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URINARY INCONTINENCE

Another possible complication of prostate surgery is incontinence. This condition afflicts twelve million Americans. Two percent to 5 percent of men undergoing prostate surgery suffer from severe or total incontinence. It is a most discomforting and humiliating problem; losing control of urination during exertion or a simple sneeze can cause shame.

Two mechanisms control male urinary continence; each has to work properly in order for a man to have voluntary control of urination. One mechanism is the musculature that surrounds much of the prostate gland and lies outside the true capsule of the prostate.

Its function is to maintain the tone of the urethra and the bladder neck and to keep them in a closed position except when the body is urinating. Severe damage to this area can lead to incontinence.

The other mechanism is the external urethral sphincter. If the surgeon damages this muscle during surgery, the result can be stress incontinence, which means an involuntary loss of urine when increased pressure develops within the abdomen and squeezes down on the bladder.

As with impotence, there are many ways to alleviate this condition. When an involuntary loss of urine persists beyond the period of hospitalization, various medications and treatments are available.

Collagen Injections

One popular treatment for incontinence is injections of collagen into tissue. Collagen is the protein extract of connective tissue from cattle. A recent investigation indicated that only 2 7 percent of men who received collagen injections were significantly helped by them. For some unknown reason, it is much more effective in women.

Collagen injections are easy to administer and typically do not cause any side effects, but this is an expensive procedure.

Kegel Exercises

Another technique used to treat incontinence is the Kegel exercise. This involves alternately tightening and relaxing the muscles of the floor of the pelvis to improve their tone and strength. The exercise is done throughout the day. You probably do this often without realizing it, for example when you are urinating and suddenly stop before you are through.

This exercise was developed by gynecologist Dr. Arnold Kegel for women who had trouble holding their urine after childbirth. Thousands of women and men have also increased their sexual responsiveness by doing this exercise. It is recommended by many therapists. Many males report stronger and more pleasurable orgasms as a result. It's also been helpful to men with erection problems and those who do not experience much feeling in their pelvic area.

Artificial Sphincter

Another technique to help the incontinent patient is the implantation of an artificial sphincter. This is not beneficial to all patients, but for the fortunate ones it does provide significant improvement and sometimes a total cure.

The artificial sphincter is a doughnut-shaped balloon that encircles the urethra. A man who has received an artificial sphincter must operate a pump implanted in his scrotum each time he wants to relieve himself. It is a device that many find satisfactory.

Modified Stamey Procedure

Dr. Thomas Stamey, Professor of Urology at Stanford University School of Medicine, has developed a technique that can cure urinary incontinence caused by prostate removal but not by neurological deterioration or other causes.

This new procedure involves implanting two GoreTex-covered pads of Dacron so that they gently compress the part of the urethra that rests below the pubic arch behind the scrotum, creating a substitute for the sphincter muscle. This allows men to urinate in a normal fashion. Since first developing this technique several years ago, Dr. Stamey has used it on sixty-five patients. The procedure, which takes one to three hours, completely relieved incontinence in fifty-eight of the men-a cure rate of about 90 percent. The men who were not completely cured by the operation have benefited nonetheless, Stamey said, because they are experiencing much less incontinence than before the sphincter surgery.

Penile Clamps

A penile clamp is a clamp that snaps on to the penis and prevents leakage. It is important not to leave it on too long, or it can cause damage to the skin. Patients are advised to take it off every half hour to allow the bladder to empty and to allow the blood flow that is essential for healthy tissue.

Absorbers and Collectors

Many absorbent products and devices are used successfully by patients having problems with urine leakage. The choice depends on the amount of urine leakage and a man's shape, size, and activity level.

There are small drip collectors that fit over the penis and absorb an ounce or more of urine. They feature collectors that can be unobtrusively stored in the pocket.

For men with a problem of uncontrolled and unexpected leakage, there are condom catheters that may be worn with a leg bag during the day and connected to a night bag at bedtime. It is important that this external catheter be fitted and applied correctly.

There are also two-piece pad-and-pant systems that allow a man to have the comfort of a fitted brief and the security of an absorbent pad.

When these products are needed, ask your urologist for a referral to a nurse specialist or a home health supplier with the skills and training to assist you. It is not advisable to select the products on your own.

Skin Care

Since skin care is very important to avoid rashes, use a special cleaner that is available for urinary incontinence. Ask your urologist to recommend one that will allow you to wash many times each day without the drying and irritating effects of most soaps.

There are also moisture-barrier creams and films that may be applied to protect your penis, scrotum, and surrounding skin. Taking this special care will help you to adjust to this problem considerably.

Lifestyle Changes

It is safe to assume that incontinence creates stress for the patient and family, so biofeedback, meditation, and visualization, which are useful to adjust to any form of stress, can be helpful.

Exercise and diet are also important for a male who has a problem with incontinence. If a man eats too much and doesn't get enough exercise, he is likely to gain weight, which will increase pressure on his bladder. Caffeine and alcohol can aggravate incontinence. A proper diet will reduce the problem of constipation without dependence on laxatives. Be aware, too, that drugs usually prescribed for high blood pressure can have a diuretic effect.

As always, it is important to drink a lot of water to help flush out the bladder. To avoid the annoyance of getting up often during the night, cut down on fluids before going to bed (after all, enjoying a good night's sleep was one of the big dividends of having the surgery).

Support Groups

There are many support groups listed in the "Resources" section at the back of this book. If you become incontinent, many men who have experienced this problem will be happy to discuss it with you. They will share their personal experiences and how they are adjusting to incontinence and overcoming its difficulties. They will also share their own sexual problems and other intimate facts that you might not discuss with others. Social interaction is a good way to lift spirits and reduce tension. You will be encouraged by the group to do Kegel exercises and to use other methods to help you.

To not share your feelings with your family and friends is an unwise decision and a surrender to hopelessness and helplessness. Going public with your problem, especially with your loved ones, provides a healing partnership and support that will improve the quality of life after surgery.

Needless to say, your bout with prostate cancer or with other prostate problems has been a challenge to you and your loved ones-but you've made it. You are alive and can now look forward to many more pleasant years. Your brain speaks to your body on a regular basis. Send it positive messages. Maintain an optimistic outlook to have a full and healthful life.

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Men's Health Erectile Dysfunction