Should One "Hold" At All Times for Improved Continence?

Good Morning Gene,

I hope the move at work is going well.  I have a good feeling about your work there!

My understanding - from my bio-feedback therapist - is that you don't hold at maximum all the time.  However, there is a certain muscle tone that develops in all of the pelvic floor muscles that will seem somewhat flexed (Think half-power while doing elevator kegals.) all the time.  Also, she suggests, after a few weeks of scheduled kegal exercises, in addition to the scheduled routine, to just do a partial routine of kegal exercises whenever you think of them.  If you compare this work to conditioning other muscles in the body, you might exercise - say your legs or arms - for even hours at a time, but you would not just flex them all the time.  The muscles you want are dynamic.  Not static.

I personally do the warm-up (2 seconds on 2 seconds off) or elevator kegals (off 5 seconds, half-power 10 seconds, full-power 10 seconds, half-power 10 seconds,  - repeat) for as many times until I get bored - whenever I think of them.  For example, whenever I sense leaking.....  whenever I am driving...  whenever I am typing at the computer..  whenever I am doing some routine job on my feet.....

Your other post mentioned your using the clamp.  Even when I was leaking at full speed (at week 4 upon return to work), I could go 2 hours with the combination of the men's 8 oz. liner and women's 12 oz. incontinence pad at 90 degrees-  mostly just replacing the wonen's liner every two hours if I remembered.  My point:  I feel that using the clamp has to be a lot like doing kegals while urinating to stop the urine flow.  My bio-feedback therapist believes that doing this for any reason except to learn to isolate the muscles is counterproductive as it confuses the smooth muscle (no conscious control) valve of the bladder that is an integral part of your ultimate continence.

When you become continent again, four things:  your overall health, the muscle tone of the pelvic floor muscles, periodic conscious control of the kegel sphincter when lifting - etc., and this bladder valve all work together.

You will recover to full health.  You are "...fearfully and wonderfully made...!"

ihs

C^Cedar

Gene:

It seems as if you and I are in the same boat.  I'm 2 months post-op,  and leak continuously during the day.  A lot of the guys on this board suffer from the "classic" form of stress incontinence.... which is leakage when coughing,  sneezing,  running,  etc.  While a real pain,  it is not as bad as the continuous leaking I have even when standing perfectly still.  This does not allow my bladder to accumulate any volume whatsoever during the day.... it all comes out in my pads,  which I change up to 15 times a day.

As far as your initial question,  I try to hold a kegel as long as I can,  but I must eventually let go,  and everything in my bladder just pours out.  It is truly ruining my life because I have seen zero progress in 2 months.... it is taking a huge toll on my well being because the total lack of any progress is so atypical from most people on this board.

Are you able to stop and start the flow in the morning?  I can only slow the flow briefly,   not stop it.  Since the morning is the only time I have a full bladder,  I can only practice this once a day.

My prostate was rather large at 60 grams,  so I am fearful that some damage was done to the sphincter or pelvic floor muscles upon removal.  The doc,  of course,  says no but I honestly feel he is feeding me a bunch of BS to cover his rear.  All he knows how to say is "patience and kegels"....  there has to be more to it than that after 2 months.  I started doing kegels weeks before surgery,  and have just started biofeedback lessons,  although the technician says that I have been doing the kegels properly.

I'm beginning to regret having the surgery at all.. I spent so much time researching all the procedures and doctors,  in order to make the right choice, only to face the prospect of being a guy in his early 50's living the life of a 90 year old in diapers.

Sorry to be so negative,  but this is becoming unbearable.  There are a lot of upbeat,  wonderful people on this board who have offered words of encouragement,  I'm sure you are better off listening to them!! Good luck to you!

Bill

Gene: Here's my two cents. Don't hold "at all times" because your muscles will be fatigued at all times. Like anything else, do your exercises consistently -- a few times a day -- but give it a break once in a while, so the muscles can recoup and eventually do their job naturally.
I'm glad you're going to talk to your surgeon.
Best of luck,
Tom

Bill23, Your only a little over a month Post OP. I would not be so hard on yourself. Just keep doing the Kegeals as your Dr. wants you to.
I'm almost 8 months Post Op and still using 6 /10 pads a day. If I can deal with it you can too. Atleast the cancer is gone!

