About these Kegels...

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Doc
New Member


Date Joined Sep 2009
Total Posts : 18
   Posted 10/8/2009 5:30 PM (GMT -6)   
OK, I am now 11 days post-catheter removal, and frustrated by lack of any significant improvement in continence.  I was not advised to do any pre-op Kegel training, so this is all on-the-job training for me now, and I'm not sure I am doing this right.
 
1.  I can feel the muscle clench during Kegel exercise by pressing in with a couple of fingers between the scrotum and anus, so I am pretty sure I have isolated the right muscle.  I can stop my first AM urine flow or squeeze a few drops out with a voluntary clench.
 
2.  I am doing 3 sets of 10 reps per day, holding the clench for 5-10 seconds.  In addition, I am kegeling whenever I get up from sitting, bend over, or feel some flow coming, typically whenever I am walking around.  I am feeling sore muscles in my lower abdomen now, actually more abdominal pain than I felt from the robotic surgery.  If I am feeling sore muscles, am I overdoing it?  My "kegel muscle" does not feel sore, just the lower abdomen and into the groin area.
 
3.  For you lucky guys who are dry:  Do you subconsciously continuously kegel while walking around?  It seems like I would have to hold a continuous kegel to mitigate the flow while just walking around, and I am not sure if this is something that I should be doing.  I thought that kegeling was to train and strengthen a voluntary muscle, like your biceps, to assist with the added load your bladder may put on the diaphragmatic sphincter during "stress" activities.  So how do you establish involuntary control?
 
I feel like someone thas old me that we all have vestigial wing muscles in our shoulderblade area, and if I could only exercise them properly then I could fly - just before pushing me off the roof!
 
Doc
PCa Dx 07/09: 3+3 in 2 cores
Age at Dx 54
daVinci RRP 09/17/09
Final path 3+3, <5%, margins neg, pT2a.
 


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 10/8/2009 6:06 PM (GMT -6)   
Hey Doc,
I kegeled a little before surgery. I peed in the shower and could stop my flow so I figured I was ok.
The doc told me not to kegel until the cath came out. Post surgery I started jogging within one week figuring I would beat this within two weeks. about three days after the cath came out, I did a kegel and did it harder, and did it harder, and did it harder and... rip! I actually felt a pop! Man that hurt. I'm still leaking at 11 weeks. Still have not discussed this with the Uro. Next meeting is 10/27.
So if you want advice on pads or incontinence clamps, I'm available. But as far as stopping the leak I'm open to all suggestions.
Jeff

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/8/2009 6:11 PM (GMT -6)   
Hello Doc. My uro/surgeon wasn't keen on kegels before or after surgery, feels a lot of men over do them during critical healing periods in the weeks after surgery. I tried them at the most for 2 days, not real relgious about them, and never again. Can only speak for myself, was 100% dry in slightly less than a month. Like most things, I am sure the correct answer has to do with moderation.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


jacketch
Regular Member


Date Joined Apr 2009
Total Posts : 179
   Posted 10/8/2009 6:49 PM (GMT -6)   
My surgeon also wasn't really hot on kegels after surgery. I did the pee-stop-pee-stop routine daily prior to my RRP but I really didn't do it much afterward since I was fully continent after cath removal. Again, it seems as Purgatory said, moderation may be the key.
62yo
V10.46 Dx Feb-09
RRP 5-5-09
No adverse SE
PSA 6-19-09 -0-
PSA 9-21-09 -0-
 
Thriving, not just surviving!
 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 10/8/2009 9:45 PM (GMT -6)   
Doc said...

3. For you lucky guys who are dry: Do you subconsciously continuously kegel while walking around?
For me, no, the feeling I have down there is just the same as before surgery -- no feeling of tension. I still Kegel when I think of it though, as I think it helps with erections.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.
14 months: Occasional nocturnal erections.


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 10/8/2009 9:49 PM (GMT -6)   
Hi Doc, I promised my doctor I'd do my kegels and everytime my wife asked, you could set your watch on the hour, every hour, I assured he I was kegeling up a storm.

I lied. I was convinced I'd get dry some day in the future, and kegel or no kegel, the date would be about the same.

I'm not quite 90 days since the catheter came out and I'm at one pad for 24 hours and every week is better than the last.

