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Thread: Incontinence

  1. #1
    Newbie Regular User
    Join Date
    Aug 2014
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    10

    Incontinence

    I had prostate surgery 8/5/14 and am struggling with incontinence. I am 66 years old. I started back to work on 9/2/14 and wear Depend underwear 24-7. I am continuing to do kegel exercises but have to slack off sometimes because of soreness. I have read comments that incontinence can take a year to improve. Seems like the general opinion is to have patience, it will improve eventually. Question I have is do the pelvic muscles and other muscles that control urine flow heal themselves from surgery over time whether I do kegel exercises or not? Thanks for your comments.

  2. #2
    Senior User
    Join Date
    Nov 2013
    Posts
    108
    Welcome to the club. Steve. I initially started doing about 50 kegels per day. I found that when I only did seven Kegels at night, in bed, in three weeks, I went from two pads a day to none. Doing too many Kegels fatigues that little sphincter muscle and increases incontinence. Several people other than me have stated that reducing the number of kegels performed each day actually helped their incontinence. I am almost five months post surgery and I am doing my kegels only on M/W/F without any negative effect to my continence.

    Good luck. Look at the signatures of others on this forum and create one for yourself. It helps in discussing problems with others.
    DOB - Oct 5, 1949
    PSA below 3.0 until 2011. Feb 2011 - 3.95; Apr 2012 - 3.31; Apr 2013 - 4.22; Mar 2014 - 5.09.
    1st prostate biopsy Jun 2013 - 12 core with ASAP in right mid. DRE revealed enlarged prostate, no lumps.
    Jul 2013 had robotic R partial nephrectomy - clear cell carcinoma.
    5 year anniversary MRI reveals cancer has not returned to my R kidney. CURED!!!
    2nd prostate biopsy Feb 2014 - 16 core - Left apex Gleason 6 (30% of one core); Left base Gleason 6 (15% of one core); Right apex - ASAP (both cores); Right mid - ASAP (one of four cores).
    RALP on 4/15/14. Final Pathology: 70 gr, G6, neg margins and lymph node, 10-15% involvement, graded pT2c NO. Both nerve bundles spared.
    Only minor leakage. 5/15 - one pad every two days. 6/1 - no pad.
    ED - 90% firmness @ Foley removal. 5/15 - 100% firmness.
    Post Surgery PSA:
    7/15/14 - <0.05
    10/15/14 - <0.05
    1/15/15 - <0.05
    3/25/15 - <0.05
    7/16/15 - <0.05
    11/16/15 - <0.05
    6/27/16 - <0.05
    2/22/17 - <0.05
    4/25/18 - <0.05

  3. #3
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
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    7,215
    Yup, several guys have mentioned that their incontinence is greatly improved after reducing the number of Kegels.

    At Mayo, they told me to do just one set (of 7) per day, best done at bedtime, also sitting on a toilet. I told them I do my set in bed before turning out the light and they said this is fine.

    They also advised me to continue doing the Kegels for the rest of my life because the sphincter muscle tends to grow weaker as we age -- and the single set a day will hopefully help prevent that from happening.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  4. #4
    Less is definitely more. I continued with 45-60 min of keagels and was fully continent in 7 weeks. However after 15 months I started to have stress leakage, once I cut back to about 12 minutes per day continence returned. I do mine when I am in bed at night.

  5. #5
    Steve, we are 6 days apart. I'm down to one pad a day. My orders from my doctor was to do 4 sets of 10. For the first 4 weeks my incontinence was like yours. I saw one of HighlandersCFH earlier post on 1 set of 7 at bed time that was recommended to him from Mayo. I talked to my doctor about the one set of 7 a day. My doctor said that 1 set would be fine and within a week I saw a big improvement.
    BD: 1967
    1 of 12 Cores positive at 35% Induction
    Gleason 3+4=7
    Bone & pelvic scans negative
    PSA (4 mo intervals); 12.4 - 11.6 - 10.8 - 11.2
    Da Vinci 7/31/14
    Catheter out in 7 days
    Prostate 73g
    Down to 1 pad a day after 5 weeks
    ED Rehabilitation - (Cialis 5mg a day) Started 5 weeks post Op.

  6. #6
    Senior User
    Join Date
    Nov 2013
    Posts
    108
    Maybe we should talk to our doctors about our experiences with 7 kegels per day over the higher numbers that they recommend. Seems that many people are having positive results with fewer kegels on this forum. Informing doctors about this might be beneficial for future club members.
    DOB - Oct 5, 1949
    PSA below 3.0 until 2011. Feb 2011 - 3.95; Apr 2012 - 3.31; Apr 2013 - 4.22; Mar 2014 - 5.09.
    1st prostate biopsy Jun 2013 - 12 core with ASAP in right mid. DRE revealed enlarged prostate, no lumps.
    Jul 2013 had robotic R partial nephrectomy - clear cell carcinoma.
    5 year anniversary MRI reveals cancer has not returned to my R kidney. CURED!!!
    2nd prostate biopsy Feb 2014 - 16 core - Left apex Gleason 6 (30% of one core); Left base Gleason 6 (15% of one core); Right apex - ASAP (both cores); Right mid - ASAP (one of four cores).
    RALP on 4/15/14. Final Pathology: 70 gr, G6, neg margins and lymph node, 10-15% involvement, graded pT2c NO. Both nerve bundles spared.
    Only minor leakage. 5/15 - one pad every two days. 6/1 - no pad.
    ED - 90% firmness @ Foley removal. 5/15 - 100% firmness.
    Post Surgery PSA:
    7/15/14 - <0.05
    10/15/14 - <0.05
    1/15/15 - <0.05
    3/25/15 - <0.05
    7/16/15 - <0.05
    11/16/15 - <0.05
    6/27/16 - <0.05
    2/22/17 - <0.05
    4/25/18 - <0.05

