New Member - Catheter just out, now what?

Hello All -

I just discovered this forum 2 days ago, while recouperating from daVinci RRP.  Looks like a very informative and supportive group.  My story is as follows:  I am 54 and have had normal PSA's every 3 years since age 40.  Then after a no PSA's for 4 years, I had a 6.7 in 3/09.  Two sets of needle core biopsies were required to establish a diagnosis of 3+3 involving < 5% of 2 cores, among a total of about 30 cores.  With a normal DRE & ultrasound, some would consider "watchful waiting" a viable option but I was uncomfortable with that so I opted to get the sucker out.  My surgery on 9/17/09 went well, my path report confirmed a very small focus of 3+3 with negative margins (pT2a), so I was feeling pretty good until the catheter came out yesterday on post-op day 11.
 
My immediate question is about continence training.  I am doing keegles as prescribed.  I am drinking lots of fluids during the daytime, but find that while up and walking around this just leaks out - my bladder pretty much seems "offline" and unwilling to expand while mobile.  Alternatively, I can rest in a recliner chair, drink lots of fluids and build up some volume, but as soon as I get up it begins flowing.  So... from the collective wisdom of those who have gone before me, is it better at this stage to walk around dripping and hoping my bladder wakes up, or is it better to lie back and give my bladder something to work with before making the mad splash-n-dash to the BR?  I know that this will get better, but want to use my limited recovery time to best advantage as I am due back at work next Monday.

Thanks to all

Doc

Hello, and welcome to HW, Doc. You are just days out of surgery, and off your cath. It will take time, some guys its days, others weeks, some months, and a few unfortunates, years. Varies that much from person to person. Hoepfully yours won't linger too long for you.

Don't over kegal, is what my uro/surgeon would say, he says if you do them all the time like some do, you overtire the muscles down there and it ends up being counterproductive. Walking is good therapy. Whatever you do, don't purposely de-hydrate yourself thinking if you intake less you will leak less. That isn't healthy and counterproductice too. And make sure you do get proper rest, another important part of your healing process.

Please keep us posted of your recovery, glad you found us.

David in SC

Doc,
The first two weeks I would lie down on the couch or bed and fill up. Then I'd try to kegel and hold it but found that to be a hopeless cause. I had to dash and splash in the shower or on the pea/pee gravel out back. (Never in/on the toilet due to the mess.)

After I lost the excuse to stay in bed I found I leaked all the time and I believe my bladder shrunk a bit but I have no data.
I am 9 weeks out and still leak like a rusty rowboat. I'm dry at night but the millisecond I stand up, Niagara Falls turns on. If I could hang a water wheel from my weiner I could at least recharge a couple of cell phones batteries. Hey at least it would be good for something besides peeing.
I have been alternating between drinking normally-when I am home and can sit in my undies; and drinking nothing-when I have to go out in public.
My experimentation with the TENS unit exhausts me and initial data looked like it helped but I am not convinced. I'll keep trying.
Good Luck,
Jeff

Seems like I've been seeing a bunch of "drink till you drop" concepts here latlely.

Doc, hopefully you aren't drinking anymore now then you would before surgery. What goes in must come out....

I found that improvement was noticeable daily the first month, first few days were pretty rough but by 2 weeks it was manageable. I did a lot of walking, also try to get off the pads as soon as possible, like when you are around the house. Learn to work the washing machine and buy a bunch of spare BVDs. I would leave a spare change of clothes at work and in my car.

It can work to your advantage, I got out a bunch of those "Do I really have to go to that " type social engagements

Hi Doc, missed this thread first time around. Sorry. But, as you can see, performance varies. The secret to showing up to work tomorrow is a Depends pad in front, one in each of your back pockets, and an emergency cache in a backpack, briefcase, or whatever. I'm 90 days post op now, still having stress issues during the day, but no big deal. Night and day I wear a pad. I could use one for 24 hours easily, but I change it twice a day after showers. I'm so used to it now if I had to be this way for the rest of my life, I'd cope, but that's easy to say as every week is better than the last and I know I'll wind up 100% dry at some point.

However, I remember being at your stage and standing in a store, talking to a nice young sales girl who was ringing up my purchases, and as we chatted Willie was squirting away as if I was in the privacy of my bathroom. I knew the pad would protect me but it wasn't easy looking 'natural.'

Have faith. It will get better. Although for a month or so you'll think it never will. Above all, have a sense of humour about it. After all, in the fun department, it's a pisser!

Sheldon AKA Sleepless

Doc,

As you can see from the replies, everyone single one of us is different to some degree when it comes to continence.

You and I share the same surgery date, (9/17/09) but different paths on IC. I have been 99% dry from the day the cath came out. I put on a guard that day and continue to wear them until I am supremely comfortable that I don't need them. My 1% non-dry occurred just the other night. I got a little frisky and decided to sleep without the guard. Now, I have been getting up once or twice a nite to go, so I figured no problem. I should mention that I take a sleep aid for insomnia put it hasn't been a problem. This one nite I figure I was just a little more tired than usual and didn't awaken soon enough. I can live with that. But I will wear the guard at nite for a while longer.

about Kegels and sphincters. I was talking with my dr's follow up nurse a couple of days ago about when I should resume Kegel training. She told me that it had been long enough and I should continue.

Then she added something I had not heard or understood.

Prior to surgery we have 2 sphincters, on is involuntary and the other is voluntary. The involuntary is the one contained within the prostate. It is this one that keeps urine from flowing out with ejaculate, thus killing sperm. And the one that men know about that makes it difficult to go when you have an erection. The other is the voluntary, the one we control. This is the one that we use to keep from going until we make it to the john. The one we use to squirt those last few drips out when we are done. This is the one that we have left. By exercising it and making it stronger (but not overdoing it to the point of weakness) we train it to stay in a more flexed and controlled position. Thus stopping flow when we don't want it to. By having it flexed and shutting off, when we want to go we voluntarily tell it to relax and let it fly.

This made a world of sense to me. Now it may have been her way of telling me it is a mind over matter thing. But it just makes too much sense. We go through life with our body telling us things but a lot of the time we just don't listen. It just comes natural.

I mean, how many of us actually knew that we had two sphincters to control urine flow in the first place? I'll raise my hand, I certainly did not. Just knew there was something that I could do to start and stop some things and other times when it just stopped on it's own.

Don't know if this helps, but just thought I would contribute it.

Good luck and God Bless,

Sonny

To Sonny's post response, I'd like to say that this should be required reading for every guy pre-op. I had read somewhere that there are two sphincters, but couldn't figure out exactly where they were. Good going Sonny! All the best. Roger

Hi again Doc. I think the bottom line is that you're doing just fine. As hard as it might be I think you just need to cross this one off your list. Sometime you're going to be dry as a bone --- unless, perhaps, you play tennis and lunge for the ball, but you'll learn, and it won't be a big deal. If you really work hard at it, you'll be dry in less than a year. If you just take it easy, don't worry, and let nature take its course, you'll be dry in less than 12 months. That's your choice: less than a year, or less than 12 months.

I don't mean to take this lightly. I remember going through as many pads in a day as you are and buying something like eight packages of 50 at the store, and then thinking I should go back for another 10. They were on sale and I was convinced I was going to need them for the rest of my life. Now, I could sometimes go for days on the same pad. Not that I'd want to, but I could.

Hang in there Doc. You're going to be fine.

Sheldon AKA Sleepless