Just Started Pelvic Floor rehab therapy and have questions

[MountainLake622]

My urologist referred me to Pelvic Floor rehab therapy, since I am still having significant urinary incontinence that medications are not helping. Daily tadalafil helps with urgency but I haven't had much success w Myrbetriq for my OAB symptoms, although I am still taking it.

Last week was my first session, it was basically an evaluation and education session.

She did assess that I have limited range of motion and some weakness in my hips and core that is probably contributing to the tightness of my pelvic floor muscles. I have incomplete bladder emptying from BPH urethra obstruction, so I guess I am holding everything too tight in that area.

She gave me some very basic Kegel exercises to work on, and is having me focus on abdominal breathing.

Anyway, I am having a lot of difficulty isolating and moving my pelvic floor muscles. I feel like I am basically just constricting my glutes.

The instructions were to draw these muscles up and in, like I am attempting to suppress gas and to thrust my penis up and out from the base, but I find I'm not really able to do either.

Anyway this week's session will be more hands on so I am sure she will be able to help me, but just wondering it others have had a hard time activating and identifying these muscles?

 

[MichaelDahlke]

Hello Mountain Lake,

BPH can also be a reason for the OAB symptoms. If the treatment with the drugs does not show the desired effect, one can also think about a prostate resection, which often solves the problems much more sustainably.

The fact that many have problems at the beginning to control the right muscles is not unusual. You have to wait and see to what extent the training is actually helpful to your problem. If the problems due to the enlarged prostate are so considerable, it is usually better to drive with a TUR-P.

Best regards
Michael

 

[MountainLake622]

Hello Mountain Lake,

BPH can also be a reason for the OAB symptoms. If the treatment with the drugs does not show the desired effect, one can also think about a prostate resection, which often solves the problems much more sustainably.

The fact that many have problems at the beginning to control the right muscles is not unusual. You have to wait and see to what extent the training is actually helpful to your problem. If the problems due to the enlarged prostate are so considerable, it is usually better to drive with a TUR-P.

Best regards
Michael

Thanks Michael

She was able to help me isolate those muscles more. And gave me some additional exercises.

I'm not sure how much of an impact this will have on my continence overall, but if nothing else having more awareness of those muscles might give me more control and confidence.

My urologist is suggesting a TUR-P, but his NP suggested I try the pelvic floor therapy first.

I'd like to avoid the sexual side effects of the TUR-P If possible.

But, I am guessing even if I can get some better bladder control thru the pelvic floor therapy, eventually I'll need to consider surgical options.

I'm also wondering if given the extent of my IC already, if after the TUR-P I'd still need protective products? Yes it would be nice to wear less bulky products but seems like a lot to go thru.

Thanks a lot, I really appreciate the feedback.

 

[mochi]

I will add that PT takes time, months, and working on the things your therapist suggests.

Overly repetitive, but..Your choice to continue or seek alternatives is your call on finding a solution that meets your specific needs.

 

[darbas]

When you went to physio did they use ultrasound on your pelvic floor muscle so you could see which exercise worked best for you. I found lying on my back with my knees bent up and used the muscles to lift my scrotum up and release works best for me. I had a TURP 15 years ago and didn't make me incontinent but does feel strange with a dry orgasm although it started working a bit better after a few years past. Unfortunately, I just had my prostrate removed due to the big C and have to do these exercises to help with my incontinence issues. Been doing them for 3 weeks now but not sure if helps. I have been told by others on the forum they do help over time not overnight.

 

[MichaelDahlke]

Hello MoutainLake,

first of all, sorry for the late reply. I want to try to answer the question a little differently, because the problem is multi-layered. Basically, with an enlargement of the prostate and a resulting obstruction, it is first the case that one tries to improve the flow of urine. This is important to prevent the bladder from being damaged. The bladder is a muscle and the more it has to make an effort to transport the urine to the outside, the thicker it becomes. This can be observed in the ultrasound when the bladder is filled, because then the bladder wall gets thicker and thicker. At some point it can no longer grow anymore and the bladder begins to get bulge - it is trebacular. If that happens it is actually too late, because the muscle then has less and less strength and the whole thing ends with urinary retention and in the worst case with ISC.

A side effect of the growing prostate is that you have to go to the toilet more often. The reason for this is quite simple, because often the bladder can no longer be completely emptied because the muscle can no longer apply enough force because of the obstruction. As a result, the volume of work of the bladder decrease. So if, for example, normally 400ml fit into the bladder before you urgently have to go to the toilet, it is only 200ml with e.g. 200ml of remaining urine. Sometimes this can also lead to such a strong urge to urinate that incontinence occurs and also the risk for UTI‘s grow.

If the obstruction is eliminated in good time, the bladder can be emptied normally again, as a result the volume of work grows again and the frequent urge to urinate disappears again.

Normally, one is treated with medication at the beginning of a prostate enlargement. Receptors that are responsible for controlling the muscle at the bladder neck are blocked. As a result, the resistance in the entire system decreases and you can urinate better again.

If that is no longer enough, you usually have to operate.

If the medication treatment initially also helped you against the urge to urinate and incontinence, it is very likely that this problem will disappear again with the surgical elimination of the obstruction. If this was not the case, it may make sense to talk to the urologist again and ask for further diagnostics. In such a case, it may makes sense to clarify with a urodynamic examination to what extent you can benefit from an operation.

cu
Michael

 

[MountainLake622]

Thank you so much for the detailed response Michael!

I have had some improvement with the pelvic floor exercises and being more mindful about flood intake and keeping on a voiding schedule.

I have to try to urinate every two hours or an urgency accident is very likely.

The problem with urinating so frequently is that even before the enlarged prostate I had bad problems with post void dribble.

I do all the techniques for emptying, take my time, try to double void, and massage from the perineum to completely empty my urethra. But an hour or so after urinating I continue to leak a lot. I used to always wear incontinence underwear for this, as without it I soak thru to my pants.

Because of the urgency accidents I'm still needing to use tab diapers. Which took some getting used to but have definitely improved my quality of life.

My follow up with my urologist is coming up. Hopefully if I can stay at this level I can continue managing with medication and absorbant products. I'd really like to avoid surgery.

 

[seano]

I’ve been going to pelvic floor physical therapy for two years and have definitely noticed improvement in my condition. My recommended course of therapy was ongoing pelvic floor, physical therapy, Myrbetriq and the use of absorbent products. I’ve been doing PTNS also. The combination helps manage the condition but has not made it go away. But it’s good to know I’m doing everything recommended to address the problem.

 

[still_here25]

I just started pelvic floor PT this week. I'm excited and hope it helps. I take oxybu and TENS for tibial nerve stimulation (home version of PTNS)