Incontinence Advice, Please

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Regular Member

Date Joined Jun 2010
Total Posts : 35
   Posted 9/29/2010 5:38 PM (GMT -6)   
I had my surgery on Sept 16 and the catheter was removed on Monday, Sept. 27.  Since the catheter has been out, I've been totally incontinent.  I realize that I may be impatient but I was hoping to see some gradual progress and that has not happened.  My doctor's advice about incontinence consisted of:  "at night, you'll probably get up 2-3 times to pee.  When you have a good stream going, stop peeing and hold it for 5 seconds."  I've done that the first two nights but still have woken up soaking wet.  The past 2 days, I've used a total of 6 pads or Depends each day and have soaked them.  I find that I'm not even aware that I'm wetting myself when I stand up, sit upright or go for walks.  The only way I know I've been peeing is when I discover that my protective garment is soaked to the core.
Is this something that I can expect to go away on its own over there something more proactive that I should be doing?  During the day time, I do not get a feeling that I have to go so I've been trying to head to the toilet every 40-60 minutes to pee.  Despite doing this so frequently, I'm still wetting myself in between my trips to the bathroom.  I do kegels during the day when I pee, also.  In Walsh's book, he suggests reducing your liquid intake...which I've done.  He also suggests not doing Kegels during the day as this may actually cause the muscle to tire.  I've been following his advice but am wondering if there's more I need to do???  As an aside, I'm still feeling moderate discomfort in the perineal region and was thinking that perhaps the incontinence would subside as the perineal discomfort subsides.
Any advice or guidance would be greatly appreciated. 

Veteran Member

Date Joined Jan 2006
Total Posts : 654
   Posted 9/29/2010 7:02 PM (GMT -6)   
It is way too early to worry about improvement. Normally they hope you have sugnificant progress in 2 months. If you are able to urinate any even if it is a very small amount is good I think. Try wearing depends diapers with a big "ultimate absorbency"pad in them for now. The big Tena brand pads might be a good choice for you now.. The combination of the diapers with the pads will help catch all the flow as the diapers have the elastic leg holes. You shouldn't have to do it this way for long but anything beats getting things ( peolpe, pets furniture ect.) wet. A very few people have good continency the day the cath comes out but they are the VERY lucy ones. I was not one of those and your wet situation sounds like mine was then. It will take some ( alot?) of patience for these early weeks but keep in mind, all but about 2% recover from the mess you ae in now. Try not to worry and do whatever you can to not leak out of the protective gear and remenber it almost surely will get better. Hang in there!

Regular Member

Date Joined Aug 2010
Total Posts : 154
   Posted 9/29/2010 7:02 PM (GMT -6)   
I believe you are expecting way too much, too early in the process.  Good grief, the catheter was removed two days ago?  Whether it be by robotic or open, your urinary tract has suffered major trauma and needs to heal a great deal more than what it has so far.  You are doing the correct Kegel exercise while urinating and stopping the flow.  Its importance is about finding which parts are the lower abdomen you are using and then make those same constrictions when you exercise.  Patience is the key.  Nothing happens overnight when dealing with PC.  Good luck........

PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3c N0 MX, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.41. Will start ADT3 after PSA reaches 1.2.

mr bill
Veteran Member

Date Joined Sep 2010
Total Posts : 707
   Posted 9/29/2010 8:06 PM (GMT -6)   
Had my cath out Sept 16 after surgery on the 8th. At night I leak while sleeping but wake about every 1 1/2 to 2 hrs and do empty my bladder somewhat. Mostly after sleeping on my back. During the day it's mostly no control at all. I spoke with oncologist today and he said "its only been three weeks." Yes, it takes time and those who are continent after cath is out are very lucky. Just be patient it will work out. Some days are good some days are bad.  
You will also improve then seem to regress. As my grandson says "enjoy the skippin kind of days."
Age 66
BPH since 2000. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photoselective vaporize Clev. Clinic
8-9-10 Aug PSA rose to 10.14 with finasteride positive biopsy Cleveland gleason 9, cat & bone scan negative
9-8-10 Robotic prostatectomy at Cleveland. B iopsy 9 nodes, 2 positive,seminal & vas deferens positive invasive adenocarc

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 9/29/2010 8:26 PM (GMT -6)   
I agree with the other guys, it just takes time.

Usually, you will be dry at night first. I remember having to pinch Willie so hard it hurt while I was running to the bathroom the first few weeks. Eventually, it got better, and I was dry at night.

But it took me 8 months to get pad free. Because of my work, I actually used a clamp for a month or so, so I didn't wet myself while working with high voltage. I know how frustrating, embarassing, and uncomfortable it can be, but it will get better.

Keep those kegels up. Cleveland Clinic has guys buy a kitchen timer and do a kegel every 12 minutes. Other techniques can be found on google that fits your preferences. It may take 4 weeks or so until you really feel the results of the kegels.

