One of the leading causes of both erectile dysfunction and stress urinary incontinence in men is the treatment of prostate cancer. However, it’s not the cancer itself that causes incontinence and erectile dysfunction, but rather the treatment and removal of the cancer. This is because the various treatment options for prostate cancer including radical prostatectomy (RP), radiation therapy, and hormone therapy can cause damage to the blood vessels and nerves, lower the amount of testosterone in the body, and limit blood flow to the penis. “Normally, an intact, healthy external sphincter is sufficient to provide continence. However, after RP, there can be some damage or dysfunction which can prevent you from recovering your bladder control. This may be due to damage to the nerves, blood supply, supporting structures, or the muscle itself as the external sphincter is located at the apex of the prostate gland,” explains William Jaffe, MD, Assistant Professor of Clinical Urology in Surgery at Penn Medicine.
Causes of Erectile Dysfunction and Stress Urinary Incontinence
While prostate cancer treatment is one of the most common causes of both erectile dysfunction and stress urinary incontinence in men, it’s not the only one.
Diabetes
Erectile dysfunction is common in men who have diabetes as a result of damaged blood vessels caused by this disease. High blood sugar can also increase the amount of urine produced which can lead to frequency of urination and waking up often at night to urinate. Additionally, individuals may also have nerve damage that causes bladder muscles to weaken. In most cases, men who have erectile dysfunction and diabetes have type 2 diabetes which is often triggered by poor exercise and diet. These men can help to improve their sexual abilities and correct erectile dysfunction by becoming more active and changing their diet.
Neurological Conditions
“Stress incontinence is seen with certain neurological conditions and can occur after surgery for prostate cancer or Benign Prostatic Hyperplasia (BPH),” Dr. Jaffe explains. Some of these conditions include Alzheimer’s, Parkinson’s, epilepsy, multiple sclerosis, strokes, spinal injuries, and brain or spinal tumors. These disorders may also interfere with nerve signals needed for bladder and sphincter muscle control.
High Blood Pressure
High blood pressure can contribute to erectile dysfunction in a number of ways. First, high blood pressure may damage the blood vessels, causing the arteries to harden and narrow, a condition known as atherosclerosis. This condition can limit the blood flow to the penis, making it harder to achieve and maintain an erection. Secondly, men who frequently experience high blood pressure may be prescribed medications, including diuretics and beta blockers, that can interfere with their sexual performance. Diuretics force the body to make more urine in an attempt to remove waste from the body. This can limit the blood flow to the penis and lower the amount of zinc in a man’s body which is needed to produce testosterone.
Bad Habits
Bad habits like smoking and drinking can also contribute to erectile dysfunction and urinary incontinence. Smoking damages the blood vessels, making it difficult to achieve and maintain an erection. It can also cause chronic coughing which over time may harm the muscles of the pelvic floor. Additionally, alcohol is a depressant, which by nature, can dampen your mood and decrease sex drive. Alcohol also limits the blood flow to the penis and acts as a diuretic causing more urine to be produced by the body.
Treatment Options
Do you currently suffer from erectile dysfunction or stress urinary incontinence, or do you have a health condition that puts you at risk for developing these issues later in life? Don’t worry, there are many treatment options available.
Medications
The first thing you should do is schedule an appointment with your primary care doctor to review the medications you’re currently taking, and see if one or more of them may be causing your condition. Your physician may change your prescription to something that doesn’t have these adverse effects or prescribe drugs that can increase sexual performance. There are also various medications for urinary symptoms and incontinence depending on the cause.
If oral medication for erectile dysfunction fails, your doctor may prescribe penile suppositories. With a penile suppository, the patient inserts a medicated pellet into the tip of the penis when needed. Penile injections are another self-administered option where the patients uses a small needle to inject insulin directly into the penis. “We usually perform the first penile injection in the office to teach you how to use it and to monitor side effects,” Dr. Jaffe notes. Both of these medications typically cause erections within 5-15 minutes after being administered. Patients will be started on low doses until they get accustomed to the drug’s effects.
Vacuum Erection Device (VED)
Vacuum Erection Devices (VEDs) are a non-invasive form of treatment for erectile dysfunction that involves placing a cylindrical device over the penis. These devices create penile blood engorgement with the use of a pump that produces negative pressure and constriction rings.
Surgery
Penile Prosthetics
“Penile prosthetics are generally reserved for patients who fail all of the other therapies, as the operation is irreversible,” Dr. Jaffe explains, “After having a prosthesis, you will always need a functioning prosthesis to achieve and erection,” he said.
AdVance Male Sling
For men experiencing mild urinary incontinence, the AdVance male sling may be their best treatment option. This surgery is performed through a small incision in the perineum (the area between the scrotum and anus) to expose the urethra. Once exposed, a piece of mesh is attached to either side of the pelvis, supporting the sphincter and bringing it back to its natural position. This helps to restore bladder control.
Artificial Urinary Sphincter
According to Dr. Jaffe, “the artificial urinary sphincter procedure is considered the ‘gold standard’ treatment for male urinary incontinence. This device has been in use for over 30 years with a long track record of safety and efficiency and can be effective even in men with the most severe degrees of incontinence,” he explains. This procedure inserts a pressure-regulating balloon, inflatable cuff, and a control pump, which all work together inside your body to control urination.
Lifestyle Changes
If you’re a smoker or drinker your doctor may recommend quitting or cutting back. Similarly, if you have diabetes or are overweight or obese, your doctor may recommend making changes to your diet and exercise to better control your weight and blood sugar levels.