Stage 3 Three To Five Months After Surgery
This is the stage of partial bladder void. Your incontinence level starts to improve. So you can begin increasing your activity levels.
Ask your doctor if you can remove the restrictions from activities like driving or lifting things.
Incontinence is minimal after you reach the 5 months mark. Once you have completed five months, you can move away from absorbent products and wearing regular undergarments.
How Can Radiation Therapy After Prostatectomy Affect Incontinence
Some men may need additional treatment after prostatectomy. This might include radiation therapy to the “prostate bed” . While every effort is made to lessen the amount of radiation that hits normal tissue around the prostate bed, some normal tissue will receive a low dose of radiation. This includes the external urinary sphincter. The radiation may irritate the external sphincter, urethra, and bladder during radiation therapy and for a short time after. This can lead to worsening incontinence that often improves in the weeks to months after completing radiation. Some men may develop increased incontinence in the months to years after radiation therapy, due to scar tissue buildup. This can cause the external sphincter to not properly open and close.
Post Prostatectomy Urinary Incontinence: How Its Treated
Despite improvements in surgical techniques, and robotic assisted prostatectomy in particular, there is still a risk of urinary incontinence following prostate cancer surgery. This type of incontinence is known as Post Prostatectomy Incontinence .
PPI can affect daily life from how able you are to work, to how confident you feel in social situations. It can feel embarrassing, stressful to manage, and incredibly isolating.
King Edward VIIs Hospital consultant urologist Mr Jeremy Ockrim takes some time out to discuss how treatment for prostate cancer can lead to urinary incontinence, and what the treatment options are.
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How To Manage Incontinence
There are multiple ways to manage incontinence:
- Pelvic floor muscle strengthening: Pelvic floor muscle exercises can help muscle strength and bladder control get better by doing exercises that tighten and relax muscles that control the flow of urine.
- Bladder training: This can help manage how often you need to urinate throughout the day by assigning certain time intervals to empty your bladder.
- Medicines: Some medications can help the muscles of the bladder and the muscles that control urine flow. Most of these drugs affect either the muscles or the nerves that control them. They work best for urge incontinence.
- Surgery: This may be used to correct long-term incontinence. It can remove blockage. Material such as collagen might be recommended and injected to tighten the muscle that controls urine flow. A small device called a urethral sling can also be implanted to press the urethra against the pubic bone. An artificial muscle controlled by a scrotal pump may be an option for men, and it’s implanted to squeeze the urethra.
- Incontinence products: They can help keep you active and comfortable. Adult briefs and undergarments are bulkier than pads worn under your clothing, but provide more protection. Bed pads or absorbent mattress covers can also be used to protect the bed linens and mattress.
Step : After Three Months: Jog/run Downhill 75% Of Solution
This, in my initial view, is the best way to overload the pelvic floor and retrain abdominal muscles. Of course, this can only be done 12 weeks after surgery, when the body has fully recovered from the surgery.
The principle here is to perform an activity in which you fail 90 per cent of the time. What jogging/ running downhill overloads the PF muscles but also massages and to challenges a large number of other inner organs. As Peter Dornan notes in his 2015 Sports Health article, there are seven command centres and thirteen reflexes which control bladder activity. KEGELS WILL ONLY ACTIVATE A VERY FEW OF THESE. YOU NEED MUCH STRONGER AND DIVERSE EXERCISE AFTER THE FIRST THREE MONTHS.
Initially, running is not safe and may cause injuries. A gentle jog is best. Going zig zag, suddenly stopping and then starting, lunging sideways, karate kicking, etc. can add to the pressure on various inner muscles and body parts.
I found a significant IMMEDIATE improvement through this method. Im still at three months and have just started this.
In my view the reason why running downhill works very well is that the body has a natural tendency to control urine flow. Various muscles and body parts get activated to prevent leakage while running downhill. This activation and rewiring of these muscles and nerves/ blood vessels ensures there is much better control over simpler things like walking on a flat surface. Even things like walking downhill become much easier and continent.
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What Happens To A Man When He Has His Prostate Removed
The prostate gland is what surrounds the urethra. If it becomes enlarged, it can obstruct the urethra from retaining and leaking urine properly at the right time.
When you treat it with radiation, it can damage the bladder’s nerves, disrupting the way it holds urine. Radiation can decrease the holding capacity of the bladder, causing muscle spasms that force urine leakage. You also have sphincters or valves that control the flow of urine from the bladder to the kidneys. If you have had to remove your prostate completely, chances are the surgeon also had to remove one of the sphincters.
Removing one valve should not cause many problems, but it may cause some damage to the nerves in the area from where you urinate.
What If My Incontinence Persists
When bladder leaks persist more than a year, other treatments may be needed to improve the urinary control.
