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Old 10-11-2009, 10:36 PM   #1
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palmas HB User
incontinence after PCA surgery

I did not realize this desease was so prevalent until i was diagnosed with PCA, on july 6 th of this year. My PAS was 6.1, underwent davinci procedure on the 26th of August. path report confirmed biopsy result. gleason 7 (3+4), nodes and margin negative. My main concern now is the incontinence. I am about 6 weeks post surgery. I was started on vasicare 3 weeks ago with some improvement but I am still wet. Not only do i have stress incontinence, I am always leaking. it is like a leaky faucet. It is very irritating, I wear the full depends at night and the pads during the day. I went back to work 2 weeks after surgery and wonder if this is aggravating my conditition. Can anyone please tell me their experience with this situation. I have spoken with my urologist who mentioned that my situation is unusual but it should improve with time. That is what is stressing me, How long before I can expect the leaking to stop and how long before the stress incontinence improves....

 
Old 10-12-2009, 07:26 AM   #2
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kcon HB Userkcon HB User
Re: incontinence after PCA surgery

Hi Plamas,

Sorry to hear that you are having an "unusual" experience in your recovery. I had what I understand is a relatively average experience, but my (still clear) recollection is that time seemed to be a challenging thing to deal with during this phase. Improvement seemed to come so slow in this age of more instant gratification. The surgical opening wounds healed much more quickly, but it really does take weeks/months to recover continence. The good thing that I can report is that once it recovered (at 11 weeks for me), it has been back-to-normal since then.

It turns out that August of this year was an active month on this board for questions on continence recovery after surgery. Here's two links of rather lengthy posts I made in August to questions...I post the links here thinking (hoping) that you might also benefit from hearing some details about my experience.


http://www.healthboards.com/boards/showpost.php?p=4050631&postcount=8

http://www.healthboards.com/boards/showpost.php?p=4059515&postcount=12


Hang in there. It is a frustrating experience. Please particularly note in the thread links that I posted that I personally believe that the Kegels I did, also incorporating them with other abdominal exercises, helped accelerate and/or solidify my continence recovery.

hope this helps...

 
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Old 10-12-2009, 01:09 PM   #3
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Re: incontinence after PCA surgery

Hello Kcon...

Thank you very much for your words of advice and encouragement. I have read the information posted on both links...I have even looked at the link that talks about the usual time it takes to achieve continence. That makes me feel better that I am not completely of the chart. I have always been an active person who enjoys the outdoors, But since my surgery i go to work and as soon as I am done I head home to rest. I am usually dry as long as I am not moving, But climbing stairs is quite challenging, every step is associated with a squirt of pee. I have learned to tighten my pelvic floor muscle with just about every bodily motion. after reading your message I think I will start becoming active once again. I had loss 10lbs after surgery because I had no appetite and partly I think depression from the whole experience and not knowing what to expect. 11 weeks, that is pretty good. I have my 8 weeks F/U with my urologist next week and I think I can be more optimistic now. Once again thank very much...

 
Old 10-12-2009, 02:24 PM   #4
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kcon HB Userkcon HB User
Re: incontinence after PCA surgery

Hi again, Plamas,

Two things...

First, please note that the "link that talks about the usual time it takes to achieve continence" was for da Vinci patients from my doctor's practice. My recollection from readings is that generally continence recovery from open surgery might average out a little longer...not sure I could say physiologically why, but this is what I recall. Nonetheless, the main point remains the same...it takes some time (your doctor already told you this), and there can be a lot of person-to-person variation.

Second, while I got pretty aggressive in exercising (incorporating Kegels in exercise) once the doctor cleared me (for core exercise), you might not go so far as to hire a personal trainer but I would strongly recommend nightly walks (as an example) to work your core muscles while simultaneously doing Kegels to work your pelvic floor muscles. Also, while walking up stairs, do a Kegel with each step...that's a great time to practice.

I've learned that there are right ways and wrong ways to do Kegels, and that it's easy to slip into doing them wrong. Here is one of the best descriptions I've seen written. Try to focus on this technique:

Imagine trying to stop yourself from passing wind. To do this, you would squeeze the muscle around the anus. Try squeezing that muscle as if you really did have wind. You should be able to feel the muscle move. You should be aware of the skin around the anus tightening and the anus being pulled up and away from whatever you are sitting on. Do not move the buttocks and thighs. Do not hold your breath - breathe normally. Do not tighten your abdominal or buttock muscles - keep them relaxed. Later, you can check whether you are contracting the correct muscles by touching the opening [I skipped this part] at the rectum as you are tightening the muscle - you should feel the opening of the rectum contract at the same time.
This was also coupled with the more common description, below, to stop your pee. But for me it was valuable to think of the "cutting off a fart" technique while also stopping the pee.

Next time you go to the toilet, try to stop the stream of urine about halfway through emptying your bladder. Then relax the muscles and allow the bladder to empty completely. The muscles you use to stop the flow of urine are the same muscles you will be squeezing when doing the Kegel exercises. Once you have identified your pelvic floor muscles this way, however, do not make a habit of doing it during voiding. This may cause incomplete emptying of your bladder and may lead to other urinary problems. Just practice contracting these muscles at other times as though you were stopping an imaginary urine flow.
One other tip/suggestion. As you see some improvement, push yourself. In other words, start going without a pad for a few hours on some weekend afternoon when you don't have a lot of physical work to do around the house. Yes, you might leak/squirt a little, but you will be sub-consciously aware of not having the pad and will sub-consciously try a little harder. Are you able to go throught the night without a pad? Try it; while in the horizontal position you don't also have to fight gravity. I've read that men using pads too long can use them as a "crutch" which makes it harder to break free. Push yourself, but a little at a time; don't expect huge steps of improvement, and make use of days/times when a little leakage doesn't really matter.

hope this helps...


