Incontinence - how much in a day?

Hi Scott. I'll let others who actually measured and recorded their numbers fill you in. Two thoughts:

1. A RP is a huge shock to the urinary system. You bladder is weak and possibly repositioned a bit, your nervous system has to reprogram itself, your urethra is shorter, your ligaments were probably affected, and you are down a sphincter or two. Basically, you had the rug pulled out under you.The important thing is that you see progress at whatever rate. (Anecdotally, I noticed daily improvement for a number of days, followed by weekly progress for a few weeks, and finally monthly progress for a few months, with almost total control in roughly 6 months.) Men differ greatly in the time needed to regain control. Some men are fully continent almost immediately after surgery; others still see progress in the 2nd or even 3rd year post-op!

2. Kegel exercises are the most important thing you can do to help you along. When I told my uro/surgeon at a certain point that I was 99.9% continent, he asked if I wanted to be 100%. He sent me for a PT session to learn how to do a (progressively increasing) series of pelvic floor exercises (kegels) correctly. I worked on them at home three times a day for a couple of months and did not have to go back for any more sessions. I'm reasonably certain that had I learned the optimal kegel technique earlier, I would have made faster progress. Search here in the Forum or online for kegel exercises for men.

Comparing volumes (or sizes for that matter) may not be the best idea.Your mileage will vary. Follow your own yellow brick road!

Djin

In my experience, progress was not consistent. I'd get better for a while and then seemingly plateau. Then I'd make progress again later. It took me about 9 months to become fully continent. Then I had radiation, which started it all over again. I did a lot of kegels along the way. BTW, I also measured my leakage with a scale. When I reported my exact leakage to one doctor, he seemed surprised.

Thanks for the feedback. The more I read, the more I learn. I suppose it doesn't make sense to compare. I guess I wanted someone to say "you're leaking X ml 7 weeks post-op so you'll be completely dry at Y weeks", but it doesn't work like that. Best thing I can do is compare with myself over the next weeks/months.

Hi Canadian, I am now almost 13 weeks post RALP. Similar to you, I had a hard time telling exactly how much I was leaking, so I started weighing the pads to get a grasp on it. I created an excel spreadsheet, tracking the daily volume, along with how many miles I walked, ran, biked and paddled (an outrigger canoe). In that spreadsheet, I have a graph of all those things, so I can see trends. In the graph, I've included a 7-day average, so I get an overall sense of what is going on. I can see that on days that I walk a lot, I leak more, particularly if the walks are over 2.5 miles or so. I don't leak much while running, and hardly at all biking or paddling. When I had my RALP, I ended up with a plastic urinal bottle, that is calibrated on the sides. Some days, when I really gotta go, the volume per pee is about 200 ml. Other days, it is up to 300 ml. I read that a normal adult men's bladder can hold 400 to 600 ml, so I've been trying to "hold it" when I can, trying to up the threshold for needing to pee. I think part of it is reconditioning the bladder and the nerves controlling it, and part of it is tuning up that sphincter muscle. A few days after my catheter was removed, I was leaking about 300 ml per day, while yesterday it was 10 (my lowest total yet). I can't predict the future, but my 7-day average is slowly heading downward, and I think it will bottom out in a month or so. I imagine it will still have intermittent dribbles for a while after that. Every week or so, I have a leaky day, and I can't figure out why, except that maybe the muscle needs a day off. Seeing the PT has helped, and now I try to kegel while doing whatever I am doing (sitting at my desk, riding my bike, driving, doing planks, sit-ups, yoga, etc.) In talking to my PT, he said that it is important to kegel while creating strain and torsion on the abdomen, so I do a lot of twisting type motions, lunges, high-knee marches, etc. I must look like a freak while going for my walks doing these things. Best wishes for a speedy and dribble free recovery.

For me, an important consideration in defining "continent" is comparing before and after. I'm 6+ years out from RALP, and I haven't used a pad in a long time. That being said, I'll share my definition of continent: Prior to RALP, I had some BPH, and I had occasional drips after urination--not enough to really be an issue--but they were there. And, at that time, I considered myself continent, but having some old-man issues.

Today, I also leak occasionally, at random times. Hard to predict. It's never more than a few drops, but it's there. It's part of my reality. My definition is this: An occasional (even once or twice a day) dribble is part of being male, prostate-less, and 62 years old. It doesn't make me incontinent. If I feel the need to put a depends shield in because I'm going on a long car trip with unknown bathroom availability, that doesn't indicate a problem. It's just part of being aware of my reality.

I was using the thin shields during the day, and thick pads at night at 6 weeks. By 12 weeks I was off night pads, and still wearing thin shields during the day. By 9 months, I was only wearing shields when I was concerned about availability of bathrooms.

I was also taking 2.5 mg cialis daily starting at 6 weeks--and I firmly believe that it helps with overall healing in the pelvis post surgery by generally increasing blood flow--which helps the muscles and nerves recover. I'm also a firm believer that keeping ones self well hydrated helps the bladder muscle healing by giving the muscles something to work against.

One of the things I looked for when I was graphing my leakage was whether I could see a difference if I went a week without coffee. After three or four comparisons of coffee weeks and non-coffee weeks I decided that it didn't make any difference in my leakage and I resumed my all-coffee-all-the-time habits.

Everyone is different. I had to give up coffee because it caused bladder discomfort and I had to pee every 15 minutes. Even decaf coffee was a problem. Tea was and remains fine. Alcohol remains a problem. Sometimes I can have a drink without causing a leak, but even now, three years after surgery and radiation, even one drink will result in wetness down there. The upside of this is that I was probably drinking too much prior to my PCa adventure and now I'm drinking far less, which has also made it much easier to lose some weight.