Regaining continence post protastectomy

Hang in there! I have had good continence since the catheter was removed. I'd done kegels for about 6 weeks prior to surgery. I'd hope that made a difference, but I still think the surgeon's skill matters.

All that being said, statistics say your continence should start improving soon. Once you "turn the corner", your rate of improvement accelerates. By one year, only about 2-3% say they need pads all the time.

Do your kegels, walk a lot, and keep the faith! Good luck.

There is a lot of hope in gaining continence after prostectemy...its a typical bell curve in recovery with a small group who are continent as soon as catheter is removed...the vast majority having incontinence for longer periods and a very small minority who need a operation which is usually always succesfull...I believe a persons fitness level in the pelvic area and the surgeons expertise are factors in the success of post op continence. Kegals are helpful in regaining continence and some sort of routine in that area should be established...yes 3 to 1 is correct...but with time and patience...you statisticaly should improve..The female has only one valve as well...others will be along with guidence soon...any other questions on any aspect of your treatment will be responded to in a variety of ways from cheerleading to being a hard arse coach...they will be all helpful if you receive in the positive spirit which every member gives...we are all different with different backgrounds...nuerosies...perspectives...and experiences...so as you said bear with us...we give good hugs....to create a signature...go to "my profile" at the left top of the page and follow the guidence there...keep your eye on the "now" as you recover and as it is for the vast majority of men your journey will not prevent you from a living a valued and productive life...other
things might...of which this particular cancer is shadowed by...Ps I stand corrected by Peter the D...2 to one..."so sad...2 out of 3 ain't bad"... Meatloaf great vocalist on this side of the pond...cheers...

Oh and of those who are continent from the jump...the caveat in myview is 99.9%{of the small percent who are continent...er ah..sticky wicket communicating that} I was...and celebrated with many a beer that evening with nary a drop...but to this day ...I will drop a drop in the morning here and ther while preparing to shower... I wear a thin pad...while working out...tho seldom is it wet but from sweat...wouldn't want a urine smell at the gym...Whot??

Welcome to HW,
Time, Kegels, and time.

They did a lot inside you. It takes months to fully heal and adjust.

Before you know it, this will all just be a bad memory.

Andrew

There are many success stories but they come with time. Though some guys are dry after RALP, many of us had to deal with incontinence for a while. I was very active a few weeks out of surgery, and just in case, I used pull up underwear with a pad inside. When ready, just dump the pad and move on, simple and quick. This was good for a busy day out, walking, golf course etc. From there, I went to a couple of pads per day, then one, then a napkin/papertowel inside the briefs for the occasional drip. Total time was about 4 months for me, and as I, you may see good improvement mixed with a few bad days, but for me it was more nuisance than concern. Prayers for your recovery.
Mack

3-31-2015 I had RALP. If incontinence was on a scale of 1 to 10, I was a 15. 15 to 20 pads a day. I didn't weigh them, no need, they were full.

I did my Kegels and was pretty down, but I saw what the guys on the board said. One person said it took him 18 months. So I did my Kegels and kept changing the pads.

I got a counter to keep up with the Kegels, I think someone on this board suggested it. Great idea. Got up to 100 Kegels. Also went to therapy to make sure I did the Kegels correctly. Another great suggestion from this board.

If I'm not a work I use one small pad a day. At work usually just 1 pad a day and it's pretty dry.

I'm at least 95% better than I was 2 years ago. I still do Kegels and it seems I'm still slowly getting better.

Just my opinion but I think your age will work in your favor. Be patient, my friend.

Colbo,

Don't get too down, you are still early in the game. Also keep in mind that the guys who post here are not necessarily a good representation of all outcomes. Many guys with "success" stories propably drop off the board while the guys with less successful outcomes continue to post looking for solutions and support for their issues. The guys with successful outcomes without ED or continence issues who still visit the site may have some reservations posting about their happiness over avoiding side effects with so many other guys in different situations. Having hit the trifecta, I know I'd do.

One thing I found helpful in getting the continence fully back was to remember to squeeze in those situations where you might have a leak or squirt such as a cough, sneeze, getting up from a sitting position, etc. If you focus on doing a kegel squeeze in those situations all the time after a while it becomes second nature and you do it without thinking. I think I was padless about eight weeks after catheter removal. Keep up the kegels.

Good luck

Joe

Delta is mostly right. Actually it's a bit more complicated.

The top sphincter -- the internal sphincter that is removed along with the prostate -- is made of smooth muscle and is controlled by the autonomic nervous system. It mostly stays closed until your bladder signals it has to pee then it opens. It is never under voluntary control although (or so it seem to me) you can, sort of, get to it by thinking about waterfalls or listening to running water.

The bottom sphincter -- the external sphincter that you get to keep -- is formed from skeletal muscle and is under voluntary control. Even before your surgery it was closed most of the time but it only had a lot of hard work to do when your internal sphincter had opened because you had to pee.

The process of regaining contenence after surgery involves strengthening the external sphincter and also learning to keep it closed all the time.