KW

Hi ~ Gene & Bill, Everyone is different….   Find what works best for you! And most importantly ~ give yourself and your body time to heal .  There are options down the road... and hopefully you won't have to research them.  Better to have the body do the work and if it takes "time"... then allow this time for recover/healing to take place.  Rushing into any other area of help "in our opinion" is not the best thing to do.   You may have already found the threads below but thought I'd go ahead and attach them.. … Hope this helps you!!   Also ~ this paragraph always jumps back to me when there's questions about kegels. EXCERPT:…..On page 247 of Dr. Walsh’s book he states: Exercises you can do:   Every time you urinate, do it standing up.   You can’t practice the following exercises, which strengthen the external sphincter and speed up your recovery of urinary control, while you’re sitting down.   Start your stream, and once it’s in full force, stop the stream by contracting the muscles in your buttocks --- not your abdominal muscles, not the muscle “up in front” around the penis.   Tighten your buttocks: imagine you’re trying to hold a quarter between your cheeks.   Hold the urine back for 5 or 10 seconds, and repeat as many times as you can.   Note: Only perform these exercises when you’re urinating; if you keep contracting these muscles throughout the day, you’ll overdo it—the sphincter tires easily—and you’ll end up wetter than you would otherwise.   Previous paragraphs address… things to speed up your urinary control.   One is not using any artificial devices…… and certain high blood pressure medication relaxes this muscle so you may need to check with your doctor.   (direct links below ~ just click on the title!   Reminder to click on the REFRESH icon once there) Kegel Help?   Thread by KW / Member Kegels - to pee or not to pee?  Thread by Pianoman   In Friendship ~ Lee & Buddy

Bill, Gene, & Ms. Bluebird Lee,  RE: WHAT ARE THE PELVIC FLOOR MUSCLES ? ******************************* Bluebird wrote: ... this paragraph always jumps back to me when there's questions about kegels. EXCERPT:…..On page 247 of Dr. Walsh’s book he states: Exercises you can do:   Every time you urinate, do it standing up.   You can’t practice the following exercises, which strengthen the external sphincter and speed up your recovery of urinary control, while you’re sitting down.   Start your stream, and once it’s in full force, stop the stream by contracting the muscles in your buttocks --- not your abdominal muscles, not the muscle “up in front” around the penis.   Tighten your buttocks: imagine you’re trying to hold a quarter between your cheeks.   Hold the urine back for 5 or 10 seconds, and repeat as many times as you can.   Note: Only perform these exercises when you’re urinating; if you keep contracting these muscles throughout the day, you’ll overdo it—the sphincter tires easily—and you’ll end up wetter than you would otherwise.   Previous paragraphs address… things to speed up your urinary control.   One is not using any artificial devices…… and certain high blood pressure medication relaxes this muscle so you may need to check with your doctor. ************************************************* Gene asked Bluebird: You recently wrote to me and Gene.....   EXCERPT:…..On page 247 of Dr. Walsh’s book he states: Exercises you can do:   Every time you urinate, do it standing up.   You can’t practice the following exercises, which strengthen the external sphincter and speed up your recovery of urinary control, while you’re sitting down.   Start your stream, and once it’s in full force, stop the stream by contracting the muscles in your buttocks --- not your abdominal muscles, not the muscle “up in front” around the penis.   Tighten your buttocks: imagine you’re trying to hold a quarter between your cheeks."   Everything I've read specifically states that one should never use the muscles of the abdomen, thighs, or buttocks when kegeling .  Does Walsh differ from this?   ************************************** Cedar Writes: My work with my bio-feedback therapist agrees with what Bill says. (.. one should never use the muscles of the abdomen, thighs, or buttocks when kegeling..) However, If you think of the suggestion to "tighten the buttocks" as " contracting the muscles in your buttocks" - that is,  more as a descript ion to get you to tighten the anus sphincter, this is what my bio-feedback therapist teaches as an integral component of the "Pelvic Floor Muscles." The descript ion she gave was: ".. like you are trying to hold back a fart..." What I have found in my efforts to control the "kegel sphincter" that we who fight for continence are trying to develop, is that often when I control the passing of gas, I also leak.  This supports tightening the anus as well as the muscles immmediately surrounding the urethra for "Kegeling."   As the anus sphincter seems to be the more difficult to learn to control of the pelivc floor muscles, from the teaching point of view, Dr. Walsh's advice  " trying to hold a quarter between your cheeks" , is a helpful approach as it brings the focus of control away from the pelvic floor muscles we seem to think of first - those muscles that immediately surround the urethra that don't work for continence control so well while walking, lifting, coughing, or climbing stairs.  Note: The last half-power portion of Elevator Kegel reps REALLY helps to learn this anus sphincter control - without tightening the actual buttock muscles.   My bio-feedback therapist showed me detailed musculature drawings of the pelvic floor muscles in both men and women.  They wrap around from the anus sphincter to the lower pubis (In women, this area surrounds the vagina.).  She said that another "feeling" that indicates that you are doing the Kegal Exercises correctly is that it feels like you are pulling your testicles up into the pubic cavity.  I only notice this sensation when I am at the peak of my elevator exercises.   ICTHUS   C C edar

