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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2005Incontinence
I had an operation to have my prostate removed. I am still leaking. I do the exercises but I am still having problem. My incontinence always starts at around 4:00pm. I do not leak at night or in the morning. I do leak sometimes if I bend down and sometimes I do not. I had the operation on March 14, 2005 and the Dr said that he could not save all the bundle of nerves ???. I tried once the Viagra 100 but nothing. My real problem is how can I stop the leak and how long usually it lasts?? I am not as worried about sex as I am about the leak. Anybody who can reply to me will be greatly appreciated You're doing about as well as most guys who have had their prostates removed. Some are dry as soon as the catheter comes out, others like myself are still leaking two years after surgery. I personally don't think Kegel exercises are worth much for the routine leaking. They probably help a bit with the stress incontinence from coughing, sneezing, bending, etc.. The fact your incontinence starts late in the afernoon tells me your muscle is fatigued, not unusual in the early stages. You're really doing quite well and I wouldn't worry too much about long term leaking. Good luck with the rest of your recovery. Dave Perry > I had an operation to have my prostate removed. I am still leaking. I do the > exercises but I am still having problem. [quoted text clipped - 6 lines] > > Anybody who can reply to me will be greatly appreciated > I personally don't > think Kegel exercises are worth much for the routine leaking. World-renowned physicians disagree, claiming that Kegel exercises, if not overdone, will strengthen the muscles we need to stay dry 24/7. Studies support them. I'm putting my faith in those docs and studies, but at a level less than the more exuberant ones advocate. BTW, I'm getting drier every week at nine months post-op, but 1) am still wearing Depends 24/7 even though some are still dry after 24 hours and 2) I still P Freely during heavy athletic endeavors. If I squirt other than during athletics, it's in the evenings, presumably as the sphincter muscle tires. Joe, you're way ahead of me if you're dry until 4:PM at 4 months post-op, and my surgeon expected me to walk out of the hospital nearly dry. I.P. Freely I.P., can you cite the study which took a bunch of PCa survivors, divided them into two groups, had one do Kegels and the other not do Kegels and then compared the results? I doubt there has ever been such a study. All uros, the gurus and all the rest, will claim Kegels can't hurt so go ahead and do them. As for helping, many uros and certainly lots of patients aren't so sure. For every guy who does them and is dry there is a guy who does them and is not dry. For every guy who doesn't do them and is dry there is ..., well you get the picture. Everything I've seen on Kegels is anecdotal and when I pressed my uro on this he admitted Kegels are something he can tell his patients to do so they think they are helping themselves. As for my own case, I can stop and start the stream at will and always could from day one. The muscle is plenty strong enough. The problem is the damn thing won't stop the flow on its own which is more the result of nerve trauma, not a weakness in the muscle. Dave Perry Dave...I've attached the abstract of such a study below. Kegels have been around for a long time and are commonly used to help women regain continence after childbirth. If you go to PubMed (http://www.ncbi.nih.gov/entrez/query.fcgi) and search [kegel, incontinence] you'll get a number of interesting hits. Obviously, kegels don't work for everyone. In the study below, the authors speculate that age may be a factor affecting whether kegels work or not...Best wishes and good health, Ron Eur Urol. 2005 Jul 4; [Epub ahead of print] Related Articles, Links Effectiveness of Early Pelvic Floor Rehabilitation Treatment for Post-Prostatectomy Incontinence. Filocamo MT, Li Marzi V, Popolo GD, Cecconi F, Marzocco M, Tosto A, Nicita G. Clinica Urologica II, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy. PURPOSE:: Urinary incontinence after radical prostatectomy is a significant clinical problem. In this prospective study we investigate the effectiveness of early pelvic floor muscle training (PFMT) on a large population, that had undergone radical retropubic prostatectomy (RRP) at our department. METHODS:: 300 consecutive patients who had undergone RRP for clinically confined prostate cancer were randomized in two groups after catheter removal. One group of 150 patients took part in a structured PFMT program. This began before discharge and consisted of Kegel exercises. The remaining 150 patients constituted the control group, they were not