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Recovering continence after surgery

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Posted 4/8/2017 1:53 AM (GMT 0)
I have been told that, in time, continence should return with the patient working hard at Kegel exercises. I'm wondering what makes for recovery. I know what Kegels do, but does the person thereafter have to keep the pelvic floor muscles clenched all the time? Or does something else happen, like the external sphincter (if not the internal one, if that was removed) returning to normal? Bottom line, does getting back to normal mean that one regains involuntary control and the strengthened pelvic floor muscles act as a backup? Or does it mean the whole burden will be on the muscles? I can't imagine ever getting to the point where I can clench them constantly.
Posted 4/8/2017 2:35 AM (GMT 0)
Hi rickw,
It seems to vary a lot based on all the reading I've done. I started Kegels as soon as I decided I would have surgery. There are apparently several muscle groups down in the pelvic region so you need to confirm that you are exercising the right ones. My doc recommended doing about 100 per day or so. I think I did at least that many or more. I would do groups of 10 or so throughout the day. I also would stop my urine flow while urinating to make sure I was using the correct muscle group. I've read by some posters that you're not supposed to stop urination or do as many as I did. I was fully continent about 3 days after my catheter was pulled. I still did Kegels for a couple of weeks but since I never leaked I guess I just kind of forgot about doing them. Since then I rarely think about doing them. I don't feel any different in that regard than before surgery. I don't intentionally do anything to maintain continence. I know based on all the posts I've read that I'm blessed in regard to continence. Good luck to you!
Posted 4/8/2017 3:14 AM (GMT 0)
Hi Rick.

Just my take. I'm about 20 months post-op. I did no Kegels prior to surgery, but started after the catheter was pulled, though I admit I wasn't very consistent. I honestly can't remember the last time I did one at this point. For the most part, I'm fine, but I sometimes wear a 'shield' as a precaution for bedtime, especially if I've had a lot of fluid intake (especially involving alcohol). I may have an occasional 'stress squirt' when I don't prepare to something strenuous.

As far as "normal" and "involuntary control" goes, no, I don't constantly have to clench. For the most part, life goes on normally. Sometimes I'll feel a slight urge and 'pucker up' a little, but it usually subsides and I can just go when I get a chance to. A somewhat bigger difference is that when I have to urgently go, I have to GO! Where us guys used to have a prostate to help constrict flow, we don't have that advantage anymore. It made me appreciate the women I knew more now that I realize the urgency they seemed to have to find a restroom, like NOW, was really an issue! LOL! So, if I get to that point, I'm in full 'clench mode' but I guess I was in the past, too. I could just buy more time if necessary, where I can't so much now.

But again, in no way do I constantly walk around clenching my pelvic muscles to avoid leaking. I was told by someone that I'll "pee like a girl now." I think that's a mostly fair comparison.

MD
Posted 4/8/2017 1:09 PM (GMT 0)
Hi Rick, I am 4 weeks out and still working on incontinence and ED. Martin P posted these two videos which I found to be extremely helpful. One is over an hour long but very helpful and also talks about ED. Good luck,


https://www.youtube.com/watch?v=ZlCTRhQQ_g8

https://www.youtube.com/watch?v=QHwVglPQR_w[url]
Posted 4/8/2017 8:10 PM (GMT 0)
rickw -
for the majority it goes back to normal if the surgeon did a decent job and didn't damaged nerves too much. Peeing is not a reflex so there is a brain relearning (similar to the process that a infant goes through during potty training). It could take some weeks/months before it stops being an effort for the brain to work out which muscles to stretch/relax and it returns involuntary again. I was among the lucky few which are continent immediately after catheter removal.
Posted 4/8/2017 8:11 PM (GMT 0)
Thanks for the responses. One of the many articles I read in preparation for this said that the internal sphincter (inside the bottom of the bladder) is routinely removed while the external one (beneath the prostate) is retained. Another article said that even the internal one can possibly be saved by skilled work. I haven't yet heard back from my surgeon regarding which of mine was saved (although I do know the nerves were saved--great news, that!). So now, just because I'm a curious person, I wonder if the kegel exercises have anything to do with getting the sphincters back in working order, or it that's just a normal part of the healing process. Whatever the case, only three days after having my catheter removed, I'm tired of this mess (literally and figuratively) already!

Time to do my afternoon clenches.
Posted 4/8/2017 8:24 PM (GMT 0)
The internal urinary sphincter mechanism do partially extend onto the prostate. These muscles could be separated from the prostate and preserved! They are not always removed. I guess it depends on the skill and experience of the surgeon how well the internal urinary sphincter is preserved.
Kegels is to strengthen the muscles by exercising them.
Posted 4/11/2017 1:05 PM (GMT 0)

rickw said...
... does the person thereafter have to keep the pelvic floor muscles clenched all the time? ...
I can't imagine ever getting to the point where I can clench them constantly.

I asked the same question, and it was never answered. It seems there is a natural assumption that if you do the kegels that at some point the muscles will work on their own. It seems that never happened for me. I went thru several months of "training" with the anal probe and all that. The therapist had me doing more and more kegels and holding them longer. At one point it was 100 per day, holding them for 30 seconds. All that did was give me back aches.

So does everyone walk around all day like they have a stick up their butt?

I can hold urine as long as I want, but that is still "holding it". At some point, I must turn my mind to other tasks. If I'm not thinking about holding it, then it just flows out of me like a garden hose. I'm not sure why the kegel fairy seems to have blessed everyone else and passed over me.

One the three points of extracapsular invasion was proximal to the sphincter (and I only know that because my RO had my surgical notes... no one else ever mentioned that) but as I understand, with my tumor was at the base of the prostate, that would be at the top, adjacent to the bladder, which I think is the one that was removed and is NOT the sphincter that is supposed to be doing all the work.

Now I'm getting the AUS next month. Hard to believe this is happening, but there is still cancer in me and the inability to hold a full bladder for an hour is delaying the start of SRT, so it has become a necessity. My Uro said there's "no way" I would have enough control to be ready for SRT in the next few months without it. This is frankly pretty scary.
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