Though rarely needed, Dr. David Samadi and his team provide a range of treatment options for men experiencing long-term incontinence after prostate surgery.
A variety of surgical procedures can be used to restore urinary control should your symptoms last more than a year.
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General Fitness/ Core 15% Of The Solution
I saw a dramatic decrease in incontinence through running/jogging downhill WITHOUT reducing any weight. Therefore I do not believe that strengthening kegels or reducing weight have anywhere close to the curative effect of jogging downhill.
DO THE STANDING BIKE
One month after having the robotic prostate removal I started a standing 20 minute per day spinning bike program.. Within 3 days all my leakage stopped, my stream went from sporadic to full and I stopped wearing pads!I asked a massage specialized and she said I had strengthened muscles around my bladder and urinary system therefore helping my post surgery problems 10 fold. I am now in my 4th week of standing spinning and I feel like a new person. I only urinate 2 times a night instead of 5-6.
Yoga, I found, has plenty of exercises designed to strengthen the muscles of the pelvic region. Further, its a way of toning the muscles without the heavy lifting and the physical exertion that a patient recovering from abdominal surgery ought to avoid, and it offers an effective, long-term way of helping the body to recover.
DYNAMIC PELVIC FLOOR EXERCISES
The physiotherapist Stuart Doorbar-Baptist, in his talk, explains this very well.
NOT A SOLUTION:
I read somewhere that Obesity has a negative effect on incontinence so you should reduce your weight.
How Do You Retrain Your Bladder After A Catheter Is Removed
Gradually increase the amount of time between bathroom breaks. Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom.
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Life After Prostate Cancer Treatment
Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.
Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.
Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.
“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.
Step 1a: Measure The Pads
This is a crucial step to track progress. I track my progress on this .
Measurements at the beginning are not completely comparable with later measurements. In the earlier days one visits the toilet excessively, so initial measurements are actually lower than they would have otherwise been. As one develops the capacity to hold more and for longer, the fuller bladder leads also to heavier leaks but this is a good thing. Measurements also vary by ones level of fitness or wellness. If one is sick and sneezes a lot, there will be heavier leakage. In my case, the later stages have involved extreme exercises, so these measurements are largerthan they would otherwise have been.
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Last Resort: Surgical Options
IF INCONTINENCE CONTINUES
A) GET TESTS
Diagnostic studies are performed to evaluate incontinence after a history and physical exam aer performed. Cystourethroscopy is used to evaluate the integrity of the external urinary sphincter under direct visualisation. A voiding cystourethrogram looks for anatomical abnormalities, while urodynamic studies evaluate physiology.
B) AFTER 18 MONTHS CONSIDER SURGICAL OPTIONS
If after 18 months things have not stabilised to a satisfactory and manageable level, additional surgery could be considered. Details here. These are ABSOLUTELY FINE, and will FIX the issue.
What Is The Normal Urination Process
Urine is emptied into your bladder from the kidneys, where it stays until you get the urge to urinate. Once you get the urge, the urine leaves your bladder and goes out through the tube called the urethra2.
This happens when the muscles in the wall of the bladder contract and those surrounding the urethra relax.
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The Truth About Incontinence After Prostate Cancer
The realities of a prostate cancer diagnosis extend well beyond the need for treatment decisions. Rumors abound regarding the risk of damage to urinary control and sexual potency functions that are core to a mans well-being and sense of worth. But the prospect of living with incontinence after prostate cancer surgery does not have to be the ominous cloud men fear. The decisions a man makes about treating prostate cancer, the preparations for that treatment and the follow-up care received each have a great impact on a mans urinary health.
For most men, robotic prostatectomy surgery is the best form of prostate cancer treatment. Complete removal of the prostate and surrounding cancer offers men the strongest chance of cure and survival. But as with many cancers, treatment can bring the bad with the good. Some degree of urinary incontinence after prostate surgery, though often short-term, is a reality of recovery.
Table : Impotence And Incontinence
The reported statistics on the likelihood of developing impotence or incontinence after prostate cancer treatment vary widely, as shown by the ranges below.
Procedure 30%50% 2%
How did the operation go? And when did it become apparent that you might take longer to recover than you had been led to believe?
The operation went fine. I went back to work very quickly, and in most respects I felt fine. I was incontinent immediately after surgery, but I was led to believe that the problem would straighten itself out within a few weeks or months. But it didnt.
Did you share your concerns about incontinence with your surgeon?
I did, during follow-up visits after the surgery. I probably visited him three to four times during the first six months after surgery. He told me the problem would get better, and for the first month or two, I believed that. But as time went on, nothing was getting any better.