I'd suggest you take a nice diazapam, or three or four, and put contenance on the 'don't worry about it' shelf for a few months. If you really, really work hard at it you'll notice things getting better in three weeks. But, if you just let it be, and not worry, you'll notice things getting better in 21 days.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 10/9/2009 12:15 AM (GMT -6)   
Hi Doc I was 95% dry from day 1 (I am 2 months fron open surgery) but I do have to be careful some times when I move quickly when sitting if I am concentrating to much on something else I sometimes to late to stop a small leak I never Kegel until I start to feel a leak coming I also have to be careful when passing wind and I have never done any Kegel exercises
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery 7/27/09
Prostate Gland weighting 34 grms
Gleason upgraded to 3+3 Tumour not closeto prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
 


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 10/9/2009 5:22 AM (GMT -6)   
Hi Doc.  Like a couple of others have said, my doc didn't really push the kegels but rather said to stop the flow 4 or 5 times each time you pee.  I did this for the 5 to 6 weeks between diagnosis and surgery and was basically dry from catheter removal.  Not perfect by any means - still have to concentrate when lifting something heavy or at intimate times but all things considered doing very well.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 147
   Posted 10/9/2009 5:25 AM (GMT -6)   
I was told by all the medics I have seen in England not to do Kegals whilst urinating apart the odd time just to check that the right muscles are being exercised. I started 3 months prior to surgery with repetitions of 10 secs per hold 10 times and did this twice daily. I started again about 2-3 days after catheter removal and I still do the exercises but not every day. I have been 99.9% dry for approx a month, and I am reasonably pleased with that. I cannot say that they helped because I cannot compare with not doing them, but I feel happy that I did the kegals pre and post op.

Diagnosed February 2009. Gleason 6, Psa 7.2, 12 core biopsy, and then Mri scan, which showed organ specific.
DaVinci at Addenbrookes, Cambridge, England 18th May 2009.  Nerves removed one side.
Catheter in for 8 days, no pain, no post op problems apart from an infection, cleared with antibiotics.
Some aching around the penis, which still occurs.
6 week psa 0.1, post op pathology all good, confirming pre op tests. Ed a problem, no treatment as yet.
Light ladies pad during the day, just to control a slight dampness and a Tena for  men pad at night for occassional leakage.
Awaiting 3 month consultation at the moment.
Sept 09 - still awaiting consultation. 99% dry during the day, tena pad at night just in case.
Sept 18th 09. PSA less than 0.1
Sept 29th follow up consultation at Addenbrookes. All ok at the moment
Virtually dry at the moment.


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 10/9/2009 6:30 AM (GMT -6)   
There are 2 parts to making the journey back to dryness

1) Strengthen the muscles
2) The mind needs to relearn when to clamp down those muscles and stay dry subconsciously


Part 1 does not take that long, do not over do it
Part 2 takes time for the mind to relearn when it is supposed to tighten those muscles around the uretha

patience, it is a 2-3 month or more process, but you WILL bet there
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 10/9/2009 11:15 AM (GMT -6)   
funny thing the nurse told me to avoid foods that make you fart, 3 months out and that is the only time I leak. I still say the best thing is to go commando, get rid of those pads. You need to develop a natural response that comes from the subconsious.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 147
   Posted 10/9/2009 11:21 AM (GMT -6)   
Unless you can squeeze the wind out slowly and gently it is a problem. If you really want to let rip you are in big trouble unless sitting on the loo. Obviously the same muscles are involved in holding both in. I wonder if this gets better with time.
Diagnosed February 2009. Gleason 6, Psa 7.2, 12 core biopsy, and then Mri scan, which showed organ specific.
DaVinci at Addenbrookes, Cambridge, England 18th May 2009.  Nerves removed one side.
Catheter in for 8 days, no pain, no post op problems apart from an infection, cleared with antibiotics.
Some aching around the penis, which still occurs.
6 week psa 0.1, post op pathology all good, confirming pre op tests. Ed a problem, no treatment as yet.
Light ladies pad during the day, just to control a slight dampness and a Tena for  men pad at night for occassional leakage.
Awaiting 3 month consultation at the moment.
Sept 09 - still awaiting consultation. 99% dry during the day, tena pad at night just in case.
Sept 18th 09. PSA less than 0.1
Sept 29th follow up consultation at Addenbrookes. All ok at the moment
Virtually dry at the moment.


CharlieTuneA
Regular Member


Date Joined Aug 2009
Total Posts : 37
   Posted 10/9/2009 2:02 PM (GMT -6)   
Doc,

11 days is not that long of a time. I'm 3 and 1/2 months (and 2 catheters) post op, and still have continence problems. I do know that I'm making progress, measured in the slowly decreasing number of dead fish I pull out of my underwear on a daily basis.

I sometimes do the Kegels, but more often than not, I forget. Right now, my doc doesn't seem to be concerned about them. There are other techniques down the road if it doesn't correct itself.

Everybody's different. Give yourself time.

