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A month out from a radical prostactomy What to expect?

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Posted 6/6/2012 2:06 PM (GMT 0)
Just need some encouragement. I will be a month out on June 10. I am 60 years old, the surgery was an open surgery due to radiation 30 years ago. So, I go through 2-3 pairs of Depends a day. If I could just sit then urinate on a regular basis it would be better, but as I am up and about walking getting up and down, I leak. Can't seem to contract the kegel muscles all day.  Anyone else in similar situation??? am I being impatient? How soon does it get better? Has anyone used a therapist to help woth the incontinence?
Posted 6/6/2012 2:34 PM (GMT 0)
I'm 59 and was using 2-4 depends per day one month after RALP. I was very similar to you in that my leakage was activity based. I was really good if I just sat around but moving caused me to go thru the depends. I saw VERY gradual improvement over the first three months that was so slow it was very frustrating. I was still using one depend per morning during my walk and 2-5 pads over the rest of the day at 3 months when most guys would normally be using 2-3 pads per day. My uro told me at our three month office visit I was just healing a little slower than most. 2 weeks latter the healing really speeded up and I was down to 2-3 pads per day and stop using the depends completely. At around 4 months I was down to one pad per day. I'm now 5 months post op and I just keep a pad in my pocket just in case but seldom use it. Keep up the kegels.
Posted 6/6/2012 2:49 PM (GMT 0)
You mention kegeling "all day."  That's not something you want to do, because y ou'll just overwork the muscles and render them ineffective.  I actually did very little kegeling and ended up completely continent very quickly, but others aren't so lucky.  Everything I've read, though, says that with kegels, more isn't necessarily better.

We all heal differently.  Be patient and let the good results happen at their own pace.  Good luck.

Posted 6/6/2012 2:59 PM (GMT 0)
2ndtimearound,

Echoing Clocknut's point: I view kegels like any other muscle/resistance training. Don't overdo it. Establish a workout routine that gradually strengthens them over time. For example, one would not do hundreds of reps a day on an another muscle group. I think the same goes for the pelvic floor muscles. Muscles need time to recover and strengthen. Good luck. You are early in the process and you will likely see sudden progress at unexpected times.

Posted 6/6/2012 3:00 PM (GMT 0)
2ndtimearound,

My husband is 8 mos. post RP and he had to go on vesicare to help with his incontinence. He started vesicare 3 monthes out.

He was in a similar situation to you, so after taking it for 3 monthes he got off and just recently felt he needed to be back on, so he is back on vesicare. It is bothersome (the incontinence) but that could be part of the healing process.
One month out isn't unexpected for incontinence!

Take care,

BOOGEE
Posted 6/6/2012 3:51 PM (GMT 0)
I'm a few years younger than you, and had robotic surgery, but it took a solid 4 months to get down to one pad a day, and 5-6 months to go to 'panty liners' for that occasional squirt. Everybody heals differently.

I agree with the "don't overdue the kegels". I found that when I did, I tended to leak more in the evenings.
Posted 6/6/2012 4:54 PM (GMT 0)
Here's one more vote for "don't overdo the kegels"!

If three sets of 10 each day doesn't help, a thousand sets won't make a difference.

And to answer your question, you are being impatient. We understand, though. Incontinence is maddening, and most of us have been there. Chances are excellent that it will get a lot better in the next couple months though. Hang in there, but understand that kegels aren't a cure; they just help accelerate the process somewhat, but only if you don't overdo them.
Posted 6/6/2012 6:16 PM (GMT 0)
I had robotic April 9th and the catheter removed two and a half weeks after. I usually use three pads a day now. Just started a pelvic floor rehab program and the nurse told me only do the kegel exercises she proscribed, and not to go beyond that. She didn't want me wearing out the muscle.