The mid stream stop is a good indicator of your progress.

Good luck, just relax, and let nature take its course.
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Forum Moderator

Date Joined Jan 2010
Total Posts : 7078
   Posted 9/29/2010 8:40 PM (GMT -6)   
At 2 days I was using a depend pant with at least 10 Walgreens guards (much heavier than the Depends guard) per day, and a Tena extra-absorbent pad over night.
Felt like I was in a hotel at night - fresh sheets daily; but felt like hired help every morning, taking the wet ones to the wash.
It took several days to get down to 8 guards, then a couple of months to get down to 6.
Do the Kegels - at least 5 sets of 10 reps a day, maybe a few more if it doesn't cause discomfort.
I got a cheap measuring cup, and did a diary of how much urine / what time, as well as any blood or debris you notice. It will help you track progress.

Regular Member

Date Joined Jun 2010
Total Posts : 192
   Posted 9/29/2010 8:57 PM (GMT -6)   
Be paient, when my catheter came out I was 10-12 pads a day, took a month to get to 8 pads. Finally made it to 2-3 pads a day after 4 months. Its a long process for most. (medium Tenna pads).

Regular Member

Date Joined Aug 2010
Total Posts : 46
   Posted 9/29/2010 9:34 PM (GMT -6)   
Bill, I can completely sympathize with you. It's been 5 weeks since my surgery and 3 weeks since my catheter was removed, and despite being in very good physical condition, I have almost no urinary control when I'm active during the day. When I'm sitting I can go maybe an hour between bathroom visits, but when I'm walking around, it seems like I'm leaking, squirting and generally wetting myself with almost no control. Very frustrating to a guy who's used to being in control!

However, there are some subtle signs of improvement that give me encouragement. First, I'm able to sleep most of the night now without getting up -- last night I only had to get up twice and ended up pretty dry in the morning, a major improvement over even a week ago. Second, I'm able to do Kegels for much longer, up to 40 seconds per "squeeze" compared to 20 seconds a week ago and only 5 seconds when I first started. So I know the muscles are getting stronger, even though they're not strong enough to keep me dry during the day.

So I guess you and I are in pretty much the same boat. But take heart, all the guys who are a few months down the road are all telling us that it gets better, slowly but surely!

Hang in there...

Age 57, PSA 6.0, Biopsy - 3/12 cores , Gleason 3+4
Aug 27 2010: open RRP at UPMC Shadyside Pittsburgh, nerves spared
lab results: 0/23 lymph nodes involved, negative margins, woo hoo!

Don K.
Regular Member

Date Joined Jan 2010
Total Posts : 74
   Posted 9/29/2010 11:07 PM (GMT -6)   
Bill (and all):
I have no business in this thread as I'm a HT patient right now.
However, I realise how miserable you must be so will offer the following:
I have read about "external catathers" that consist of a condom like device that terminates in a collection bag.
The cautions are that it may delay healing because no effort to control flow is needed.
It seems to me like short term use would make life more pleasant.
Best wishes,
Don K.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2217
   Posted 9/30/2010 3:03 AM (GMT -6)   
Very early days.
It will take a long time for stuff to heal. The fact that the robot just leaves a few tiny scars on the outside means that you can forget that it's made a great big mess on the inside, and that's where the real healing has to take place.
I know I'm one of the "lucky" ones, but I only have what control I do have by going to the bathroom very frequently. I still squirt and dribble every day, and still pop in a pad if driving or doing strenuous activities (and for example I also intend to have a pad in for an upcoming visit to the dentist too in case I am stuck in the chair for ages)
And having had SRT now too, things are also worse now that six months after surgery.

I don't think it is realistic for any of us to imagine that we are going to return to a situation where we have the same level of bladder control that we had before surgery. What I guess I'm saying is that I have learnt to manage my continence and live with it and around it. (I also find it kinda feels better to refer to it as my continence and not my incontinence problem)

Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
BMs weird
14 Sep 10 PSA <0.1
Erections OK

Regular Member

Date Joined May 2010
Total Posts : 129
   Posted 9/30/2010 7:35 AM (GMT -6)   
You most likely will improve rapidly, but being patient is difficult, I know. I tried some mind tricks, like not wearing a pad around the house so I HAD to rush to the bathroom.
Good luck & hang in there!
50 Yrs. old. DX Feb, 2010 w/6.6 PSA.
Biopsy 04-24-10, Gleason 3+3=6
4 of 5 cores left side inv. 4 of 6 rt side
RRP 06-07-10....
16 days post-op, catheter out.
Gleason upgraded to 3+4
No involvement of lymph nodes & seminal vesicle.
Perineural invasion present :(
Totally continent @ 8 weeks post-op. (!!!)
1st post-op PSA @ 12 weeks - Less than 0.05

Regular Member

Date Joined Jun 2010
Total Posts : 35
   Posted 9/30/2010 8:04 AM (GMT -6)   
Thanks all...I feel better knowing that my situation is similar to what others have experienced. I guess I need to work some more on being patient!

