Pads and guards

[Mattsmith3134]

I'm 3 weeks out from catheter removal after prostate surgery. I'm trying to find a way to make it through a work day with minimal changes. I still don't have control yet. I do kegel sets and I can interrupt a stream but not stop. Anyway when I combine a diaper with a booster pad it seems like I have even less control. Maybe it's more pressure especially when sitting. Has anyone else experienced this or am I just where I am in my journey

 

[darbas]

I'm 3 weeks out from catheter removal after prostate surgery. I'm trying to find a way to make it through a work day with minimal changes. I still don't have control yet. I do kegel sets and I can interrupt a stream but not stop. Anyway when I combine a diaper with a booster pad it seems like I have even less control. Maybe it's more pressure especially when sitting. Has anyone else experienced this or am I just where I am in my journey

Hi Matt
I am surprised that you have gone back to work so soon after your surgery. My doctor wouldn't allow me back to work for 8 weeks. Anyway, back to your question about pads. As I have now been back to work for 2 week and still leak up to 600 MLS a day at work although only about 100mls at home mostly because I am on my feet all day at work. I was worried about what to use at work as I didn't want to be changing pads all day so I opted for an external catheter and leg bag. It comfortable and not noticeable and I don't worry about changing pads. I am a tradesman and very active at work and have not dislodge it yet but do wear an absorbent pad just in case but it is only a thin pad. This certainly takes away the worry and anxiety of the situation. Good luck with you recovery as I too have found this forum very helpful and supporting

 

[sandiego]

Matt, I use both diaper and pads. I have zero control when standing or sitting. I find no difference with just a diaper.

Darbas, "8 weeks"?! My doc wanted me up and about the day after surgery. But i am not a tradesman who uses their body to lift and such. "External catheter"!? Wow! You are much more tolerant of the discomfort of having a catheter in than i was. Just having it in for a week was brutal. Every time i moved, it dug into sensitive nerves. When it came out, i was so relieved. BUT... the pads and diaper tether me to the bathroom so i understand not wanting to have that on the job. I easily go thru 10 to 20 pads a day. Just depends on how wet i want to be.

My BIG question to both of you is, why are you incontinent? My surgeon assured me that only about 3% of men experience incontinence after a prostatectomy which (the more i research) seems like a complete lie. Was the involuntary sphincter removed from you when your prostate was removed?

 

[darbas]

Matt, I use both diaper and pads. I have zero control when standing or sitting. I find no difference with just a diaper.

Darbas, "8 weeks"?! My doc wanted me up and about the day after surgery. But i am not a tradesman who uses their body to lift and such. "External catheter"!? Wow! You are much more tolerant of the discomfort of having a catheter in than i was. Just having it in for a week was brutal. Every time i moved, it dug into sensitive nerves. When it came out, i was so relieved. BUT... the pads and diaper tether me to the bathroom so i understand not wanting to have that on the job. I easily go thru 10 to 20 pads a day. Just depends on how wet i want to be.

My BIG question to both of you is, why are you incontinent? My surgeon assured me that only about 3% of men experience incontinence after a prostatectomy which (the more i research) seems like a complete lie. Was the involuntary sphincter removed from you when your prostate was removed?

Hi Sandiego
First off, I think you doctor was giving misinformation on prostrate removal it is more likely only 3% don't have incontinence after surgery. I was informed majority of Men will be incontinent to various degree and can take up to 12 months to come good depending on the individual. Mind you I was told if you have a high PSA you are likely to have cancer, and a low reading was good, but my reading was .8 every time I was tested but this time other test showed I had cancer. As for the external catheter it is not inserted in your penis but goes over it like a condom but with a tube connected at the end which then connects to the bag. It is held in place with a Velcro strip around the penis (the ones I buy supply a self-adhesive strip which I found come of when you start to sweat). I don't even know I am wearing it most of the time but after work I just use a pad as I don't leak much then. During my 8 weeks off from work I would walk every day from 2-5 ks a day and on occasion even further so I wasn't couch bound all that time. I am 69 but still do alot of physical work which I can still run rings around the younger guys I work with.

 

[sandiego]

Matt, I use both diaper and pads. I have zero control when standing or sitting. I find no difference with just a diaper.

Darbas, "8 weeks"?! My doc wanted me up and about the day after surgery. But i am not a tradesman who uses their body to lift and such. "External catheter"!? Wow! You are much more tolerant of the discomfort of having a catheter in than i was. Just having it in for a week was brutal. Every time i moved, it dug into sensitive nerves. When it came out, i was so relieved. BUT... the pads and diaper tether me to the bathroom so i understand not wanting to have that on the job. I easily go thru 10 to 20 pads a day. Just depends on how wet i want to be.

My BIG question to both of you is, why are you incontinent? My surgeon assured me that only about 3% of men experience incontinence after a prostatectomy which (the more i research) seems like a complete lie. Was the involuntary sphincter removed from you when your prostate was removed?

