Posted 4/8/2014 6:21 AM (GMT 0)
Here is an excerpt from Dr. Catalona on incontinence:
"Over weeks and months, the bladder expands again and, most often, returns to normal size and normal function," Dr. Catalona said.
Dr. Catalona knows that men are anxious to have the catheter removed, but most often, they leave the hospital with a catheter in place and it remains for one to two weeks, rarely more. The time frame for removing the catheter depends upon how nicely the urethra and bladder come together. If it's with little tension and little stretching, the catheter can be removed sooner.
Also, when the bladder is exposed during the surgery, it takes some physical blows and it swells, just as other parts of your body swell when they take a hit.
"Frequent urination is normal after a radical prostatectomy," Dr. Catalona said. "The main cause is that the bladder wall is swollen and thickened and irritable. Normally, the bladder wall is thin and very elastic and maintains a low pressure until it has stored 8 to 10 ounces of urine. After surgery, the swollen bladder does not store much urine at a low pressure. As soon as it starts to fill, the pressure goes up and the patient feels the need to urinate. In the great majority of cases, this gradually improves with time, but it can take more than a year in some cases."
Other consequences occur too.
"You create surgical planes or in lay terms, cuts, and as those cuts heal, it's possible they create scars," Dr. Catalona said.
Later in the healing process, those scars can cause difficulties for the bladder because they make it difficult for the bladder to expand as it should. The scars increase the time it takes for the bladder to expand and therefore increase the time to return to continence.
"Also, sometimes after surgery, the patient can get a stricture at the point where the urethra and bladder are connected. Then, after the catheter is removed, the already irritated bladder is trying to force out the urine through a pinpoint," Dr. Catalona said.
Often, symptoms are the worst at night.
"After surgery, some fluid that is retained in the lower half of your body during the day gets redistributed at night and is excreted by the kidneys at night," Dr. Catalona explained.
Eventually, most damage to the bladder and the urethra heal, but it takes time and the improvement in continence is gradual, with complete recovery taking from six to 18 months.
"The most common cause of incontinence after a radical prostatectomy is a weak external sphincter muscle," Dr. Catalona said. "The surgeon has to try his best not to injure it and to preserve its length.
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Things should get better. For me, I continue to drink lots of water to "exercise" the muscle and "stretch" any scar tissue. At night I lay down and read for a couple of hours, during this time I have to get up frequently. After lights out I can normally go 7-8 hours without getting up. Works for me!
Cheers, Doug