Again, thanks so much for the posts and the explanations.
I'm having as much a problem with the 'feeling' (so to speak) in the whole area... a feeling of needing to pee almost constantly (I think this is worse because I've ALWAYS needed to pee often, ever since being a kid) and the bladder/penis feeling 'irritated' through large parts of the day. As if it can't calm down and relax. Is this normal? I've continued to take Tamsulosin, even though I've got no prostrate left, as I've read it can help to calm the bladder.
The whole sensation only seems to feel relaxed when I'm lying prone for some time. It's so weird to feel like the whole thing is 'irritated' so much of the time.

Hey Colbo

I had open surgery on Dec 20, 2016 and was incontinent for about a month. Luckily I didnt use more than 2 pads a day for the first two weeks after the catheter was removed and then one every day even tho they were dry most days and on the 15th of Feb i stopped all pads but have some for emergency situations when i plan to go out and want to be safe. Now i do believe my age had a lot to do with it as i am only 57 and my Uro did not tell me anything about Kegel exercises but from what i have read they are very important to do. Hope this helps and there is a light at the end of the tunnel. I was prepared and bought 4 bags of pull ups and 2 bags of bed pads and also got 2 bags liners and a case of Male incontinence pads. I still have almost all my supplies and am thinking of donating them to a local Veterans location for others that might need them and can not afford to buy them.

I've been in that place of frustration where you are, it is something that happens.

The frustration isn't going to help you, at all, all you can do right now, is deal with it. It sucks, I know, I'm now almost 3 months out and still leak, but it IS getting better. Rehab is not quick for some of us on this, it is a time and patience thing, the mental exercise here is far greater than the physical. I stopped counting pads, I'm VERY competitive, and found that counting pads sent me into a spin as I didn't see an improvement as quickly as I wanted. So quit counting for awhile, take a deep breath, and just hang on for the ride for a bit. Otherwise you will make yourself miserable.

Something I remind myself of when I start to get down. I have a friend, who through various issues, can't pee, so three or more times a day he has to catheterize himself, I am so thankful that I don't have his situation...

Hang in there colbo. Same boat here. 6 week post-op and probably 8 pads/day, mostly full. Wear a 'Depends' at night with slight leakage. I have a moderate to strong flow when I pee. Both my uro and PT recommend....stay well hydrated. I found after work, I would drink 250-500 ml water quickly, then lay down. After 20-30 minutes, get up and pee. It seemed I was able to gain some urine volume..my theory was I was slowing increasing the volume of the urine my bladder was able to contain. It has seemed to work as when I am fully hydrated and I have not been upright or active, I have substantial volume, albeit frequent, if not near constant leakage.

I had PT last Thursday, specifically for Kegels. Here are some tips I learned:
- Fully relax in between reps
- I will fatigue the muscle if I do too many. I am to build up over time
- New routine for me
- 2 sets of 12 reps, 3x a day
- develop a routine of different positions...I do my first two sets on my back, legs bent(feet pulled toward body with knees elevated) before getting out of bed. Sets 3/4 mid day, sitting in ergonomic office chair, bent slightly forward at waist, hands on knees. Set 5 similar to 1/2, then set 6 rotated one one side, next day, the other side, third day on stomach. The idea is to work the muscle under different stress points.
- DO NOT clench stomach muscles (although the Kegel in question is tied into a transverse stomach muscle, so you will feel a slight tension in abdomen). I feel I really need to focus to isolate only flexing the specific Kegel.
- Build up at my own pace...I'll add a set or two or increase the reps after one week...some other add after week 2, etc.

Also, it is my understanding to focus on the urinary Kegel. When you are able to have a moderately streamed pee, stop the flow during the pee....this is the specific muscle you are trying to work, or so I have been instructed, by both my PT and uro. (Edit - this is a one time thing, only to ensure you are focusing on the correct muscle)

Also, when I am doing reps, I hold for a count of three and track reps by this system: "1-2-1, 1-2-2, 1-2-3, 1-2-4....etc." PT said this was a good idea.

I can relate that having urinary incontinence can cause depression. For the first few weeks, it was very tough on me as well...I had anxiety over it adn came close to tears on several occasions, with the whole 'why me' deal. And having a slight leak into my boxer briefs was near traumatic. Now I'm like...f-k it, did it leak through to my shorts or pants? No? It'll dry, then. I do change my pads frequently, esp at work as I want to be comfortable and decrease the possibility of leaking outside the pad. I look at it now as an inconvenience rather that a huge downer.

Mental toughness and a positive outlook on things is, for me, a major component of my recovery.

Hey Colbo,

I have some suggestions that might make this a little easier.
Keep a large plastic cup, at least a pint, on the toilet tank and pee into that when you go. Pee into that and pour it down the sink when you are finished.
This offers some serious advantages:
1) You don't have to aim. It all goes in the cup not on the floor or seat.
2) You don't have to worry about spraying when your pee comes out in a wide pattern.
3) You can see your pee and readily tell if it is getting cloudy so you get a jump on any UTI that might be starting.
4) With a little practice you can trust yourself do it in other rooms so you are not confined to the bathroom.
5) You save water by not having to flush.
6) You save heat energy by not having to heat up the water that refills your toilet.
--------------------- Do the following only if you live alone! ------------.
7) Pee in the shower while you are shampooing.
8) Leave the full pint on the counter for about an hour until it cools to room temperature. By doing so, you are extracting roughly 35 BTU of heat energy and are warming your house saving energy.

Odds are very good you will look back on these days as a mere bump in the road.

Jeff