Pelvic Floor Rehabilitation for Incontinence

I want to share my experience in using pelvic floor rehabilitation to remedy my incontinence caused by a radical prostectomy almost two years ago. This narrative is neither an endorsement nor a criticism of physical therapy to address continued incontinence – just a summary of my own, possibly unique, experience.

I’m among the unlucky few men who remain incontinent long past their prostatectomy. On the one-year anniversary (September 2012) of my surgery, I was still heavily incontinent (3-4 pads per day). I kept my urologist informed about the slow progress and he continued to advise patience and daily Kegel exercises. But I never made any significant improvement. My urologist was puzzled by this situation because he told me he was able to avoid cutting into the bladder sphincter when he removed my prostate. He thought I should be recovering faster. In February 2013, he finally referred me to pelvic floor rehabilitation. Maybe he felt I just wasn’t doing my Kegels correctly.

I started rehab in March 2013 with a physical therapist. She first evaluated the condition of my pelvic floor and then had me do several exercises to start strengthening the pelvic floor muscles. My urologist may have been right because my pelvic floor wasn’t as strong as it should have been. My therapist ended the first session by giving me daily exercises to do before my next appointment. My first three appointments were weekly and every other week afterwards. In each session, the physical therapist evaluated the strength of my pelvic floor muscles and gave me increasingly more difficult exercises to do between appointments.

My average daily leakage when I started the rehab was a little more than 600ml (mostly 3 pads but sometimes 4 pads per day). One month after the rehab sessions, my daily leakage average fell to around 550ml. I felt the rehab was producing good results; so I continued to do the exercises and go to rehab sessions. My daily average for April fell again, this time to 500ml, and in May fell once more to an average of 450ml per day. I was elated by this development because, at this rate of improvement, I would be practically dry by year-end. During her examinations, my therapist noted that my pelvic floor muscles had gotten much stronger. So she continued to give me new, more challenging exercises for to do at home. I figured it was only a matter of time and exercise until I'd be down to one pad per day.

In June, unfortunately the improvement stopped (despite my doing prescribed exercises diligently) and I even slid back to 500ml per day. And I stayed at the 500ml average through July. I have two more appointments this month and then my provider’s authorization for physical therapy runs out. The timing may be fortuitous because it appears that I’ve hit a plateau on my improvement and more sessions may be a waste of time and money. But even after the rehab ends, I’ll continue to do the exercises I’ve learned so that I can keep my pelvic floor muscles strong. I want no further backsliding if I can prevent it. And who knows – maybe a miracle will happen and I’ll hit another streak of improvement by doing it.

In any case, it appears that while a strong pelvic floor may be important to supporting the bladder and regaining continence, it may not be the full story – at least in my case. Five months of physical therapy has given me a strong pelvic floor but a reduction of only about 100ml per day in my leaking. At this point, I don’t know what is driving my incontinence. It could be because of my anatomy is somehow unusual, inadvertent damage to the bladder sphincter was done during surgery or neural signals between my brain and bladder are getting scrambled during micturition. After my rehab ends, this month I’ll consult with my urologist to see what other options are be available to get better control of my leaking.

By way of background, I suffered from BPH for more than 10 years before my prostate cancer diagnosis. I treated the symptoms with Terazosin prescribed by my doctor. Even while taking the medicine, I would have episodes of uncontrollable urgency to void and sometimes wet myself if I couldn’t make it to a bathroom in time. I’m happy that doesn’t happen any longer.

The first thing my urologist said to me after I woke up from the surgery: “Your prostate was much larger than I expected.” I found out from the pathology report that my extracted prostate weighed about 80 grams – almost four times the size of a normal prostate. I’m not a big guy; so that thing was taking up a LOT of room in my lower abdomen! Maybe that has something to do with my lack of progress in regaining continence. Anyway, I hope my urologist eventually has some answers – or better yet, some solutions - for me. I’ll post again if he and I find something else that gets me closer to dryness.

Mike

Knotreel said...
I can tell you I never urinated during a usual day for me, it all leaked out, water in water out. I am guessing you aren't that bad.

No, knotreel, I'm don't leak that badly. I urinate in the morning when I wake up and frequently during the day. So, I had some hope for the pelvic floor rehab. I did get a small improvement from the physical therapy but not enough to get down to one pad per day. I still have a steady drip-drip-drip that adds up to an average of 500ml (about 2 cups) per day. I want to knock that down to almost nothing if I can.

My urologist has mentioned the possibility of a sling or an AUS down the road. I think he wanted to wait and see if the problem got fixed through the physical therapy ... and I did too. Now that's been tried and didn't work as well as hoped, maybe it's time to move to the next option. Given a choice, I'd be willing to try the sling first to see if that does the trick. If that doesn't work, then move to the final step.

As to prostate size, I have seen here on Healing Well that some men had prostates up above 100 grams. I can't imagine the problems they must have had before (and after) their prostatectomies. An enlarged prostate gave me fits before, and apparently after, my surgery. Someday I'd like to get a good explanation on why yanking out a big prostate makes post-surgery incontinence harder to fix through Kegels and/or physical therapy.

You didn't mention it in your reply but I hope the AUS has solved your problem with incontinence.

Mike

Knotreel, I'm glad to hear the AUS fixed your incontinence and I'm sorry you now need adjustments to regain your continence. You've given me things to think about for the next step and I appreciate your feedback. Thank you very much for that.

I've recently come to the conclusion that I'd eventually need some mechanical assistance for my incontinence. Even if Kegels/physical therapy had gotten me dry, I was wondering if I would be able to maintain a strong enough pelvic floor to stay dry for the rest of my life.

I realize that neither the sling nor the AUS are permanent fixes either. But then everything in life is temporary, isn't it? I just want to be dry again ... for as long as I can.

Anyway, my urologist and I need to chat about next steps after I finish my physical therapy.

DougInLA,

I'm very glad that the PFR worked for you! And you were very smart to start the kegels before surgery. I didn't and now wonder how much recovery time I may have saved if had done so.

The PFR did help me and I'm happy that my doctor referred me. For example, I can now lift heavy things without squirting and I generally have better control of my leaking because of a stronger pelvic floor. But the physical therapy did not get me as far towards dry as I had hoped. There is clearly some other factor causing my leaking that the PFR can't resolve.

As knotreel and I were discussing, my case may be more difficult to fix because of the relatively large prostate (or the hole it left behind when it came out). If that's the case, only a sling or AUS may do the trick.

Thank you for your good wishes! I hope your recovery continues to go smoothly.

Mike