formally instructed in PFMT. Incontinence was assessed objectively using the 1hour and 24hour pad test, as well as with the ICS-Male questionnaire. All patients who were incontinent after 6 months underwent urodynamic evaluation. RESULTS:: In the treated group, 19% (29 patients) achieved continence after 1 month, and 94.6% (146 patients) after 6 months. In the control group 8% (12 patients) achieved continence after 1 month, and 65% (97 patients) after 6 months (p<0.001). Patient age did not correlate with continence in the control group (p>0.05), although a significant correlation was revealed within the treated group (p<0.01). Overall, 93.3% of the total population achieved continence after one year. CONCLUSIONS:: After RRP an early supportive rehabilitation program like PFMT significantly reduces continence recovery time. Well, I'll eat my piece of humble pie (but not the whole pie). The quoted study showed Kegels hastened the recovery which makes sense in that the exercises improved the muscle's ability to clamp down during stress (sneezing, etc.) resulting in improved control over the patients who did not exercise. The reason I won't eat the whole pie is that both groups were mostly continent at one year. So, as far as I can tell, the Kegels shifted the curve for the exercisers to their benefit but the end result was the same and nowhere is there evidence that long-term leakers - the ones whose muscles don't contract totally without conscious effort are helped by Kegels. If I had a nickle for every Kegel .... The problem lies in those precious nerve bundles we try to preserve. No doctor including the great gurus have any idea which nerve fibers do what within the bundles. All they know is that the bundles have a connection to erectile function and to a lesser degree, continence. When the bundles are preserved, more hard-ons and less leaking. When cut out, no erections and more leaking. During surgery these nerve bundles are stretched, twisted, and traumatized in one way or another suffering some degree of damage and each patient has differing rates and amounts of healing depending on the damage. It's obvious the nerve(s) that allow us to stop/start the stream are not in these bundles or most of us right out of surgery could not do that. However, it's also apparent there are nerves within the bundles that preserve the automatic squeezing of the muscle and it's these that heal in their good time or not at all. Kegels don't do squat for that problem. Dave Perry > The problem lies in those precious nerve bundles we try to preserve. > No doctor including the great gurus have any idea which nerve fibers do [quoted text clipped - 10 lines] > the automatic squeezing of the muscle and it's these that heal in their > good time or not at all. Kegels don't do squat for that problem. That's why I was surprised my uro didn't jump on my suggestion. Look what discovering the erectile nerves and how to spare them did for Walsh and Johns-Hopkins; think what discovering continence nerves and how to spare them will do for the next such doc and institution. My doc was very surprised that I wasn't continent within days to weeks, as he says >98% of his patients are in surgeries as "textbook" as mine went. Beginning the day I removed my catheter, I was dry sitting and sleeping and could send Morse code with my firehose . . . but left a trail as I walked away from the toilet because I couldn't PERCEIVE the leak until it hit my feet. That's clearly not a sphincter strength problem. I suspect that you, Tdub, and others are right that there's an undefined nerve trauma issue involved here. I.P. > I.P., can you cite the study which took a bunch of PCa survivors, > divided them into two groups, had one do Kegels and the other not do > Kegels and then compared the results? I doubt there has ever been such > a study. Nope. But one such study was referenced by someone else here a few weeks ago, in a discussion about Dr. Catalona's emphasis on the importance of Kegels. Other book authors have referenced other studies showing that "Kegelers" recover their continence earlier by some certain period of time, a couple of months if I recall correctly. > As for my own case, I can > stop and start the stream at will and always could from day one. The > muscle is plenty strong enough. The problem is the damn thing won't > stop the flow on its own which is more the result of nerve trauma, not > a weakness in the muscle. Same here . . .except in the evening when my Kegel muscles tired. I presented exactly that possibility to my uro months ago, hoping that as an academician it might suggest some more research. As an academician, OTOH, his response was that the only method of achieving earlier continence proven by studies is Kegels. I.P. More than the studies...I agree with many of the posts. I