Hi Sandiego
First off, I think you doctor was giving misinformation on prostrate removal it is more likely only 3% don't have incontinence after surgery. I was informed majority of Men will be incontinent to various degree and can take up to 12 months to come good depending on the individual. Mind you I was told if you have a high PSA you are likely to have cancer, and a low reading was good, but my reading was .8 every time I was tested but this time other test showed I had cancer. As for the external catheter it is not inserted in your penis but goes over it like a condom but with a tube connected at the end which then connects to the bag. It is held in place with a Velcro strip around the penis (the ones I buy supply a self-adhesive strip which I found come of when you start to sweat). I don't even know I am wearing it most of the time but after work I just use a pad as I don't leak much then. During my 8 weeks off from work I would walk every day from 2-5 ks a day and on occasion even further so I wasn't couch bound all that time. I am 69 but still do alot of physical work which I can still run rings around the younger guys I work with.

Darbas, I asked Google about the percentage and the official line seems to be that only 6 to 8% experience incontinence...which seems contrary to what you and i think or believe. My question for anyone who is incontinent like me is this, "Was the involuntary sphincter removed?" I meet with my surgeon next week and I'll be putting that question to him about me because i have no idea if it was. I'm wondering if its removal guarantees incontinence. Have the patients who have not experienced incontinence not had their involuntary sphincter removed? Googling the removal of the involuntary sphincter comes up with 2 answers. One, it is always removed. Two, it is only sometimes removed. The condom catheter is new info for me. I'll have to look into that. Thanks.

 

[MichaelDahlke]

Hi Sandiego,

The internal sphincter is part of the bladder neck that merges into the prostate. With a complete removal of the prostate, this muscle is almost always affected. However, the internal sphincter has only an indirect influence on continence. Its main task is to prevent ejaculate from entering the bladder during ejaculation.

Therefore, a retrograde ejaculation is a common side effect of radical prostate removal. However, the problem of incontinence has another cause. The prostate functions as a constriction and acts as a pressure reducer. The larger it becomes, the less the actual sphincter has to work against the pressure. As a result, it loses strength, similar to any other muscle that is not trained.

When the prostate is removed, the sphincter is suddenly exposed to full bladder pressure. He can no longer hold this pressure because he lacks the strength to do so. This strength must first be rebuilt, which can take some time, depending on the endurance and effectiveness of the training.

If a radical prostate operation is imminent, it is advisable to start training in advance. This can shorten the duration of incontinence after surgery.

Caution is advised when interpreting the numbers mentioned. After a radical prostate operation, almost everyone is initially incontinent. However, targeted training significantly improves incontinence. After one year, only 3-10% of those affected have a continence problem. If the problem persists, for example, an artificial sphincter can help.

cu
Michael

 

[darbas]

Matt, I use both diaper and pads. I have zero control when standing or sitting. I find no difference with just a diaper.

Darbas, "8 weeks"?! My doc wanted me up and about the day after surgery. But i am not a tradesman who uses their body to lift and such. "External catheter"!? Wow! You are much more tolerant of the discomfort of having a catheter in than i was. Just having it in for a week was brutal. Every time i moved, it dug into sensitive nerves. When it came out, i was so relieved. BUT... the pads and diaper tether me to the bathroom so i understand not wanting to have that on the job. I easily go thru 10 to 20 pads a day. Just depends on how wet i want to be.

My BIG question to both of you is, why are you incontinent? My surgeon assured me that only about 3% of men experience incontinence after a prostatectomy which (the more i research) seems like a complete lie. Was the involuntary sphincter removed from you when your prostate was removed?

Darbas, I asked Google about the percentage and the official line seems to be that only 6 to 8% experience incontinence...which seems contrary to what you and i think or believe. My question for anyone who is incontinent like me is this, "Was the involuntary sphincter removed?" I meet with my surgeon next week and I'll be putting that question to him about me because i have no idea if it was. I'm wondering if its removal guarantees incontinence. Have the patients who have not experienced incontinence not had their involuntary sphincter removed? Googling the removal of the involuntary sphincter comes up with 2 answers. One, it is always removed. Two, it is only sometimes removed. The condom catheter is new info for me. I'll have to look into that. Thanks.

Sandiego
Maybe the percentage of incontinence was related to long term incontinence not immediately after surgery like the majority of us are. And no my sphincter wasn't touched just the bladder where the urethra was reattached.

 

[joe64]

Hi Sandiego,

The internal sphincter is part of the bladder neck that merges into the prostate. With a complete removal of the prostate, this muscle is almost always affected. However, the internal sphincter has only an indirect influence on continence. Its main task is to prevent ejaculate from entering the bladder during ejaculation.

