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An excellent article on incontinence and Kegels

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Prostate Cancer
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Posted 8/28/2008 12:41 AM (GMT 0)
This has probably been posted before but it is the first time I have seen explained exactly why incontinence often occurs after prostatectomy and how Kegel exercises may help restore bladder control and the importance of continuing them. The article also explains why, after the op you may lose urine during sex.
www.prostate-help.org/download/pilgrim/17incont.pdf
Essentially:
Prostate Cancer Surgery and Incontinence
One of the major problems men have after prostate surgery is incontinence. A quality of life (QOL) study done by UCLA found that for those men who were incontinent, it was more of a problem than impotence. Some statistics say that most men are able to regain control by the end of 24 months in about 98% of cases. Other estimates place the number of men who are incontinent to some degree as high as 10% especially during the first year or so after a radical prostatectomy. A few have incontinence problems that may be long term and severe. Some may have to use several pads or adult diapers per day.
Generally, the more procedures a doctor has done, the greater his expertise and less complications with incontinence and impotence.
Sphincters
A sphincter muscle is usually a circular muscle that surrounds an opening, such as the pyloric sphincter that controls the emptying of the stomach, the sphincter vesicae or urethral sphincter that controls the emptying of the bladder and the anal sphincter. The urethral or bladder sphincter is a donut shaped muscle just below the bladder neck. The base of the prostate is intimately connected to the primary sphincter. It may be difficult to determine where the sphincter ends and the prostate begins. So it is often damaged during a removal of the prostate.
Men have two sphincters that control the urine. The main or primary valve is the sphincter vesicae just below the bladder. It is also sometimes called the internal sphincter. The second valve is a musculo-membraneous sphincter just below the prostate. This sphincter is sometimes called the external valve or sphincter. Nature did not necessarily design it to control urine flow. If it was not damaged during the radical prostatectomy, it can be trained to work fairly well to control the urine after a prostatectomy.Men who have incontinence problems can also benefit from the Kegel exercises. To learn which muscles to strengthen, practice stopping the flow of urine several times. Then during the day clamp and hold the muscles tight for five to ten seconds. The exercises should be done at least 100 times per day. It would be even better to do 300 per day. These muscle exercises can allow the men to have a considerable amount of control over the movement of the penis, especially when it is erect. This muscle control can add to the pleasure of both male and female during the sex act.
The exercises can be done while watching TV, driving a car, sitting in church, or any where at any time. No one but you will know that you are doing them.
We spoke earlier about the fact that the primary bladder valve closed tightly when a man has an erection. This is so that the semen would be forced out of the end of the penis instead of taking the shorter route into the bladder. We also noted that the secondary musculomembraneous sphincter or secondary valve opens up when a man has an erection so that the semen can pass. This secondary valve usually closes down after a normal voiding of urine. This is the valve that lets you squeeze out the last few drops.
If a man has had a radical prostatectomy and the primary valve was severely damaged, it is usually possible for the man to regain normal control by using the Kegels to strengthen the secondary valve. This secondary musculomembraneous valve can be trained to control the normal voiding functions. But, since this valve has always opened up when a man has an erection, no amount of Kegels will cause it to remain closed when he has an erection or even just trying to have an erection.
Bill
Posted 8/28/2008 12:51 PM (GMT 0)
Thanks for the great article! Very helpful!

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04
Posted 8/28/2008 11:25 PM (GMT 0)

BillyMac said...
This secondary musculomembraneous valve can be trained to control the normal voiding functions. But, since this valve has always opened up when a man has an erection, no amount of Kegels will cause it to remain closed when he has an erection or even just trying to have an erection.

Interesting article, BillyMac. I take issue with the last point you quoted from the article. The implication is that we will automatically leak urine during erection/intercourse and cannot control it. Based on my experience, I don't think this is so.

I am one of the lucky ones with continence. I agree there is a natural tendency for the valve to open during erections When pumping I notice an occasional drop of fluid, that I take to be urine, and sometimes also a little moisture. And in one of my first orgasms, I ejaculated urine. However I found I could control that by Kegeling at the moment of orgasm -- and although I still do it, am not sure it is now necessary.

During intercourse (missionary style), I don't even think about Kegels. My wife has reported that she detects no urine -- so if I leak at all, it must be slight.

Posted 8/15/2015 9:59 PM (GMT 0)
I had robotic prostatectomy 11months ago. Still need two pads daily. Used to be 7 -8 pads daily in first 3 months post op, but put myself on sustained relief oxybutinin 10 mg daily. Certainly help almost immediate reduction to 4 pads per day. Evidence from medical literature search is that pelvic floor exercises make no difference to continence outcome at 12 months. I can see the reason. It is all about neurological damage and ability to feel leakage. I cannot feel leakage as it happens only after it has leaked. If sensation has not returned by 12 months I doubt it will.
Being dry at night is not simply lying down. In sleep we rely on the subconscious to wake us if the bladder fills. The sensation passes via a different route using the sympathetic nerves not usual sensory nerves. The course is different and follow the blood vessels not in the pudendal nerves. Children learn the art of being dry at night by making these connections in the brain. When the sympathetic nervous system detects bladder filling messages are sent to the brain to wake you up and then normal sensation of needing a wee take over. How often have post prostatectomy patients woken at night wondering why, but if you take the hint and go to pass urine despite little sensation of needing to you remain dry at night.
I found no benefit whatsoever from pelvic floor exercises and no benefit from the Vital stimulating device.
It is all down to time and increasingly now I am learning to accept the need for pads. Thank god for Tenna.
Posted 8/16/2015 12:54 AM (GMT 0)
I had a prostatectomy about 2 years ago. I was using one shield pad a day. I stopped using anything with caffeine and other stimulants and it has made the world of a different for me. I also take 5mg Cialis daily. Now, no pads and I get to wear boxers again. Maybe this will help with those who dribble as it did for me.
Posted 8/18/2015 12:23 PM (GMT 0)
This thread reminds me of when I had my catheter removed. July 6th to be exact, I hated that thing. I remember being depressed while shopping the local Walgreens for the large bag of the big heavy pads, not knowing what I was actually going to be facing. Turns out I only needed about 2 dozen of the small pads before I didn't need any at all. While some aren't as fortunate, In my case I think Kegels helped a lot. I started them six weeks before my surgery. I also did them while the catheter was in. I highly suggest any newbie looking at RALP surgery to start them as soon as you know this is the path you'll be taking. It will likely help.
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