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How long for Kegels to work?

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Posted 8/8/2011 4:07 PM (GMT 0)
Hi all,

Working the routine the best I can, hard to keep a schedule.

It'll be 2 weeks tomorrow since the cath came out. I noticed some good improvement the 1st week, but seems I'm not making much progress now.

Moved up from the "5's" to now doing 20 seconds off/on for 20 mins and extra sessions when I can. Wondering if that's why my internal rectum area is feeling sore now?

For those that acheived "dry", how long did it take? Is "dry" completely dry - no pads, etc.?

Just trying to see if I'm on schedule or need to do something different.

Thanks,

 

Posted 8/8/2011 4:17 PM (GMT 0)
 

 The post-surgery road to continence isn't a lot of fun, but you'll undoubtedly continue to see small but steady progress on a regular basis.  I'll caution that for a large percentage of men, the rate of progress will seem to slow down and be difficult to "measure", but keep doing your Kegels because they will help reduce the time to your fullest extent of recovery.  When studied by medical professionals, the conclusion was that when taken in aggregate (large population) Kegels don't make you continent; rather, they make you continent faster.

Time.  It takes time, and there is a large variation from man-to-man on how long.  My doctor publishes these results from the University of Chicago practice, although this was for robotic surgery patients.  You can eyeball where the "average" is, but what is more striking to me is the wide range and variation which occurs.  Some guys get lucky, but don't expect too much too soon.

Months after surgery:.........Percent of patients "pad-free":
..........1............................. ..............20%..........
..........3............................. ..............45%..........
..........6............................. ..............70%..........
.........12............................. ..............94%..........

Kegel technique?  Here's the best description I've found:

Imagine trying to stop yourself from passing wind. To do this, you would squeeze the muscle around the anus. Try squeezing that muscle as if you really did have wind. You should be able to feel the muscle move. You should be aware of the skin around the anus tightening and the anus being pulled up and away from whatever you are sitting on. Do not move the buttocks and thighs. Do not hold your breath - breathe normally. Do not tighten your abdominal or buttock muscles - keep them relaxed. Later, you can check whether you are contracting the correct muscles by touching the opening [I skipped this part] at the rectum as you are tightening the muscle - you should feel the opening of the rectum contract at the same time.

best wishes...

Posted 8/8/2011 4:22 PM (GMT 0)
By now you have already gotten through the Kagel exercises. My Dr. told me to do a minimum of 10 sets of 100 daily. Eventually, I tripled that by doing 1500 before getting out of bed and the remainder while I watched TV.
I was glad I did because after 7 months I threw the pads away and have not looked back since. In this case overdoing paid off.
Posted 8/8/2011 4:26 PM (GMT 0)
Sounds like I've got a ways to go and need to step up the frequency.

Thanks for the feedback guys.
Posted 8/8/2011 4:47 PM (GMT 0)
It is possible to do too many Kegels.

My uro/suregeon advised starting at 3 sets (a set being hold 10 seconds, release 10 seconds, repeat 10 times) a day, moving up to 5 sets a day.

When I got to 5 sets a day, it was too many - I literally went back to open flow mode for a few weeks. The PT nurse said I pushed it too fast, and actually did damage.

She also suggested doing the short version as well (a set being hold 5 seconds, release 5 seconds, repeat 10 times), alternated with the long version.

I saw little pad improvement for the first 2 months - virtually nothing changed. I was dry at night (mostly), and went throgh a Depends pant and 7-8 pads a day. I pushed up the Kegels, got better, than had the major setback. Backed off to 3 sets a day (still do that about 22 months out). Then about 4 months out I dropped to 3-5 pads a day, then at 5 months got rid of the pants and down to 3 pads a day. Within a month I was down to 1 pad a day, but then started adjuvant RT. That kicked me back up to 1-3 per day, and that appears to be permanent.

For me, a pad is wet, and gets changed, when it is uncomfortable. At the beginning, full was a literally wet and heavy Walgreens pad that would about pull my pants down from the weight. Now I use the Tena guard more often.

Posted 8/8/2011 4:57 PM (GMT 0)
hello, last summer after my RP it took about 5 weeks to become dry and when I did it seemed to happen quickly like 3-4 pads down to none in a few days. I hope you have the same outcome.

Alsp, I found an application on the internet for a Kegel exercise timer for mac or Ipad. It was a big help to have it clock my time and reps for me several times per day.

