Biofeedback for Incontinence

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RHC Jr.
Regular Member


Date Joined Feb 2009
Total Posts : 39
   Posted 3/15/2009 2:02 PM (GMT -6)   
I am 13 weeks post-RRP, and am totally incontinent. I use approx. 6 super absorbent diapers daily (usually 5 daytime and 1 nighttime). I usually am active daytime (tennis 3X per week for 2 hrs. +).  I try to sleep on my back at night. My principal frustration with the incontinence comes when I rise from the sitting or lying positions, when I almost always and w/o any control void immediately 1/2 to 6 oz. (usually dependent upon the length of time sitting or lying).
 
I perform kegel exercises daily.
 
On 3/3/2009 I started 12 weeks of biofeedback, designed to curb the incontinence. The session is divided into 2 parts:(1) alternating kegels (holding for 5 sec. each) with rest periods (15 sec. each), for a total of 6 min.; (2) the same pattern of kegels and rest periods, but with electrical stimulation applied during each kegel (total of 12 min.). The level of electrial stimulation is determined solely by my pain threshhold. It is raised until I say that it hurts, then it is backed down.  I tolerate this procedure because, according to articles that I have read, the theory is provide sufficient electrical stimulation to cause a pelvic muscle response. Theoretically, this leads to a "reawakening" or reactivation of the pelvic floor muscles.
 
My question is directed to anyone who has undergone biofeedback sessions combined with electrical stimulation.  Has anyone had an adverse reaction to an overuse or over-application of the electrical stimulation?  Are there any risk factors known or explained to you of which I should be aware? What specifically have you done in the biofeedback sessions, or in addition to the biofeedback sessions, that have improved your results?
 
Thanks in advance for your replies.
 
RHC
Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood test  -  2/2/2009     PSA  -  undetectable
Scheduled for 12 weeks biofeedback, starting 3/3/2009
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/15/2009 2:54 PM (GMT -6)   
Hi RHC,
I was fortunate here...i did not have this side effect. Some of the guys have poken about biofeedback and the results have been mixed from what I have read. I have heard that there is some cases where kegels have slowed progress and taking a break improved the situation. Not knowing you and how you have tried to deal with this, I throw it out there merely as a thought.

I hope you are able to get this under control...I have seen how annoying it can be for those who are healing.

You have my best wishes...

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 3/15/2009 7:55 PM (GMT -6)   

    RHC,  I did have biofeedback but I did not have electrical stimulation of the pelvic floor muscles.  I was showing very small gains in muscle tone but no change in the leaking.  I finally gave in and went the AUS route and have not regreted the decision.  I hope you regain control but do not get down if you don't.  There are ways to take care of it. 

    Good Luck,  KW


    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
    Oct. 6th, 2008 - AUS Activation by Dr. Morey.  Working Great, only light drips and dribbles.
    Jan, 31st, 2009 - PSA 0.00  Next test in July, 2009  


RHC Jr.
Regular Member


Date Joined Feb 2009
Total Posts : 39
   Posted 3/15/2009 8:46 PM (GMT -6)   

KW:

Thanks for responding.

From your bio, I previously noticed that you had undergone biofeedback therapy. I was hoping that you could shed some additional light based upon its practical application in your situation.  Also, one of the Registered Members, JerseyCity, also spoke of biofeedback therapy. I also look to him for informational feedback, if any.  Plus, any others who have undergone biofeedback/ES therapy are requested to share. I'm just looking for some edge that additional information can provide so that I can take maximum advantage of this therapy.

RHC


Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood test  -  2/2/2009     PSA  -  undetectable
Scheduled for 12 weeks biofeedback, starting 3/3/2009
 


jerseycity
Regular Member


Date Joined Nov 2008
Total Posts : 123
   Posted 3/16/2009 5:27 PM (GMT -6)   
I had 2 sessions and  right after that I had a drop off in leakage. I was right were you are now at around thge same post op time. 4 pads a day plus briefs. Got better around 4 months. At 6 months I'm using 1 pad a day. Keep doing kegels. I know the hassel and uncomfortable issues you are going though. It will get better.

 3-17- 8 went to Bruce Springsteen concert , great time
3-18-8 routine exam
3-19 doctor called said psa was elevated
what's a psa?
referred to Uro, had several more blood tests.
PSA steady at 4.75
biopsy  June 08 , 12 cores, 4 on left confirmed , right clear
gleason 3 + 3 T1c
research time.
decieded on open RP, Head of Uro  is my Doctor
Surgery done 10-1-8 by Dr See at Frodoret Hospital in Milwaukee
Cathater out 10-13 no problems
Post op,  organ confined, gleason up to 4 + 3, all clear margins
T2c 20% volume, very good outcome I feel
Incontinent and ED.  Time will tell, was told all nerves  saved.
back to work 11-5-8.
 
Rich man in a poor mans shirt.