Bill,

You mentioned that you you think your prostate size might be an issue....

My prostate was larger than 120 grams! My doctor is doing some research as to this being a record! He said the size will make a difference in the recovery time for Continence compared to a normal sized prostate. The body has to go through more traumatic changes to accommodate the loss of a large prostate.

But my point is, I leaked as severely as you. I even leaked while laying down, I had to sleep in my recliner for the first three weeks... . ..then at week 4 I started walking building up to 2.25 miles a day and practicing my kegals as i walk. I am now entering my eight week and have noticeable improvement. I was doing 6-8 pads a day and now its down to 3-4 a day.

Yes I still leak when I stand, squat, bend over, lift my legs to put my socks on and sneeze and cough..but only dribbles not streams!

Patience and determination is the key! say to yourself everyday! I WILL WIN!! make yourself believe it! I do!

Every step you take holding your kegal is a win!! every trip to the bathroom holding that kegal is a win!!

Good luck in the never ending battle of PCa,

Your partner in pads,

Dave M.

Bill23

 

Just caught up with your email from end of May

At 4 months out from open RP I too still leak almost continously all day if I am not sitting down. Just standing starts it off. Nights are OK & although I get up a couple of times for a pee I am dry in the morning.It seems that what we have is different from straightforward stress incontinence. Currently I am trying the electro magnetic chair 3 times a week but so far no good news. Previously I have done plenty of Kegels & have always been able to stop the flow of urine.

I use pads called "Molicare Mobiles" Super which are like Grandma's knickers but with very good absorbency & I know they will last for at least 4 hours. I haven't seen anyone on this site talk about them. In fact I can get through a whole day using only 2 - 3 pads - they are made in Germany & although more expensive are quite practical & no underpants to worry about.

I would like to hear of your progress

& wishing you all the best

 

Mike

Bill23 said...

Gene:

It seems as if you and I are in the same boat.  I'm 2 months post-op,  and leak continuously during the day.  A lot of the guys on this board suffer from the "classic" form of stress incontinence.... which is leakage when coughing,  sneezing,  running,  etc.  While a real pain,  it is not as bad as the continuous leaking I have even when standing perfectly still.  This does not allow my bladder to accumulate any volume whatsoever during the day.... it all comes out in my pads,  which I change up to 15 times a day.

As far as your initial question,  I try to hold a kegel as long as I can,  but I must eventually let go,  and everything in my bladder just pours out.  It is truly ruining my life because I have seen zero progress in 2 months.... it is taking a huge toll on my well being because the total lack of any progress is so atypical from most people on this board.

Are you able to stop and start the flow in the morning?  I can only slow the flow briefly,   not stop it.  Since the morning is the only time I have a full bladder,  I can only practice this once a day.

My prostate was rather large at 60 grams,  so I am fearful that some damage was done to the sphincter or pelvic floor muscles upon removal.  The doc,  of course,  says no but I honestly feel he is feeding me a bunch of BS to cover his rear.  All he knows how to say is "patience and kegels"....  there has to be more to it than that after 2 months.  I started doing kegels weeks before surgery,  and have just started biofeedback lessons,  although the technician says that I have been doing the kegels properly.

I'm beginning to regret having the surgery at all.. I spent so much time researching all the procedures and doctors,  in order to make the right choice, only to face the prospect of being a guy in his early 50's living the life of a 90 year old in diapers.

Sorry to be so negative,  but this is becoming unbearable.  There are a lot of upbeat,  wonderful people on this board who have offered words of encouragement,  I'm sure you are better off listening to them!! Good luck to you!

Bill