And he didnt seem to care. In a typical visit, I waited a half hour or an hour to see him for literally five minutes, and then he moved on to the next person. So I finally gave up on him.
What sort of problems were you experiencing?
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Incontinence After Prostate Surgery Forums
Going through prostate cancer and having your prostate removed can be a physically and emotionally trying time in life. Many men are unprepared for the extent to which they may experience bladder leaks after prostate removal and it can be disheartening to have undergone surgery only to experience a loss of bladder control for a period afterward.
Fortunately, this is usually resolved within a year. During that time though, you may find that you need someone to talk to about your experience. Finding a forum or message board filled with people who can relate can help ease some of the tensions that you may be going through.
The NAFC message boards are a great way to connect with others who may also be experiencing incontinence, due to prostate surgery or other conditions. Theyre free to join and the forum is anonymous so you can speak freely without the worry of feeling embarrassed or ashamed. NAFC is proud of this amazing group of individuals who visit the forums and courageously share their stories, offer support, and provide inspiration to each other. We encourage you to check it out!
A Few Lifestyle Changes
In addition to these innovative solutions, Dr. Cornell may recommend that you also do your part to counteract any urinary incontinence after your prostatectomy. For example, losing weight or voiding your bladder before strenuous activities can help. As well, you should avoid caffeine, which activates your bladder. A few pelvic floor exercises, such as Kegels, can go a long way toward restrengthening the supporting tissues surrounding your bladder and urethra, allowing you better control.
If youre experiencing post-prostatectomy incontinence, please contact our office in Houston, Texas, to learn more about your treatment options.
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Why Do Prostate Cancer Treatments Cause Urinary Incontinence
It helps to know a bit about how the bladder holds urine. When urine is emptied into the bladder from the kidneys, it is stored inside the bladder until you have the urge to urinate. The bladder is a hollow, muscular, balloon-shaped organ. Urine flows out of the bladder, and leaves the body through a tube called the urethra. Urination happens when the muscles in the wall of the bladder contract, forcing urine out of the bladder. At the same time, muscles that surround the urethra relax and allow the flow of urine. The prostate gland surrounds the urethra. Because an enlarged prostate gland can obstruct the urethra, it can cause urination retention or other problems with urination.
Removing the prostate through surgery or destroying it through radiation can disrupt the way the bladder holds urine and can result in urine leakage. Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can, at times, damage the nerves that help control bladder function.
Preliminary Step: Use Pads To Support Biofeedback And Measure Urine Leakage
Sanjeev: The dripping is an invaluablebiofeedback mechanism. The brain needs feedback to learn.
Whatever you do, do NOT wear an incontinence device with an attached bag, a condom catheter, or clamp! If you use any artificial device, you will hurt yourself in the long run. You wont be able to recover urinary control, because you wont develop the muscle control you need. Until your urinary control returns completely, wear a pad or disposable diaper.
Note: I tried Jockey washable underwear with pad and would not recommend it. Its absorption capacity is ordinary and leaves a layer of sticky stuff around ones legs.
Note: If AFTER 18 months of trying, control is limited, THEN consider this: Sayco Dribblestop. It costs around $130 in Australia it is worthwhile also for short social events. THIS too can help for short intervals: Conveen Sheath connected to a Conveen Active Thigh Bag shop Note, Ive recovered most continence well before the 8th month, so this is not relevant to me.
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Does Radiation Treatment For Prostate Cancer Cause Incontinence
After prostate removal, some men require radiation therapy. Some of the normal tissues around the urinary sphincter, urethra, and bladder may be exposed during radiation therapy, producing discomfort and incontinence afterward. This usually goes away after a few months of radiation therapy, but if it doesn’t, the extra treatments listed below may help.
Surgical Approaches: Male Slings
In recent years, various novel surgical treatments have been introduced as alternatives to the AUS. Anti-incontinence procedures can be classified into non-adjustable male slings , adjustable male slings , and adjustable balloon devices . Unlike the AUS, which compresses the urethra circumferentially, thereby interfering with venous blood flow and predisposing the patient to urethral atrophy and even erosion, the male sling compresses only the ventral aspect of the bulbar urethra, leaving the dorsal and lateral blood flow intact. Moreover, tissue, including the bulbospongiosus muscle, is left intact over the urethra, serving as a cushion between the urethra and the sling and further minimizing the risk of erosion.
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After Prostate Surgery What Causes Incontinence
Prostate removal surgery might cause urinary incontinence as a side effect. The urethra is surrounded by the prostate, which is placed directly below the bladder. The nerves and muscles of the bladder, urethra, and the sphincter, which controls the passage of urine from the bladder, can occasionally be damaged when it is removed or treated with radiation. Urinary incontinence can arise as a result of this.