal takes less than a minute with sharp scissors. The pad can be further shortened by trimming some off at the bottom, if that makes it more comfortable.

The modification of the top half left an elasticized small plastic overhang on the edges for a good reason. Take a strip of 5 sheets of toilet paper. Fold the first sheet at about the 2/3 point and wrap the rest of the paper around it, and flatten. Place the now-flat tissue pad onto the top half of the diaper padding, and arrange the remaining elastic edges over it to keep it in place. Now you have a waterproof outer pad with a toilet paper insert to provide extra protection. If you get a couple of drops of urine on the toilet paper, discard and fold a new insert. No need to throw away the main pad for every minor leak that does not touch it.

Yes we can really squeeze a nickel, but doing so makes good cents :-)

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