New Member

Date Joined Sep 2010
Total Posts : 16
   Posted 9/30/2010 9:29 AM (GMT -6)   
It happened for me in big strides for no apparent reason. First 3 weeks zero control, stand in the shower and drip while trying to stop it. Went from 10-12 pads soaked to 4-5 over a weekend. Two weeks later I noticed I only needed 1-2 a day. After about a month more I noticed I was dry. While I still have occasional dribbles (stress leaks), I am now continent and confident.
Hope your path is as good or better.
Age 53 no symptoms.
1/2010 First ever PSA 5.4 DRE abnormal
2/2010 First urologist exam PSA 5.5
3/17/2010 Biopsy 7 of 8 cores positive avg 20% Gleason 6=3+3
6/15/2010 Davinci by Dr. Williams Cincinnati. Over 400 performed
Labs prostate size 36g, 15% involved Margins uninvolved
No extraprostatic or seminal vesicle invasion
perineural invasion present
nerves spared
Final Gleason 6=3+3

Regular Member

Date Joined Aug 2009
Total Posts : 147
   Posted 10/1/2010 4:48 AM (GMT -6)   
I never had a big problem with leaking, but small dribbles on getting up from a chair continued for months after operation. I was mostly dry at nights quite quickly but a dribble was forthcoming on arising from bed, and twice nightly visits to the bathroom for a pee was the norm. After approx 9 months I was able to throw away the pads, which were just the light ladies type and was continent apart from a very occassional stress dribble when using the stomach muscles in the wrong position and bathroom visits are now very seldom during the night. . Coughing and sneezing did not cause any problems right from the word go.
I still do the kegals several times a week to keep the muscles in good shape. Patience is the key word in recovery, but I can understand the frustration with the slow recovery process, but it will come right in the end.
All the best fron England.

Veteran Member

Date Joined Jan 2010
Total Posts : 2845
   Posted 10/1/2010 6:26 AM (GMT -6)   
I echo the other comments - it is way too early to expect your body to be functioning the way it was before surgery....

I was a heavy leaker at the start, having to change pads and clothing 3-4 times a day - I was giving up hope for any improvement and was looking at external catheters ( not too expensive but they can cause irritation due to the stickum and they can fall off !)...

.. but it was a posting by someone on HW that stated it takes about 14 weeks for the nerve endings to regrow after all that trauma from surgery - and have the body bits start talking to each other ... that gave me hope ...

... and at week 16, I was finally able to get out of the car and stand up without losing 4 oz or more into my pad ... and soon after that, things improved greatly...

- do keep up with daily kegel routines - mine was 5 times a day - 20 reps each time -

-wishing you all the best ....

Age: 55 -gay with spouse, Steve - live in Peteborough, Ontario, Canada
PSA: 10/06/2009 - 3.86
Biopsy: 10/16/2009- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/2009
Pathology: pT3a- gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
Post Surgery-PSA: April 8, 2010 - 0.05 -I am in the ZERO CLUB
Sept 23, 2010 -0.05 - again -hoorah !

Regular Member

Date Joined Aug 2010
Total Posts : 234
   Posted 10/3/2010 4:23 PM (GMT -6)   

Keep the faith, Bill.

Up until a couple of weeks ago, I thought that it would never stop..   I suspect that when the UDoc removes the prostate from the bladder, they sometimes remove too much muscle, and hence for some of us, it takes much longer, to re-grow that muscle.  The Muscle from the Prostate is GONE.

My physical work has made it harder...  Were I sitting at a desk, it would have been easier.   I could sit all day at the computer, without drama.
So here I am at just four months and a pad  now lasts two days when changed for cleanliness, and a couple of tissues  or a feminine mini-pad (inside the 'Man-Pad'), absorbs the one or two drops that sneak out when I let my guard down.

I definitely found that I got worse later in the day..  ie.  the muscles became tired -- But - I think that it's important to keep those pelvic crunches up during the day - I'm sure that it pays off in the long run - "No pain=No gain"


Full Bloods -- Nov 09 = First-PSA 5.0 @ 60yo - Absolutely NO symptoms - DRE-Non-Palpable
Jan-2010 = TRUS Bx DX - AdenoCar T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
Jun-2010 = RRP- Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
Margin-Involvement (extensive) Posterior , Grade3 x 8mm
+8week PSA <0.01 , Full-ED, Mild Incont
+12W Full-ED, Minimal Incont

Post Edited (BuiDoi) : 10/3/2010 4:25:22 PM (GMT-6)

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