Why may I have urinary incontinence after the surgery?


Incontinence has a very high impact on the quality of human life, forcing one to use absorbent principals, feel inadequate and is often required to modify or reduce their social life.


However, why can urinary incontinence appear after radical prostatectomy and what can one do to prevent it, reduce it or resolve it? At the base of the bladder, where it begins the urethra, the channel that carries the urine to the outside, continence is characterized by the presence of a kind of valve, called the sphincter, which blocks the leakage of urine from the bladder.


These valves can be partially sacrificed during surgery for radical prostatectomy. The patient may postoperatively encounter difficulties in maintaining a full bladder or blockage of the flow of urine. Below the bladder and the prostate there is a muscle called perineum, which is crossed by the urethra.


What is the perineum?


It is that part of the body that rests on the bike saddle. It is precisely located between the pubic bone and the coccyx. The perineum, or pelvic floor consists of a set of muscles, which close down the abdominal cavity. This voluntary muscle contracts when you want to avoid leakage of urine from the bladder or stool from the rectum. It is released when urination and defecation begins. In addition, it is used as an accessory muscle during intercourse.


The contraction of this muscle can block the passage of urine since the urethra passes through it becoming aid to continence. It is therefore understandable that in cases where surgery has weakened the level of urethral continence, and then the effect of "locking" the passage of urine, this mechanism may be "substituted" or helped by the contraction of the muscle.


However, the Perineal muscle does not by itself possess the features needed to fully take charge of continence; however, it can acquire them through appropriate training. The training of this muscle, called "gymnastics or perineal physiotherapy" must aim to provide enough area to hold until its contraction is able to stop the flow of urine. You can hear and recognize the contraction of the muscle by placing two fingers on the skin area between the penis and anus, just below the scrotum. If contracting the muscle makes the area become swollen and stiff it is sure to use the correct muscle. Do not confuse this contraction with contraction of the anus, which would not be as useful.


It is not a proper workout trying to block the urine during urination. This gesture can be used to assess the strength of "locking" of the perineal muscle; however, it is not correct from the point of view of rehabilitation because it trains a kind of contraction that is not correct and effective.


It is good to remember that the proper training of the perineal muscles starts early, possibly within one month after surgery, and always produces an improvement of continence. Moreover, the best results are obtained with patients who, in addition to training at home, also submit to weekly rehabilitation sessions. To be used together with gymnastics, outpatient instrumental methods are available that can speed up and improve the contraction of muscles and may include:


  • Functional electrical stimulation;
  • Biofeedback;
  • Extracorporeal magnetic stimulation, to be executed under control of subjective prepared



What can I do to reduce urinary incontinence after radical prostatectomy?


The pelvic floor for rehabilitation in preparation for prostatectomy surgery aims to prepare the muscles of the pelvic floor, specifically the one closest to the urethra to take an active role in continence in order to make an early recovery after surgery.


It consists of one session during which the patient gains awareness compared to a musculature that is often not known. Based on a careful evaluation of the individual characteristics of the perineal muscle, (each person has strength, tone and ability to use different muscles), posture, body weight as well as work and sport activities, patients will be taught simple exercises that can prepare the muscle to tackle the post-intervention period and be properly used during the movements of the day, (efforts, physical activity) so that after surgery the recovery of continence is complete as early as possible.


The exercises will be performed at home by the patient until the intervention and then resumed after the removal of the catheter; if within a short time continence is not improved, the rehabilitation program is revised based on the characterization of symptoms.


What techniques can be used, together with physiotherapy for the pelvic floor training?


Functional electrical stimulation (FES)


A small electrical charge is applied to the muscle through a probe inserted into the anus, in order to reach the perineal muscles, or electrodes supported from the outside directly on the muscle. In this way the current, properly set for when and how, and according to the purposes, will cause the muscle to passively contract. The objective is to raise awareness of the contraction and train the muscle through a massive recruitment of all muscle fibers, which occurs passively. The movement induced by the machine is always associated with a voluntary contraction of the perineum by the patient.


Biofeedback (BFB)


Biofeedback is a tool that allows the detection of the voluntary contraction of the perineal muscles and displays it on a computer screen in the form of a track. In this way the patient is able to "see" the contraction of their muscle, show any errors and correct them in our clinic. A particular tool allows you to do the exercises in a standing position, to observe them while walking and performing daily activities (climbing stairs, lifting weights, coughing and sneezing). Moreover, it allows one to observe how the muscle behaves, by controlling the layout, enabling one to try to obtain a correct perineal activation even during complex movements, not only in the supine position.