Urinary incontinence, or the loss of the ability to control urination, is common in men who have had surgery or radiation for prostate cancer. Urinary incontinence complicates recovery and will, in the short term at least, have a negative impact on your life.
One week after being discharged from hospital I had the catheter removed by my own G.P. in his surgery. I brought a pad with me to wear after catheter was removed. My doctor did mention that men may have a problem with urine retention after catheter is removed. If you have problems like this you should contact your doctor immediately. I did not have this problem. Once I stood up I could feel the urine flowing into the pad – not a pleasant sensation! There was an overwhelming feeling that I wouldn’t get home before I started to wet my clothing. That didn’t happen, however, as the pads were very absorbent and kept the moisture away from my skin – presumably a similar design to modern baby nappies. This knowledge gave me the confidence to get out and walk longer distances every day.
What appears to be a ‘freeflow’ of urine can be terrifying and give rise to anxiety at a time when one needs to remain calm and focused. It is important to remember that at this stage healing is still taking place and you need to give this time.
There are two *sphincter muscles that keep men from leaking urine before radical prostatectomy, the internal urethral sphincter and the external urethral sphincter (see diagram). Where the bladder and urethra join, there is a ring of muscles called the internal sphincter, which opens and closes like a camera-shutter. In a normal person this is closed most of the time to prevent urine leaking out. The internal sphincter is not under your control and will open involuntarily when bladder is full: an involuntary muscle is one that contracts and relaxes without conscious control like the muscle of your stomach. In the diagram you can see that when the prostate is removed the urethra is re-joined very close to this ring of muscle. It is likely that during the surgery this muscle may be damaged or even removed. After surgery, therefore, it is unlikely that this sphincter will play any part in preventing urine flow from the bladder. The external sphincter is part of another set of muscles below the prostate called the pelvic floor. These muscles are also involved in urine flow from the bladder and under your voluntary control. These are the muscles that you use to suddenly stop the flow of urine when you’re actually peeing. This muscle may be put under stress during surgery but when healed can be used to stop the flow of urine. This external sphincter muscle will need to be exercised to get it performing at its best. Hence the necessity to do pelvic floor exercises when you get home.
(*A sphincter is a ring of muscle surrounding and serving to guard or close an opening or tube, such as the anus or in the stomach where it keeps stomach acids and other stomach contents from pushing up and into the gullet).
Pelvic Floor Exercises
Two good ways to identify your pelvic floor muscles;
- When your peeing stop the flow of urine. If you can do this you are tightening the pelvic floor muscles. It is important not to do this as a way of exercising the pelvic floor as it may lead to a bladder infection.
- Stand in front of the mirror naked from the waist down (maybe draw the curtains) and tighten your pelvic floor muscle. If you are tightening the right muscles, you will feel your anus tighten and you should see the base of the penis draw in and scrotum lift up.
Pelvic floor exercises should be started only after the catheter is removed. I did the exercises very gently for the first few days gradually building up to do them more often and more frequently by week two. I started drinking decaffeinated tea and cut out all alcohol.
I quickly noticed that while sitting I wasn’t wetting myself so I slipped into a lazy routine. I was getting up having breakfast, allowing beverages to pass through to bladder, going for walk, having lunch followed by waiting period, moving around a little before dinner, watching TV and going to bed. By week three I had read quite a number of books but didn’t feel I was making any progress and beginning to feel very discouraged. My partner was fantastic in keeping me positive and focused on doing the pelvic floor exercises. I was so desperate I went back to the internet and found a paragraph that changed my whole attitude and daily routine.
'When you have to urinate, the nerve signals the muscles in the walls of the bladder to squeeze and force urine out of the bladder and into the urethra. At the same time the bladder squeezes, the urethra relaxes. This allows urine to pass through the urethra and out of the body. After surgery any sudden movements, like standing up, bending over, going down a step, lifting something etc.,seems to trigger the bladder to contract.'
I realised I had to train my brain to get my pelvic floor muscles to tighten in response to these sudden movements when they occurred. This training would have to be so successful that when these movements occurred my brain would respond almost ‘involuntarily’. This is referred to as muscle memory.
‘Muscle memory occurs when a movement is repeated over time, a long-term muscle memory is created for that task, eventually allowing it to be performed without conscious effort. This process decreases the need for attention and creates maximum efficiency within the motor and memory systems. Examples of muscle memory are found in many everyday activities that become automatic and improve with practice, such as riding a bicycle, driving a car and typing on a keyboard'. (https://en.wikipedia.org/wiki/Muscle_memory).
Excellent Video, above, to teach you how to do the pelvic floor exercises properly
Towards of the end of week three I stopped my routine of the previous weeks and started challenging myself by getting up, moving around more frequently and doing all those movements that would cause my bladder to contract. I started to practice what Australians call the ‘knack’ which is squeezing your pelvic floor muscles just before you undertake one of those challenging movements. During this time because peeing is always on your mind you may visit the toilet more as a precaution than a need. It is important to train the bladder to hold more urine and also to only go when needed – ‘mind over bladder’. I drank lots of fluid and challenged myself to only visit the toilet when my bladder was really full. It took a while but by week five I was seeing major progress and by week six I was dry for 90% of the time. By week seven the only major leak that occurred was when I was walking. By the end of week eight I was fully dry and no longer using pads. I was experiencing the odd dribble which I dealt with by using female panty liners cut in two and positioned in the correct location in my underwear.
By the first of July I was having the occasional glass of wine with dinner and even a beer. The last two weeks of July I painted our two storey house and only experienced an odd minor dribble while up a ladder.
Video, above, explains the 'knack'.