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 3/16/2009 6:57 PM (GMT -6)   

    Rhc,  All I can say is do your exercises they give you and see what happens.  The Majority of guys will eventually dry up.  Hope you are in that group.   My sessions went kinda like this!  The therapist would give me a "sticky" sensor pad to take to the bathroom to put on my perenial area.  Just a hint!  You may want to start shaving down there!  Then once in the office she would place another sensor pad on my lower abdomen.  Those would be pluged into the machine and we would do various exercises to try to get my body to learn to use the pelvic floor muscles correctly.  Then I would be unplugged and she would give me more exercises to do to work my weak areas!

See ya...KW

 

 

   


    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
    Oct. 6th, 2008 - AUS Activation by Dr. Morey.  Working Great, only light drips and dribbles.
    Jan, 31st, 2009 - PSA 0.00  Next test in July, 2009  


RHC Jr.
Regular Member


Date Joined Feb 2009
Total Posts : 39
   Posted 3/16/2009 7:46 PM (GMT -6)   

KW and JerseyCity:

Thanks to both of you for responding.

BTW, I have had 2 sessions already, so I am familiar with my format. Two sensors are applied externally to the lower abdominal area. A third sensor is inserted rectally. That sensor also supplies the electrical stimulation.  The two-part session itself is I previously described.

Prior to my first 2 sessions, I only had seen studies showing indefinite conclusions about biofeedback with electrical stimulation. So, I was skeptical, and my cooperation mirrored my skepticism. Lately, I have seen additional and more recent studies concluding that biofeedback, combined with electrical stimulation, is helpful in speeding up continence. This has changed my attitude, and I now wish to do whatever is required to make each session the best that it can be.  My principal concern focused on the amount (amplitude) of the electrical stimulation. The study from Prysberterian Hosp. in NYC talked about a "mild" electrical stimulation. Other studies have talked about a more substantial electrical stimulation, with the theory being that sufficient voltage must be applied to cause a reflexive response in the pelvic floor muscles. So, in my session tomorrow, I guess that I'll go with the concept of ramping up the voltage until it hurts, and then backing it down to a more tolerable level. I'll first discuss it with the therapist (I am not comfortable with the scope of her knowledge - but she does try). I'll give that procedure 2 to 4 sessions, and then see what happens. At the halfway mark (6 sessions), I'll try to touch base with my operating surgeon (or with his partner who performed the biopsy), and discuss with him/them the details of my status.

BTW, as to the kegels at home, I have done them, and continue to do them, religiously.

JerseyCity - I am aware, as you may have found, that the mere passage of time may present the cure. Just as you, and others, have done, I will try to make the most of each opportunity  --- and if it's just the passage of time, so be it.

RHC


Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood test  -  2/2/2009     PSA  -  undetectable
Scheduled for 12 weeks biofeedback, starting 3/3/2009
 


Jack Reid
New Member


Date Joined Mar 2009
Total Posts : 1
   Posted 3/24/2009 10:27 AM (GMT -6)   

    Rhc,  All I can say is do your exercises they give you and see what happens.  The Majority of guys will eventually dry up.  Hope you are in that group.   My sessions went kinda like this!  The therapist would give me a "sticky" sensor pad to take to the bathroom to put on my perenial area.  Just a hint!  You may want to start shaving down there!  Then once in the office she would place another sensor pad on my lower abdomen.  Those would be pluged into the machine and we would do various exercises to try to get my body to learn to use the pelvic floor muscles correctly.  Then I would be unplugged and she would give me more exercises to do to work my weak areas!


RHC Jr.
Regular Member


Date Joined Feb 2009
Total Posts : 39
   Posted Yesterday 8:40 PM (GMT -6)   

Interested Observers:

Today I completed 12 weeks of biofeedback therapy, coupled with electrical stimulation.  The sessions went as described in my first posting under this thread, except that kegels are not performed while receiving the electrical stimulation. Just lay back and feel the low dosage voltage.  As suggested, I did have the operator ramp up the voltage from time to time to a point just before pain. Shaving was not necessary.

Based upon what I can see, there have been no improvements in my condition. I remain totally incontinent, meaning that I still have no ability to control urinary leakage.  My immediate conclusion: it was just a waste of time. However, it is possible that there are things that I don't see or of which I haven't felt the impact (such as additional muscle fibers growing as a result of the electrical stimulation). So, for anyone in my postion who is just grabbing at anything to improve the condition, it is a possibility.  Have very low expectations, and be grateful for any positive results.  If treatment is not covered by insurance (as was mine), you may wish to think twice.

RHC Jr.


Last PSA prior to biopsy  -  11.9
Biopsy  -  8/7/2008
Cancer findings at left lateral and left medial apex of prostate
Gleason score  -  3+3 = 6
Staging  -  T1c
Prostate size/weight  -  128 cc./ 99 grams
Bone and CT scans  -  9/12/2008  -  both clear
Age at biopsy  -  65         Health  -  Excellent (other PCa)  (Lift weights, play golf & tennis (incl. singles))
da Vinci RP surgery  -  12/15/2008 at Naples Hosp.
Surgeon  -  Dr. Wm. Figlesthaler
Hosp. Stay  -  1 night
Catheter removed  -  12/23/2008
Post-Op blood tests  -  2/2/2009, 3/27/2009 & 5/7/2009              PSA  -  undetectable
Completed 12 weeks biofeedback, coupled with electrical stimulation  
 

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