I didn't realize we had two sphincters and lost the upper one in surgery leaving the lazier one down below to pick up the slack. Nurse said I was about in the middle of the severity of incontinent range. Hopefully eight weeks of therapy (which my insurance doesn't pick up by the way) will show improvement.
Posted 6/6/2012 6:34 PM (GMT 0)
I think one of the goals of the exercises is to not only strengthen that remaining sphincter but to bulk it up, much like your other muscles increase in size as a result of weight training. I think the mass of a larger sphincter muscle can help keep that bladder neck closed even if you are not concsiously squeezing or doing a kegel.
Posted 6/6/2012 7:55 PM (GMT 0)
Bill, the way it was explained to me is that men get 3 mechanisms to hold back urine: I believe the 3 are the pelvic floor, the muscle near the bladder, and the prostate. Women only have the 2. When we lose the prostate, we have to learn how to use our muscles for the first time in the same manner that women have their entire lives. Aside from the kegel muscle getting stronger, it takes some getting used to.

You can definitely overdo the kegel exercises - don't get discouraged if you backtrack temporarily if you do, it is just part of the healing process.

2ndtimearound, although some guys are lucky (dry from the time the catheter comes out), 1 month out from surgery is typically not a dry time. At 3 months a lot more guys are down to a few pads a day - that is more typical. You will see a huge difference soon (my prediction). I don't know how the rad damage affected you, though - but I would be optimistic.

Cheers, Jeff
Posted 6/6/2012 7:56 PM (GMT 0)
I was in the Depends pants and using booster guards for 5 months before things suddenly got better.

Early on I was using the pant with a Walgreens Certainty male guard. Cut the pant costs significantly, and the logistics of changing the pant. First few months I was at 1-2 pants and 8+ pads a day.

I worked out a plan of walking, then doing a set of kegels, three times a day. That was what brought the biggest improvements. Early on I was trying to do 5 sets of kegels a day, but when I went to a physical therapy nurse, she had me scale back, with the admonition that too much is too much. We also did some checks to be sure I was doing them right.

Posted 6/6/2012 8:55 PM (GMT 0)
Just to add my 2c - I think I saw major improvement by end of three months, but it took into the fifth month before I was pad-free. Best of luck with the healing and don't get mad - get even!
Posted 6/6/2012 10:27 PM (GMT 0)
In case nobody has mentioned it, I would add that base don my personal experience you can also expect to feel a bit depressed and fall victim to heightened anxiety. I was all charged for the surgery and the recovery and can only compare it to going into battle. then a month out when things start to become normal again and the battle becomes more distant it felt like weird. And as bizarre as this is going to sound, you almost miss that fighting spirit you almost miss that fighting spirit you had and how all your energy was aimed at fighting and getting through it. A month later I was just left to put the pieces together psychologically and it wasn't easy. Someone here suggested I and many others go through post traumatic stress.
Posted 6/7/2012 12:19 AM (GMT 0)
And here is my 2c... I was fairly lucky, my Uro set me up with a biofeed back nurse while I was waiting for surgery. This I swear had two purposes. One, it gave me something to concentrate on before surgery and two, learn this kegal thing correctly first. It didn't take long for her to show me the correct way. And like everyone said more is not better. Her rule of thumb kegals at meal time. So three sets starting out at 15 per set... Working up to 30, but never more than three sets. Quality not quantity. And as much walking as I could. The hard part is determinig if you are doing them correctly. So if in doubt ask for some help. It really is important to do these correctly.
Posted 6/14/2012 4:34 PM (GMT 0)
Thanks to all. I will scale back on the Kegels. I will stick to a regimen with them. I scheduled an appointment with a therapist that specializes in incontinenece in men and women. sorry it took so long to reply but work and technology issues got in the way. Thanks again for the support. It is great to have those that understand to talk to.
Posted 6/14/2012 9:12 PM (GMT 0)
I'm in a similar situation as you - 59 - open RP a month ago today - I get more leakage as the day goes on as that muscle gets tired - right now it is 2 Depends per day and 3 liner pads..

URO recommends doing the exercise thruout the day whenever I think about it - no mention of doing sets of them - He says as Im_Patient points out, we have to learn to use that muscle like woman do and it will happen - the exercises just speed up the process, so am optimistic this incontinence will improve over the coming weeks...
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