DEAR DOCTOR K:

I have urinary incontinence that started after I was treated for prostate cancer. What can I do?

DEAR READER:

The involuntary leakage of urine, urinary incontinence, unfortunately is a common -- and aggravating -- side effect of prostate cancer treatment. In some cases, incontinence improves on its own. If it doesn't, there are several options for treating, or at least managing, the problem.

Three main types of urinary incontinence may develop after prostate cancer treatment.

If you have stress incontinence, you leak small amounts of urine when you cough, sneeze, exercise or put pressure on your bladder. Kegel exercises may help strengthen the muscles in your pelvic floor. This allows you to delay urinating until you reach a toilet.

You may have thought that Kegel exercises were something only women do. In fact, the muscles that are strengthened with Kegel exercises are the same in both sexes. (I've put a description of how to perform Kegel exercises on my website, AskDoctorK.com.)

If your stress incontinence resulted from having your prostate gland removed, bulking agents can help. A physician injects a substance, usually collagen, into the area once occupied by your prostate. This supports your urethra so you don't lose urine as easily.

Urge incontinence occurs when your bladder suddenly contracts and expels urine. You get an urge to urinate even though you know you emptied your bladder not long before. You urinate, and then get the urge again a half-hour later. Urge incontinence often comes in waves. It may not bother you all morning, for example, but it beomes insistent mid-afternoon. In the course of a few hours you may feel the urge four or five times.

Bladder retraining helps by increasing the amount of urine your bladder can hold. In this technique you suppress your urge and gradually prolong the time between trips to the toilet. This really works, but now and then there's a crisis. You've ignored the urge, and ignored it again, and suddenly you're pretty sure you aren't going to hold it and need to dash to the bathroom. The trick is to know when your bladder is at its limit and go to the bathroom just before you have to make that mad dash.

Prescription medications, particularly oxybutynin (Ditropan), tolterodine (Detrol) and some antidepressants, can be effective. The antidepressants aren't treating depression: They calm the sensations that come from your bladder.

Overflow incontinence results when your bladder cannot empty completely. As a result, urine dribbles out. Alpha blocker drugs help to more fully empty the bladder.

Even if your incontinence can't be cured, it can be managed. Absorbent underwear and highly absorbent disposable pads can be worn with everyday clothing. A condom-like device can be fitted over your penis and connected to a drainage bag.

Coping with incontinence can be frustrating, but with time and patience, you should be able to find an option that works. If your incontinence is severe, you may need to consider surgery.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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