This note added later as a post-script: In re-reading what I posted, I realized that in the first paragraph I talked about recovery from "open" surgery, but then realized that I was mixing my response to you with a recent response to another member. Although you didn't mention which type of surgery you had, I realize that if you were back to work after 2-weeks, you must have also had laparoscopic surgery. Rather than re-write that whole first paragraph to exclude the "open" comments, I'll just add this post-script. The main points from that first paragraph remain the same.

Last edited by kcon; 10-12-2009 at 02:46 PM. Reason: added post-script

 
Old 10-12-2009, 04:53 PM   #5
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Re: incontinence after PCA surgery

Like KCON I am also sorry to hear about your situation.

One thing I might suggest is to try and take it easy ... much easier said than done. I had robot surgery and had every intention of returning half time after my two weeks off. I found that I got tired in the evening and that was when I started to leak more. I also was able ID when I leaked more than not. Most of the time it came from watching comedies and laughing ! But I also find that when I sit in a chair and bend over - without thinking I tend to squirt a bit. I decided not to go back to work the third week. It was a little easy as most of my work is on the computer and I can work at home - so I was able to stay in touch. Bottom line - do not push yourself. My wife keeps reminding me that even though it does not seem like I had major surgery - I did have major surgery and I need to take the time to let things heal.

One other thing I do is I try and urinate more than I used to. I do not let the "feeling" determine when I go ... that way I am "on empty".

I also want to echo what KCON said when he said - do not push yourself. Everyone heals differently and this will take time.

Best of luck.

Mike

 
Old 10-14-2009, 03:31 PM   #6
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Re: incontinence after PCA surgery

Quote:
Originally Posted by palmas View Post
I did not realize this desease was so prevalent until i was diagnosed with PCA, on july 6 th of this year. My PAS was 6.1, underwent davinci procedure on the 26th of August. path report confirmed biopsy result. gleason 7 (3+4), nodes and margin negative. My main concern now is the incontinence. I am about 6 weeks post surgery. I was started on vasicare 3 weeks ago with some improvement but I am still wet. Not only do i have stress incontinence, I am always leaking. it is like a leaky faucet. It is very irritating, I wear the full depends at night and the pads during the day. I went back to work 2 weeks after surgery and wonder if this is aggravating my conditition. Can anyone please tell me their experience with this situation. I have spoken with my urologist who mentioned that my situation is unusual but it should improve with time. That is what is stressing me, How long before I can expect the leaking to stop and how long before the stress incontinence improves....
I had robotic prostate surgery a month ago and am still leaking. Like you it is inconvenient. I spoke with my surgeon yesterday and told him about my experience. He did not seem to be overly concerned and has not prescribed anything other than continuing to try to build up the musculature. The one positive is that I seem to do well during the night (lying flat) but I do get up about 3 times each night to get to the bathroom to void. I continue to leak while walking, getting up from a seated position or when laughing.

 
Old 10-14-2009, 04:17 PM   #7
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Re: incontinence after PCA surgery

Hello Hopkins,

Your brief description sounds very much like the typical recovery. It sounds a lot like mine. From my doctor's practice, only about 20% of men are "pad-free" just one month after robotic surgery. It took me 11 weeks, which was close to the average...and, in fact, by definition a full 50% of men end up taking longer than the "average." (I studied advanced statistics in college. )

The day-to-day progress seems slow when you are living minute-by-minute, but it sounds like you are on the path forward and just need continued patience.

Are you also following the Kegel routine I described below? Other core exercises (core, meaning your mid-section)? Kegeling while walking up stairs?

best wishes...

 
Old 10-15-2009, 05:13 AM   #8
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Red Nighthawk HB User
Re: incontinence after PCA surgery

W & W!

Walk & Water!

Everything said by Kcon and MrMike is true and hopefully helpful. To those comments I would add drink plenty of water and walk at least a mile each day.

hang in....

john

 
Old 10-15-2009, 08:14 AM   #9
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mudrunner HB User
Re: incontinence after PCA surgery

Palmas,

I seldom come over to this board anymore, (after so many years - I think this bullet has been successfully dodged) but saw your post and decided to respond.

Your concerns about this problem are almost universal and have been posted here many, many times. I only know of a few guys who have not leaked for at least a little while. All who do, voice the same alarm as yours. It’s a natural thing to do.

I’ve been at this for a while (coming up on 10 years) and not to sound too much like the curmudgeon I am…things will either 1-get better, 2-get worse or 3-stay the same. If you do all the “right” things it may actually help. Or it may do no good at all. Only time will tell. Your individual situation is unique and cannot be accurately predicted from the overall statistics of other’s surgical outcomes. My advice to others (and repeatedly to myself) is to practice patience and perseverance…not so easy to sustain at times.

Hang in there and keep on keepin’ on. Those same statistics do suggest you will eventually get on the dry end of the bell curve. If you wish to see a few of my missives from the wet side, just type mudrunner in the search box under the HealthBoards banner above.

 
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