 

Posted 8/8/2011 5:01 PM (GMT 0)
I'm the same age, in good health and also had the RP. It took me about 3 months to go without pads, it was very gradual and frustrating at times but overall went OK. I probably could have stopped using pads sooner. Toward the end it felt like I was leaking more than I really was, a single drop can feel like a significant amount. 
Posted 8/8/2011 5:27 PM (GMT 0)
The big thing to remember is that every person seems to have their own timetable and route on recovery. In my case, I was doing 20 short contractions then 10 long contractions and then 20 more short contractions three times a day after the catheter was out. After about three weeks I started to notice a gradual improvement in continence. After about another three weeks I felt confident enough to go pad-free while at home but did wear a pad when I left the house as a precaution. Another three weeks went by without a significant problem so I stopped wearing pads altogether but now and then there was still a little drip so my wife's mini-pads provided the needed protection. I gradually did the Kegels less often as the drips became less and less frequent and eventually stopped altogether. Soon after I started doing the Kegels I did encounter the kind of rectal soreness you described. Doing the Kegels with too much force seemed to be the problem. Reducing the force of the contractions eased the soreness I encountered. Whatever you do, don't regard my experience as the "schedule" you should be on. This is just how it went for me and some guys recover continence more quickly than my case and others take longer. Be patient, you won't know your own "schedule" until it happens.
Posted 8/8/2011 8:42 PM (GMT 0)
Great info everyone, I really appreciate it. Will keep with the routine.

Thanks for the encouragement,
Posted 8/8/2011 9:43 PM (GMT 0)
d-in-sc,

I had open surgery the day before you and, from your description, it sounds like we're in a similar place. My Dr. says to do 4 sets of 10 kegels each day (breakfast, lunch, dinner and bedtime) plus stop the flow 2-3 times each time you pee. Doing this will give you roughly 50 -60 kegels per day which, according to him, is all you should do. I'm mostly dry at night (even skipped the pad one night), do very well while seated, but leak pretty regularly when standing, walking, etc. I think many us (me included) feel that since our bodies seem to be healing so well, the side effects (i.e. incontinence) should be going away as well. This entire adventure is a lesson in patience.
Posted 8/9/2011 12:15 PM (GMT 0)
I never did one kegel and I was dry in 3 months. 

Posted 8/9/2011 6:06 PM (GMT 0)
It looks like every doc has their own number of Kegels to do each day. The day my Foley came out (June 15th) my URO told me to do my Kegels by holding the muscle for a 5 count, five times for one set and to do no more than 20 sets a day. He said too many sets will tire out,  the up to now unused, sphincter muscle and make the leaking worse. I did just what he told me to and on July 1st I quit the pads and have been dry ever since.

Good luck and give it some time before you get too worried, everyone's story and progress  is a little different.

Terry the Water Guy

Posted 8/9/2011 7:03 PM (GMT 0)
As to not having to do Kegels -

I know of several surgery guys who were dry from the time the cath came out. A little bit of generalization can be made - they are all younger (40-55), in outstanding health / very good physical condition generally before surgery, and caught the PCa early (G 6).

It happens. Just didn't happen to me sad

Posted 8/9/2011 7:08 PM (GMT 0)
Regarding the various Kegel exercise programs given here, no study (according to one recent medical report) has demonstrated the superiority of one over another, but the experts agree that a dedicated regimen of contracting the right muscle (without overdoing it) is all that is mandatory (see my earlier post focused on identifying the right muscle). As I also mentioned in that earlier post (and shown in the data I provided, and demonstrated in the variety of responses received here already), there is wide variation in actual results.   There are other factors which you haven’t mentioned here which also influence outcomes, such as:   ·          Was your surgery “nerve sparing?”   Sparing the nerves may better preserve nerve signals to the sphincter.   One study focused on this reported that men undergoing nerve sparing surgery recovered continence twice as quickly (5.3 versus 10.9 months). ·          Data shows that obesity and/or sedentary lifestyle unfavorably impacts recovery of continence after prostatectomy.   Be patient. best wishes...
Posted 8/9/2011 7:21 PM (GMT 0)
It took me 3 months to go pad free all the time.  Even then I still had some dribbles.  It took about 2 months to be dry at night while sleeping.  Now at just over 6 months post-op, urinary control is pretty much the same as before surgery.  Actaully, I would have to say things are better.  Before surgery I would regularly get up at night to take a leak about 5 - 7 times.  Now, I only get up once or twice a night if at all.

For the first couple of months post-oop I felt like I had to pee all the time.  That situation has pretty much resolved also.

My Uro specifically stated that I should not over-do the kegels.  He said that over-doing kegels would fatigue the muscles and delay continence recovery.  I did minimal kegel exercising and continence improved as the body healed itself.  It is possible that I had well-developed kegels before surgery because I was always having to force the last bit of urine out of my bladder due to BPH symptoms.

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