help welcome managing incontinence

Hey guys, I'd welcome any tips you can give me on managing my incontinence.  I had a robotic prostatectomy on 8 Oct and catheter out on the 15th.  So I'm four+ weeks post-catheter.

From the get-go I've been dry at night.  I feel the little signal telling me it's time to go, so I get up and do it, and in the morning the pad is still dry.  The downside is that I get up every hour or two so my sleep is pretty well interrupted.  A couple times I've slept for two hours, and once even for four -- it was heavenly, or was it just a dream?  Any tips on how to stretch the intervals a little longer?

But the day time is another thing altogether.  I dribble all day long, and by the end of the day Mr. Depends is soggy.  I don't get the signals during the day that I do at night so usually I'm not aware when I'm dribbling.  I try to anticipate and visit the bathroom at least once an hour.  Usually I'll be able to produce a little urine, yet I'm still dribbling in between.  And the urine flow is pretty modest compared with before surgery.  I'd say there's been virtually no improvement from day one to now.  Any tips, other than patience, on how to make some progress during the day?

Many thanks, Dan

I agree with RCs - kegel exercises can strengthen the weakened muscles due to surgery ( and having only one sphincter now) ..

....my doctor had me do 5 sets a day - 20 contractions each set - and as noted below - overdoing it can tire out the muscles and not help them.

- it can take 14-16 weeks to get control again over the bladder - some can get control earlier.
-don't stress out too much - you are still healing - take care,
Bronson

Post Edited (tatt2man) : 11/15/2013 7:42:29 PM (GMT-7)

I 2nd that...Kegals and routine walking will help the pelvic floor muscles recovery.

It's early times for you yet. There are some guys who are continent when the catheter comes out but they are rare. For most men it takes a while. Kegel exercises help, but don't do too many. If you still feel like you aren't making any progress six weeks from now you might talk to you doctor about biofeedback training or pelvic floor physical therapy. That can help.

i started my recovery by trying to stop the flow while peeing. then start then stop it again.
every time.

that sensation when you stop the flow is what you want to mimic with a Kegel.

i takes months or longer to retrain your nerves and muscles so be persistent but patient.

Thanks for the support, encouragement, and practical tips, especially patience and also moderation with the Kegels.  I was sent home with directions to do 10 reps 4x/day.  Way too many.  Didn't work for me.  So, based on your suggestions, I'm going to try 6 reps 3x/day. Dan P

Hi

I'm a physio in Sydney, Australia specialising in continence training for men following prostate surgery. I'm doing research at the moment into improving outcomes following surgery with pelvic floor training.

I thought I might add my 2 cents worth to see if this helps.

Firstly I'm a big believer that Mother Nature is in charge of the healing process. Therefore for the first few weeks following surgery, be patient...relax...don't push your activities too hard. In fact I recommend to be as active as you can be whilst being dry at the same time (If that means you have to sit on your bum and read then do it!) Yes I know we need to exercise to stay well but limiting yourself to a number of shorter (drier) walks is better than an hour slog leading to soaked pads.

As your external sphincter muscle (recently cut, stitched and splinted open while the catheter was in) recovers you should find that you are able to push your activity levels up whilst still staying relatively dry.

The kegel exercises you should do in the early stages should be much more about improving the motor control (i.e. the location of the pelvic floor muscles). Most guys I see tend to have a very posterior (anal) dominant approach to recruiting their pelvic floor muscles (I use transperineal real time ultrasound to watch the muscles working) Only we leak through our willies not our bums!
So I teach them gently to get a sense of the more anterior (front) parts of the pelvic floor (penile and testicular lifting) before starting to push the strength.

We need more research into this area as a lot of advice is given to men by womens health physios who are just applying the knowledge they have on women on men. But childbirth damage is different to the trauma of surgery and we may need to challenge what we think we know.

Thats what I'm working on!!

Hope it helps people

Stuart

I totally agree with Stuart about the anterior versus posterior muscles. I found that out by trial and error. I gained a huge amount of confidence when I really focused on and strengthened the front pelvic floor muscles. At this point, I can seemingly contract either set of muscles independently. By keeping those front muscles strong, I am confidently dry all the time. When I was not paying so much attention to those front pelvic floor muscles, I had less confidence, and needed more situation awareness to avoid a small drip. I also do reverse lunges, planks, and straight-up leg lifts (by contracting my abdominal muscles). All this seems to help me a lot and keeps my pelvic core muscles strong. Good luck.
SC

Dan- Along with others, I ditto the kegels. One other side note,don't wait till the depends gets soggy. It is a little more costly to change frequently, but you need to avoid a lot of moisture down there against your skin and testicles. Rashes or infections can happen. If you are wearing a full depends, line it with a thin pad and change when it is wet. I went through about 5 Tena medium liners a day, while at work. Regards Inkhorn