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Thread: Working With Incontinence

  1. #21
    Regular User
    Join Date
    Apr 2019
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    21
    Quote Originally Posted by DjinTonic View Post
    When I told my uro at about 6 months that I was essentially dry except for a few drops with a laugh or inattention, he asked if I'd like to be completely dry and suggested PT. I did one session, was taught how to do a correct Kegel in the easiest position: on your side in a "seated" position with knees bent. In this position, you can easily contract the urinary sphincter without engaging the anal one.

    Deep breath, exhale, contract urinary sphincter (only), hold x seconds (while breathing), relax.

    Therapist found I could hold it for 6 seconds (you want to be in control of the release, not a "collapse" from fatigue) and gave me a routine. Over the next weeks, working alone, I graduated to a seated position, then standing, finding that I could gradually increase the hold time. Exercises were 20 regular Kegels then 30 short ones, holding about 1 sec, twice a day if I remember. Therapist confirmed is it possible to overdo Kegels. I'd say I was fully dry at about 9 months. I didn't need to go back to PT after that one session.
    Djin
    I've been checking to see if anyone else had described their PT for urinary incontinence and found your post in this thread. My PT (physical therapist) instructed me in a similar way, used the same position and also said to focus on the urinary and not anal sphincter -- eventually you end up feeling a small tilt in your pelvic floor when performing a contraction -- that's the sensation that I got.

    She also said that fully relaxing the pelvic floor between contractions is an often overlooked and very important thing to do during the exercises. Image that your pelvic floor is a rope hammock that you bladder gets to lay upon. Consider the discomfort that your bladder might experience due to the unequal forces or pressure points created by pulling one rope taut on this hammock (internal surgical scars or muscle imbalances). Thus, deep belly breaths between contractions helps get the pelvic floor relaxed. Tone is more important than strength -- you don't need to try to crank things shut with all your might. A double step-wise contraction can be helpful: two slow deep relaxing belly breaths, then contract a LITTLE for 3-5 seconds, then step up the contraction a LITTLE more for 3-5 seconds, then release gently, then repeat (starting with the belly breaths) for 10 reps 3-5 times per day. Once you get it mastered, it can be done lying on your back, sitting in your chair or standing up. After telling her during a session that I had a couple of half dollar sized wet spots on my pants after standing up from a seated position during my son's baseball games, she said that if you do a couple of these before standing up that it could help. It does help, you just have to take the anticipatory/preemptive action.

    I've had to deal with osteitis pubis (inflammation of the pubic symphysis at the front joint of your pelvis), so some core strengthening and abductor/adductor muscle evaluation and exercises were done before the pelvic floor was addressed. She said that the core work is frequently done even without other indications, since your core supports and stabilizes your pelvic floor attachment points.

    My five sessions of therapy thus far has gotten me to a pad-free state (surgery was on Dec 4, 201 with very minor dribbles during some physically stressing moments. I have popped in a shield a couple of times, once when dealing with a 32 foot fiberglass extension ladder when cleaning the gutters led to leakage just getting it off of the hooks in the garage. It is a process and requires work as stated by my URO, PA, RO, PCP and PT. "Suck it up, ask for help and do the work" <--- almost a direct quote from my RO when she replied to my statement during an RT review meeting that I was still having some leakage.

    These are just my experiences. I was almost to the point of thinking that just one shield a day for the rest of my life wouldn't be so bad before the wake-up call from my RO, which my wife echoed. Not everyone will recover urinary continence, but PT is worth a shot. My daily dribbles when just removing my penis from my pants before urination are a thing of the past and stress incontinence from activity is diminishing (jogging across an intersection when walking my dog doesn't result in leakage anymore).
    Last edited by farmanerd; 06-07-2019 at 04:58 PM. Reason: trying to get rid of annoying emoji that popped up into date and failing. 2018 is year
    6/18 New PCP asks "When was your last PSA level checked?" --> 11.5 so off to URO
    9/18 PSA 12.4, TRUS biopsy 10/18 yields 2 of 12 positive: LA GS6 <5%, RA GS7(3+4) 5% and the 4 is cribriform approaching 50%
    Clinical staging T1c, Decipher biopsy 0.94, 58 years old at DX
    12/18 RARP, pathology GS7(4+3) with cribriform, tumors in 10-15% of gland
    -SVI, -LVI, +EPE, +PNI, +BNI, +SM multifocal >=3mm pattern 4
    pT3a,pNx (lymph nodes inaccessible due to large mesh placement from 15 year ago bilateral hernia repair
    4/19 second opinion of pathology GS8, primary tumor composed of >95% cribriform (4+4), <1% pattern 5 and very minor focus comedo-necrosis, intraductal and postive margin at bladder resection
    still at pT3a,pNx and started six months of ADT with ART to start in a month or two
    1/19 PSA <0.1, 4/19 PSA <0.1

  2. #22
    Top User
    Join Date
    Aug 2016
    Posts
    1,519
    Lifting your pelvic floor muscles and not clenching your anus is the key. It's like learning to rub your stomach and pat your head. You learn the distinction between the muscle groups and to control them separately.

    The best advice I got was to do some exercises like being in an elevator. Go up and down slowly. Stopping on the way, hold, and then continue on up or down while working to relax your anus at the same time. Eventually you begin to feel the distincion between the muscle groups.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  3. #23
    Robotic Surgery Completed 6/5...
    Ill update sig later.
    My husband's URO was amazing.. Vigilant and Aggressive with treatment and I'm thankful to God for such an amazing medical team.
    Surgery day was a bit hectic. It got pushed back 4 times the day of which caused some nervousness. But we said, stay patient.. And relax.. Surgery was set for 1p but he didn't get rolled to the Back until about 6:20ish . He end up having to do emergency surgery., well help another surgeon I should say.

    But the Dr said my husband did excellent. He was super surprise by the husband small amount of blood loss. He was able to save both side as far as nerves and said that the removal went awesome. His words, nerves basically just fell from prostate and that the cuts got removal went amazing.

    My husband made it to recovery about 10pm. And was in his room by 10:45 ish.. He was pretty out of it but managed to stay sitting up and even walked the halls before getting in bed by midnight.. We were released and went home yesterday at about Noon.. Last night was a bit different. He had a lot of pressure he said in his buttocks area and he HATES THE catheter but is bring such a trooper. He's been passing a little gas and has had a medium bowl movement. Any suggestions for relief.? I did get prune juice. Doc said no Milk of Mag until after a good bowel movement. Followup with URO is Wed, so now to await Final path. I'll keep you guys posted. O and sleeping in the bed last night didn't work. Recliner has been God sent.

 

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