How does a normal bladder work?

The bladder is a hollow organ in the lower abdomen. It stores urine; the liquid waste produced by the kidneys. Urine

 passes from each kidney into the bladder through a tube called a ureter. Urine leaves the bladder and exits the body through another tube called the urethra.

As the bladder fills with urine, pressure is exerted on its walls, which you experience as the need to urinate. This triggers the brain to send a message to the layer of muscle that surrounds the inner lining of the bladder, forcing the muscle to contract (tighten) and the urine to flow out of the bladder.

At the same time, the sphincter muscle that surrounds the urethra relaxes, letting the urine flow out of the body. This process requires both nerves and muscles working together to prevent urine leakage. Damage, weakening or injury to either muscles or nerves can result in incontinence.

Are you showing signs of incontinence?

Below are some simple questions to think about before talking to your doctor:

Do you leak urine unexpectedly?

Yes

No

How much do you leak?

A few drops
Wet undergarments
Wet clothing

Do you leak urine when you:

Cough?
Sneeze?
Laugh?
Bend?
Lift?
Change positions (i.e., sitting or laying to standing)?

Do you leak urine continuously during the day?

Yes
No

Do you leak urine while sleeping?

Yes
No

Does urine leakage affect your life?

Yes
No

If you answered yes to any of these questions or if you think incontinence is preventing you from enjoying life, talk to your doctor. They can diagnose your type of incontinence and help you find the most effective treatment option.

Incontinence can be caused by:

• Prostate removal
• Infections or medications
• Diseases
• Urethral strictures
• DESD (Detrusor External Sphincter Dyssynergia)
• Pelvic trauma
• Spinal cord damage
• Multiple sclerosis
• Neurological disorders

The cause of incontinence and the impact it has on the nerves or muscles will determine the type of incontinence you may have.

What are the types of incontinence?

Stress incontinence

Is the accidental release of urine when pressure is applied to the bladder, such as when you cough, sneeze, laugh or lift something heavy. This is the most common type of incontinence post-prostate cancer surgery.

Urge incontinence

Is when the bladder contracts at the wrong time giving you the feeling that you have to urinate immediately even if you may have just emptied your bladder.

Overflow incontinence

Is leaking that occurs when the bladder does not empty properly. This can be due to other medical conditions such as an enlarged prostate or a narrowing of the urethra.

Total incontinence

Is continual leakage of urine due to complete sphincter deficiency.

Mixed incontinence

Is a combination of different incontinence types. This can be difficult to diagnose, as one type can mask the other(s).

No single incontinence treatment works for everyone. In some cases, treatment for one type of incontinence can actually worsen another. It’s a good idea to discuss all the options with your doctor.

Non-surgical treatment options include:

• Absorbent products (pads)
• Catheters; internal or external
• Incontinence or penile clamps
• Behavioural modification
• Kegel exercises
• Limiting liquids
• Timed urination
• Medication
• Changing existing medications
• New medication

If these options are not suitable for the type of incontinence you experience or your lifestyle, there are also minimally invasive surgical options to consider.

Why surgical treatment? 

No single incontinence treatment works for everyone. In some cases, treatment for one type of incontinence can actually worsen another. It’s a good idea to discuss all the options with your doctor.

Surgical treatment options include: 

• Sling

• Artificial urinary sphincter (AUS) 

Consider using a sling

Once your incontinence issue has been assessed by a doctor or urologist, it may be that the best treatment is a sling such as Coloplast’s Virtue® male sling.

The Virtue® sling is made of a soft, flexible polypropylene mesh material. It is implanted to support and elevate the urethra and via gentle compression, it can help to prevent urine leakage.

Virtue is usually fitted during an outpatient procedure. Once it is implanted, you will have to limit your activities for a short period to allow proper healing and maximize the effects. Once the healing process has completed, you can enjoy the active lifestyle you had before, without fear of leaking.

Your doctor will want a complete medical history and information about your urinary habits. It’s important to accurately describe the problems you are having, such as when and under which conditions you have problems with leakage.

It may be beneficial to track your voiding habits in a journal to share with your doctor. This “24-hour voiding diary” should include information such as what you eat, what you drink, the number of times you urinate and if you have episodes of leakage.

Voiding diary (click to download as pdf)

Specialists, such as urologists, use different tests to measure the:

• Amount of urine in the bladder before urinating
• Force of the urine as it leaves the body
• Internal pressure of the bladder as it fills with urine
• Control of the urethral sphincter muscles

Some common tests used to diagnose incontinence are:

• Urinalysis
• Stress test
• Post-void residual
• Urodynamic testing
• Cystoscopy

Help get the most out of your Virtue® male sling by following these guidelines in consultation with your doctor. 

• After surgery, it is important to keep your pelvic area as still as possible to allow for proper healing.
• It is not uncommon to experience some pain at the incision sites after surgery. This pain should be controlled with the pain medication prescribed by your urologist.
• Post-operative pain should resolve within four weeks. If pain persists for longer than this, please contact your urologist.
• In addition to pain medication, your urologist may prescribe a stool softener and/or antibiotics for use after your procedure. Make sure to follow the instructions for taking them.

Your urologist may have additional guidelines for you to follow.