  7. #7
    Senior User
    Join Date
    Sep 2013
    Posts
    323
    Yes, less is usually more, although we can't be one hundred percent on that.

    What's been said thus far should give everyone a good idea of what works well for many.

    I'd only add that if that little sphincter muscle is SORE..........YOU'RE OVERWORKING IT (caps for emphasis).

    Overwork will do harm.

    Age and physical condition are important factors.

    I am (after a slow seven months) to the point where leakage is little enough that I don't need pads, but sometimes if I'm going to be out and active I'll wear two pair of underwear so none of those few drops can get to the outer clothing.

    Let me also add that getting plenty of rest is important. If you don't get enough sleep (including, ideally, NAPS) and you are a bit tired......that sphincter will also be a bit tired, your brain will be a bit tired--and you will have more little leaks.

    Be patient, be smart, listen to the guys who wrote above......and you'll have the best chance of your best possible outcome.

    As my doc said.......a few drops of urine now and then is no big thing. Of course, he's a urologist and not me.

    Good luck.
    I will resume more active participation when the bellicose forum culture improves.

  8. #8
    Newbie Regular User
    Join Date
    Aug 2014
    Posts
    10
    Thanks so much for the comments. When you reference 7 kegels a day are you meaning 7 sets (one set being flex (hold 10 seconds), rest (hold 10 seconds), flex (hold 10), rest (hold 10), flex (hold 10)?

    I received an exercise guide from my urologist to start with 10 sets per day for 1st week, increase to 15 sets per day for 2nd week, increase to 20 sets per day for 3rd week, increase to 25 or 30 sets per day for 4th week (I am at work and trying to recall the schedule). I currently get sore at 15 sets per day.

  9. #9
    Senior User
    Join Date
    Sep 2013
    Posts
    323
    I think your urologist is wrong and could be doing you harm. It would seem that your results are beginning to show that.

    As I said before.......if you get sore, you're doing too many.

    You are not training for the Goddamned Olympics, though your urologist seems to think so.

    Seven kegels just before you go to sleep is plenty for most people.

    Sets are for tennis.

    We're getting our sports all mixed up.

    A kegel is clamping that sphincter down for ten or 12 seconds and then relaxing for 30 seconds or so.

    (At least that's what's worked for me.)

    I will resume more active participation when the bellicose forum culture improves.

  10. #10
    Experienced User
    Join Date
    Mar 2014
    Posts
    74
    Steve,
    I am 64 and am 6 months post Robotic Prostatectomy and still wear pads 24-7. I wonder about the kegel information. My urologist wants me to get to 50 kegels per day and that is what
    I do. I stopped for about 10 days and went with the 7- 10 at bedtime recommended on this forum and saw no difference so I felt like I needed to follow my own urologist's advice and go back to 40-50 kegels per day. I may be slow..ly improving but not much.
    I think a lot of folks here were going to be fortunate and be continent early no matter what. It is dependent on a lot of things beside kegels like anatomy, surgeon's skill, size of prostate removed,etc. I was told I had an extra middle lobe of my prostate that was extending into my bladder. My urologist said he got a good water seal on the sphincter but who knows, it may be
    weak because I never used it.
    There is no way that you should get really discouraged 5 weeks after your surgery. Most people get continence eventually and I bet you will be the same. I well know it is damn frustrating!
    Hang in there and good luck,
    Jebstart
    Jebstart

    64 yrs old Robotic Prostatectomy 3/4/14 Biopsy : 1 of 12 Gleason 3+3 12-12-13. PSA rose from 2 to 3 over 6 months. Internist sent me to a urologist who felt a nodule and then the biopsy.

    Path report post Rob. Prostatectomy:
    Gleason 6 (3+3)
    Tumor Quant 5-7%
    Extent of Invasion pT3a
    Periprostatic Fat Invasion: Present (a microscopic focus of adenocarcinoma is seen
    to extend beyond the prostate capsule into periprostatic connective tissues-Block 4
    Margin evaluation: R0 Distance of tumor from closest margin: Less than 1 mm
    (anterolateral margin - block 4)
    Seminal vesicle invasion: Absent
    Perineural invastion: Present within but not outside the prostate
    Post Surgical PSA: 5/6/14, 7/23/14, 11/2/14, 5/1/15,12/23/15 < 0.008
    Artificial Sling 7/27/15

 

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