Question

I had a transurethral prostatectomy (TURP) one year ago. At that time I was diagnosed as having a neurogenic bladder. I now have urinary incontinence. What can be done about this?

Answer

In men who have no known neurologic problems (such as spinal cord or disc injury, diabetes, or multiple sclerosis), the term 'neurogenic bladder' usually refers to a bladder that has been 'stretched' or overworked over the course of many years. Mostly, this is due an enlarged prostate that caused symptoms for a long time and was never treated. The analogy I use with my patients is that of a new balloon filled with air and an older, stretched-out balloon filled with air. The new balloon, when the neck is released, will force the air out and fly around the room. The older balloon, which has been stretched for quite some time (i.e. a bladder that has been overstretched for a long time from having to push urine past an enlarged prostate), will have much more trouble emptying the air (i.e. urine); it's very hard to get that 'stretch' back once it's been lost.

With time, practicing contracting the sphincter muscles will help. You can try emptying your bladder every 2-3 hours for several months, even if you don't feel the sensation to go. This should help to retrain the bladder to empty with smaller volumes in it.

Additionally, your urologist should scan your bladder after urinating to make sure that the bladder is, in fact, emptying.

Links

• Incontinence in Men