Sphincters, Kegels and Urinary Control

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 10/5/2009 7:11 AM (GMT -6)   
I recently posted this in response to another thread. At the recommendation of another member I am starting a new thread to make the info a little easier to find and of course to open it for discussion. If I am off base with this info I am sure that my experienced brothers here at HW will be sure to straighten me out. After all, what do I know? I have only been dealing with PCa for barely over 3 months and certainly one of the lessor experienced here.

To the newly arrived researching prostate cancer information and to those that are recovering from whatever alternative they selected to address, I offer the following about Kegels and sphincters.

I was talking with my dr's follow up nurse a couple of days ago about when I should resume Kegel training. She told me that it had been long enough and I should continue. I am 17 days post surgery.

Then she added something I had not heard nor understood before now.

Prior to surgery we have 2 sphincters, one is involuntary and the other is voluntary. The involuntary one is contained within the prostate. It is this one that keeps urine from flowing out with ejaculate, thus killing sperm. And the one that men know about that makes it difficult to go when you have an erection. The other is the voluntary, the one we control. This is the one that we use to keep from going until we make it to the john. The one we use to squirt those last few drops out when we are done. This is the one that we have left after some PCa treatments. By exercising it and making it stronger (but not overdoing it to the point of weakness) we train it to stay in a more flexed and controlled position. Thus stopping flow when we don't want it to. By having it flexed and shutting off, when we want to go we voluntarily tell it to relax and let it fly.

This made a world of sense to me. Now it may have been her way of telling me it is a mind over matter thing or she was just giving me something to do while nature healed me. But it just makes too much sense. We go through life with our body telling us things but a lot of the time we just don't listen. It just comes natural.

I mean, how many of us didn't actually know that we had two sphincters to control urine flow in the first place? I'll raise my hand, I certainly did not. Just knew there was something that I could do to start and stop some things and other times when it just stopped on it's own.

Don't know if this helps, but just thought I would contribute it.

Good luck and God Bless,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


TheoTeacher
Regular Member


Date Joined Jul 2009
Total Posts : 47
   Posted 10/5/2009 7:39 AM (GMT -6)   
Sonny,
Oh the things we learn as we get older.  I too am a life learner!  I was told all of what you said two months before surgery!  So I started kegels 60 days before the big event!  However, unlike your nurse,my doc said to start "a few kegels" each day even with the cath in.  So on day three post surgery there I was squeezing the tube!  Now 3 months out I'm down to 1 pad a day.  Good luck on your healing!
Dad dx at 72 with Pca; RP at 73; Died 11/08 at 88 from Pca met.
3 Uncles have had Pca; 2 deceased from Pca met.
Me: Age 51: Joyfully Married; father of 7!
Routine Physical 11/07 PSA 1.73 DRE normal
Routine Physical 1/09 PSA 2.77 DRE abnormal.
1st Urologist visit 2/09 DRE normal, small - PSA 6.3!
Biopsy 3/17- St. Patty's Day! 3 of 12 cores positive with 5-8% Pca
3+3 Gleason; Visit Johns Hopkins 3/26/09 and decide for surgery.
Lapro RP 6/29/09; discharged 6/30/09
Cath out 7/9/09 Gleason unchanged 3+3;
"Larger amount of cancer" than expected.
Organ confined Pca, positive margin as "artifact" of surgery.
All other tissues clear.
7 wk psa 8/20/09 - 0.05

"We walk by faith, not by sight."


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 10/5/2009 8:02 AM (GMT -6)   
My dr told me no kegels right away because I did not have a foley, I had an SP. They didn't want me squeezing the area where there was no support, just stitches healing. Made sense to me. Besides I tried once and it hurt like crazy.


Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 10/5/2009 6:07 PM (GMT -6)   
Sonny, did you also know that there is an ASP? An artificial Sphincter? That can be implanted to help with incontinence if continence does not return after surgery ....Pete has had one for one year....although not perfect...still 2 pads a day and 1 at night, it is a lot better than being wet all of the time....Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09
PSA .9 8/29/0


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 10/5/2009 7:12 PM (GMT -6)   
Diane,

Yes I know. Like everyone that faces some form of treatment for PCA, my main worry about the cancer was the IC.

Fortunately (and I knock on wood everyday) for me it has not been an issue. I hope and pray that it never is.

Thank you for the feedback,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 10/5/2009 7:37 PM (GMT -6)   
The other ineresting fact about the sphincter is that is has muscles like the neck muscle, that operate on an involuntary basis. Your neck muscles are constantly flexing and relaxing to keep your head level.

We don't tell our neck muscles to do this. Likewise, your sphincter has to keep pressure on the urethra, and when we cough or lift something heavy, they have to respond to keep it tight, but then relax enough to hold the urine back, without clamping down too tight.

But then they will respond when we tell them to, like when we have to pee.

That is a lot of what kegeling is doing besides building strength, is teaching them how to automatically control the flow, without us always telling it what to do.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)

New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, April 25, 2018 5:33 PM (GMT -6)
There are a total of 2,955,667 posts in 324,245 threads.
View Active Threads


Who's Online
This forum has 162243 registered members. Please welcome our newest member, Winger2908.
363 Guest(s), 11 Registered Member(s) are currently online.  Details
Break60, mattamx, MrJavier, Annastazya, KYLEb23, sierraDon, Danielle1035, Alexandros96, Livingforhope, Aurora2013, livinglightandfree000