-Charlie


Age at diagnosis 59, PSA 1.4
Biopsy 12/08 12 cores, 6 positive
Gleason 3+3=6
CAT scan negative.

DaVinci surgery 6/16/09
After 10 days, cystogram revealed fistula
Catheter Removed 7/17/09
Fistula still evident week of 8/24
PSA 0.03
Catheter Reinserted 8/28/09
2nd catheter removed 9/28/09

Continence is a future goal.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/9/2009 3:42 PM (GMT -6)   
dogbot, for me it did get better over time, i can generally rip a good one with no fear of a squirt from the other end.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


Doc
New Member


Date Joined Sep 2009
Total Posts : 18
   Posted 10/9/2009 9:44 PM (GMT -6)   
Sounds like this is just going to take time, and I should not be too discouraged at this point. It can be a double-edged sword to read posts by guys who have spectacular success in staying dry early - it is very encouraging, but also creates a challenge to "work harder doing whatever he did" with the hope of sharing some of that success.

Never considered the etiquete of flatulence training before, and I am too damp to worry about that now. This disease really makes you appreciate the intricacies of normal physiology.

Doc
PCa Dx 07/09: 3+3 in 2 cores
Age at Dx 54
daVinci RRP 09/17/09
Final path 3+3, <5%, margins neg, pT2a.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/9/2009 10:14 PM (GMT -6)   
yep ,doc, lol, this disease sometimes gets us down to the basest of thinking, and we take big thrills in the simplist body function. Ah, what a world.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 10/9/2009 10:32 PM (GMT -6)   

Doc,

Eleven days is nothing in this journey. Measure your progress by the week, not the day and you will see that you have made progress. I found that I would do kegels any time I thought about it...sitting in traffic, on a walk trying to hold it from point a to point b, watching TV. Don't be shy about it but don't go wacky. It took me 3 months total to taper off. Hang it there.

Ted


Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....
 


T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 10/10/2009 11:44 AM (GMT -6)   
I did kegels once a day 2 weeks before surgery. I started up as soon as the catheter was out using a program I found that suggested holding 10 seconds then releasing 10 seconds for 15 reps. Then wait 60 seconds and hold for a second then release for a second for 10 reps. Once in the morning and once at night. This wasn't doing anything. I told my urologist and he said that was nuts. He recommended holding 3 seconds, then waiting 5 seconds for 10 reps and to do that as often during the day as I liked. I usually fit in 2 to 3 times a day and at 6 weeks I wear 1 pad a day out of security more then need. I just played 54 holes of golf the last two days and I might have leaked once but that was from drinking beer. Passing gas is sometimes a problem if I force it. I do think the kegels help. Walking in my opinion is even better.
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Uro recommended Robotic for someone of my age. My research confirms.
Surgery performed August 19th, 09.
One side nerves spared. Nerve graft on other side.
Six weeks incontinence almost over. ED a work in progress but seeing some response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.


Army Guy 80
New Member


Date Joined Oct 2009
Total Posts : 2
   Posted 10/13/2009 9:12 PM (GMT -6)   
I have to agree with the kegels. I started mine hold for ten, release for ten and have now built up to hold for 60 release for 10. I do this during my walk to the bus stop (8 minutes) and bus drop to office (12 minutes). May seem like overkill, but threw the pads out after less than 90 days and no leaks since

webstergl
Regular Member


Date Joined Mar 2009
Total Posts : 25
   Posted 10/14/2009 1:29 PM (GMT -6)   
I kegeled for 8 months my uro told me I was probably not going to get any better but I kegeled for another 6 months and I did do it faithfully Finally they scoped me Dec (08) and did some test and it was determined that I had 80% control and told me that was as good as it would get, but they also found that I had some scar tissue that was restricting flow also so I had to get the scar tissue fixed March 08 then I had the AUS implant done this Aug 28 Monday Oct 12 they activated in the past 2 days since I have not felt this relieved in a long time.

as you will hear we are all different and that makes the difference in how you heal but on the other side there is nothing quick about any of this after surgery or radiation etc.... give it time learn all the options out there stay as positive as possible it does help
Age 54 (Dx age 52)
11/06 severe prostate infection PSA was at 52
2/07 PSA still at 6.2
3/07 Biopsy
4/07 5 of 12 core samples positive with Gleason at 6 -7
6/07 Robotic Radical Prostatectomy
Pathology showed Cancer was organ contained
Last 4 PSA’s 0
11/08 Dx with BNC (Bladder Neck Contracture) due to scare tissue
3/08 balloon dilation
8/09 AUS implant now waiting 6 weeks for activation
10/12 AUS was activated life has gotten much better

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