when does the incontinency end?

Maurs · New User Joined: 17 Jul 2009 Posts: 3

I am a spouse, so I hope you don't mind my jumping onto this forum. My husband had DaVinci surgery on June 25th. Post op lots of pain, some complications (blood loss, UTI after catheter) so he has not been able to keegle as much as he would like and feels the incontinence is worse instead of better. I keep reading Keegle and exercise - how factual is that? It seems from posts that everyone is different - I'm struggling to offer him hope and direction since I am watching him slip into depression. Any suggestions are so welcome. I thank you.

His Stats: gleason 7, Negative marginals, 49 yrs. old., loss of nerves on the right.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

Hi--spouses are more than welcome. I'm sure Jean will say hi.

He doesn't have to rush the Kegel exercises.

How long ago did the catheter come out? Usually the incontinence is the worst in the few weeks immediately after catheter removal.

Tell him to hang in there. It's likely that things will improve on their own somewhat, and when he's more comfortable he can work on the exercises.

I wore pads and full diapers for a couple of weeks after catheter removal, but I'm dry now.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Maurs · New User Joined: 17 Jul 2009 Posts: 3

Thanks for the quick reply. I had a nice long chat with him last night and urged him to not get discouraged - that it does end it just takes time. This morning he said he was feeling up to a walk to he went for a 1.4 walk, not pushing it too much, but my feeling it will help his head as much if not more than his body!

One last question, when it does end does your body return to normal or do you spend your entire life keegling? the way I read things is that you are building those pelvic floor muscles to help your bladder hold and so I'm hopign that eventually that means you will feel the normal urge to go and it will wait until you get to the bathroom to release it. If you have any tips on that issue it would be great!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

Before surgery, men have 3 separate parts that control urine: a sphincter at the bladder neck, the prostate itself, and the external (striated) sphincter.

The prostatectomy takes away 2 of those, leaving only the external sphincter. Because the man has always had 3, the external sphincter is not immediately strong enough to handle the task. This is what is strengthened by the exercises. Youth can also help, since like with other muscles, tone is better in younger men than older.

Men, after surgery, are left with the same urinary control equipment as women. I know from wives Wink

and girlfriends (in the past LOL) that the one sphincter sometimes just isn't enough--like when exercising, sneezing, or watching 30 Rock. So we're in good company. (But men unfortunately have more muscular bladders than women--not a great combination to have a powerful bladder and an untested sphincter).

Eventually, your husband should be dry enough that he doesn't need pads, but he may always lose an inconsequential drop or two once in a while, if he does something strenuous.

However, sometimes that one remaining sphincter gets damaged during surgery. Hopefully your husband had an artist doing his surgery.

Walsh recommends doing the exercises like this: start the stream, and once its full force, stop it by contracting the muscles in the butt--not the abdominals, and not the muscles near the penis. Tighten the buttocks, like you're trying to hold a coin between the cheeks. Hold for several seconds. Repeat as often as you can. Walsh says to do these exercises only when urinating. If you do them all the time, the sphincter gets tired, and you end up even wetter.

There is biofeedback physical therapy available for men who have trouble learning control. If a medical reason prevents getting dry, there may be medical treatments that work, like collagen injections or an artificial sphincter.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Maurs · New User Joined: 17 Jul 2009 Posts: 3

thanks for the education - honestly it is difficult to wade through all the info and determine what really suppose to happen. So, do Walsh exercise or keegle? Ugh, sounds like you can overwork the darn thing and end up with more trouble. Our doctor was very good so far as we can tell but really at this early stage it is difficult to say. He had cath removed 7/3, had a UTI after that and very painful 'bottom' area which made keegles and/or walking difficult. That has since subsided.. doctor said to keegle, exercise and it will all happen in good time. Husband is looking for some more solid leads and direction on just how he's suppose to handle all this - I'll share what you have told me and pray that he sees some improvement soon so he can have some bright spot in all this. Thanks again.

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

I do not think you can overwork Kegels and I do think they work. I do have an explanation that is a bit contrary however. I too have read that thinking of gripping a thousand dollar bill between your butt cheeks in a wind storm was the proper muscles. Later however I read this is misinformation and that the goal is to be able to cut off the urine stream as Replicant explained (from Walsh) but WITHOUT any tensing of the buttocks. The two contractions are close, and involve related muscle groups. The tensing is similar. However, tensing the buttocks supposedly cause one to lose the primary focus and fail to isolate the actual muscle that cuts off urine flow.

For maximum benefit of Kegel exercises the suggestion is to isolate the muscle that cuts off urine flow and learn to contract that without tensing the buttocks or any other muscles. These others muscles should remain relaxed. The exercises can be done in sets of 50 reps held for 1 or 2 seconds. They can also be alternated with a few reps that are held at maximum contraction for up to 30 seconds each.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 262

Hi Maurs,

I'm one of the other wives who post about Hubbys' PCa.

As you're finding, the fellows here are full of great advice, lots of knowledge and experience that can be of help to us.

Hope all goes well.

Jean

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

I think that experience after surgery varies greatly, and people with problems tend to be the ones who post. For perspective, I'm giving my experience. I had a radical open prostatectomy about 2 months ago. I will told that I had "a wide bladder neck" and needed "a lot of stitches" to attach the bladder to the urethra. I had the catheter in for 11 days. I did the Kegels many times during those 11 days. When the catheter came out, I was prepared with pads. By the time I got home, I had sneezed and coughed, the pads were dry, so I stopped using them, and stopped the Kegels. I've noticed slight (insignificant) leakage when passing gas on a couple of occasions, but I've been fortunate that I haven't had the problems that others posting here have. Erectile function is very poor (not functional), but not absent, so hopefully one day it will improve.

I think the anatomy of how we control urine varies. When you've had the surgery, you control your urine with the pelvic muscles (external spincter). I think that's pretty much how I've done it my whole life--it doesn't feel any different. For someone else, they may be using the internal spincter more, and that gets cut out during the surgery, so they have to retrain their muscles. Most of the artlcles say that this happens for most people during the first year, but this must be really awful (and the thing I had feared the most from surgery). Doing Kegels, trying to hold the urine for some time must help, but it just seems to take time. Most articles indicate that if the surgeon is experienced, the great majority of people eventually regain urine control. On the other had, erectile function doesn't do as well. Many people never regain it, especially if they are over 65 or don't have both nerves spared. Also, it seems like it takes 18 to 24 months to get what recovery you are going to get. It seems that having a patient, understanding and committed partner must determine how that affects your life.
_________________
John

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

One note. I think Kegels should NEVER be done with a Folley catheter in place. There is a risk of of damage to the stitching that reattaches the urethra.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

I did the Kegels with the catheter in place because my urologist told me to. He said that views on doing this have changed. I think one needs to ask their surgeon about this one.
_________________
John

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

Thanks for that info. My surgeon at MSKCC told me NOT to do them until the catheter came out. Yet another ambiguity with PCa. Smile

_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

	Cancer Forums Forum Index -> Prostate Cancer Forum	All times are GMT - 5 Hours
Page 1 of 1

A website for discussions about any type of cancer, including lung cancer, breast cancer, prostate cancer, laryngeal cancer, leukemia, lymphoma, multiple myeloma and others