think that the nerves make a difference, I think that the anatomy (length and strength) of the sphincter makes a difference and there are probably other factors above and beyond the kegels that make a difference. I don't think they hurt and MAY help. Earlier in this thread I posted the Catalona link about incontinence. He likes them...so..."I" do 'em and they seem to help. As always...everyones mileage may vary. Ron B. Chicago Dave Perry's point is right on. I had virtual/almost complete continence all last summer, then lost it immediately after restarting Kegels in September '04 (which I did to "finish off" the little incontinence that was left), and haven't regained continence, or anything near it, since. I am convinced that the (heavy) Kegel exercises broke a nerve connection which controlled the natural sphincter function. Another way to exercise the muscles, without risking interfering with the natural nerve response, is to drink a quart of liquid (I use Silk Very Vanilla) and hold for as long as you can, feeling the muscles get tenser and tenser as the bladder fills. It is best done in a sitting position for some reason. You'll get an immediate muscle strengthening response, you will really feel it, and it will feel good (i.e., stronger) afterward, IMO. > I.P., can you cite the study which took a bunch of PCa survivors, > divided them into two groups, had one do Kegels and the other not do [quoted text clipped - 12 lines] > a weakness in the muscle. > Dave Perry After 3 years and being dry, I still leak when aroused! With or without erection. I tell my wife that she gets the ultimate compliment from me. "You make me squirt"...  SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories > After 3 years and being dry, I still leak when aroused! With or without > erection. I tell my wife that she gets the ultimate compliment from me. "You > make me squirt"... Same thing here after almost 5 years. Of course, with Lupron, the squirts are few and far between. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > > After 3 years and being dry, I still leak when aroused! With or without > > erection. I tell my wife that she gets the ultimate compliment from me. [quoted text clipped - 3 lines] > Same thing here after almost 5 years. Of course, with Lupron, the squirts > are few and far between. My wife makes you squirt too Steve? SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories > > > After 3 years and being dry, I still leak when aroused! With or > without [quoted text clipped - 6 lines] > > > My wife makes you squirt too Steve? Oops! Was that YOUR wife? Damned Lupron! > > > > After 3 years and being dry, I still leak when aroused! With or > > without [quoted text clipped - 10 lines] > > Oops! Was that YOUR wife? Damn..... SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories As Dave mentioned - you are doing absolutely fine. Try to have a nap at 2 PM for an hour and see if that changes the routine of leaking. As far as erection - that could take many months to come back with help of viagra. >You're doing about as well as most guys who have had their prostates >removed. Some are dry as soon as the catheter comes out, others like [quoted text clipped - 17 lines] >> >> Anybody who can reply to me will be greatly appreciated As the guys have said Joe, you're doing fine. I had my RRP on March 21st of this year and after leaking early...I've moved from Depends to a smaller pad inside my jockeys. I squirt a little and drip sometimes but it seems to be getting better. The impotence thing is a longer road. I can have orgasms with manual stimulation but no erections. I take Cialis every other day (per my doc's liking) but nothing yet. Erectile function can take up to several years to return I've been taught. This may be of interest about incontinence: http://www.drcatalona.com/quest/quest_spring03_2.htm Best of health, Ron B. Chicago Joe, I wore a depends pull-up (diaper) for six weeks and a pad for six months. Some go even longer. It took almost 2½ years before I had a usable erection without medication. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > I had an operation to have my prostate removed. I am still leaking. I do the > exercises but I am still having problem. [quoted text clipped - 6 lines] > > Anybody who can reply to me will be greatly appreciated > I had an operation to have my prostate removed. I am still leaking. I do the > exercises but I am still having problem. [quoted text clipped - 6 lines] > > Anybody who can reply to me will be greatly appreciated It took me about 6 months to get dry. Some are dry from day one. Hang in there.... SignatureJK Sinrod Sinrod Stained Glass Studios www.sinrodstudios.com Coney Island Memories www.sinrodstudios.com/coneymemories |
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