Therefore, a retrograde ejaculation is a common side effect of radical prostate removal. However, the problem of incontinence has another cause. The prostate functions as a constriction and acts as a pressure reducer. The larger it becomes, the less the actual sphincter has to work against the pressure. As a result, it loses strength, similar to any other muscle that is not trained.

When the prostate is removed, the sphincter is suddenly exposed to full bladder pressure. He can no longer hold this pressure because he lacks the strength to do so. This strength must first be rebuilt, which can take some time, depending on the endurance and effectiveness of the training.

If a radical prostate operation is imminent, it is advisable to start training in advance. This can shorten the duration of incontinence after surgery.

Caution is advised when interpreting the numbers mentioned. After a radical prostate operation, almost everyone is initially incontinent. However, targeted training significantly improves incontinence. After one year, only 3-10% of those affected have a continence problem. If the problem persists, for example, an artificial sphincter can help.

cu
Michael

Outstanding explanation. Thank you. What you have said makes it clear why when I get aroused, I sometimes get a little spurt of pee.

 

[slimjimbest]

Matt, I use both diaper and pads. I have zero control when standing or sitting. I find no difference with just a diaper.

Darbas, "8 weeks"?! My doc wanted me up and about the day after surgery. But i am not a tradesman who uses their body to lift and such. "External catheter"!? Wow! You are much more tolerant of the discomfort of having a catheter in than i was. Just having it in for a week was brutal. Every time i moved, it dug into sensitive nerves. When it came out, i was so relieved. BUT... the pads and diaper tether me to the bathroom so i understand not wanting to have that on the job. I easily go thru 10 to 20 pads a day. Just depends on how wet i want to be.

My BIG question to both of you is, why are you incontinent? My surgeon assured me that only about 3% of men experience incontinence after a prostatectomy which (the more i research) seems like a complete lie. Was the involuntary sphincter removed from you when your prostate was removed?

I had the same question, sandiego. Why? How often? How do I compare?

Seems like many reasons for the "why?" Anastomotic Leaks are one reason. They have to stretch the urethra across the gap where they took out the prostate and sew the ends back together. I'm unclear about the two sphincters. Can you explain exactly where each one is?

Numbers. From what I could tell, it's more frequent than was quoted to me. I haven't dug around on this for while but here's one meta-review ("The 12-mo urinary incontinence rates ranged from 4% to 31%, with a mean value of 16% using a no pad definition"). Lots of studies are really crude ("are you still using a pad?" not homw many? how big?). The best ones do what I did, weigh the pad every day to get the number of grams of urine captured in the pad.

 

[sandiego]

I had the same question, sandiego. Why? How often? How do I compare?

Seems like many reasons for the "why?" Anastomotic Leaks are one reason. They have to stretch the urethra across the gap where they took out the prostate and sew the ends back together. I'm unclear about the two sphincters. Can you explain exactly where each one is?

Numbers. From what I could tell, it's more frequent than was quoted to me. I haven't dug around on this for while but here's one meta-review ("The 12-mo urinary incontinence rates ranged from 4% to 31%, with a mean value of 16% using a no pad definition"). Lots of studies are really crude ("are you still using a pad?" not homw many? how big?). The best ones do what I did, weigh the pad every day to get the number of grams of urine captured in the pad.

Slimjimbest, I met with my urologist/surgeon yesterday. He explained that the upper sphincter ("involuntary sphincter", it is between the bladder and the prostate) is always removed in a prostatectomy. So, where i had two sphincters (and a prostate) to prevent streaming and leaking, i now have only the lower sphincter ("voluntary sphincter", it is below the prostate.) that must be trained to clench all the time to prevent urine from leaving the body involuntarily. I have my doubts about that ever occurring since the surgery left me with no feeling of urine passing through my urethra. How am i supposed to stop something i can't sense? (My surgeon hosed me permanently.) (His educated and experienced response to my stating that i have no feeling was, "That's not normal." Ha! Thanks for enlightening me. That is soooo helpful.)

 

[slimjimbest]

Slimjimbest, I met with my urologist/surgeon yesterday. He explained that the upper sphincter ("involuntary sphincter", it is between the bladder and the prostate) is always removed in a prostatectomy. So, where i had two sphincters (and a prostate) to prevent streaming and leaking, i now have only the lower sphincter ("voluntary sphincter", it is below the prostate.) that must be trained to clench all the time to prevent urine from leaving the body involuntarily. I have my doubts about that ever occurring since the surgery left me with no feeling of urine passing through my urethra. How am i supposed to stop something i can't sense? (My surgeon hosed me permanently.) (His educated and experienced response to my stating that i have no feeling was, "That's not normal." Ha! Thanks for enlightening me. That is soooo helpful.)

Wow! Lots of empathy from your doctor! Thanks for the info. I think mine said the same, that the sphincter at the bladder is gone. I wonder if it's just your affective nerve (sensory) that's impacted but the effective nerve (controls the voluntary sphincter) is untouched? That would mean that you could possibly learn to control it, although it would be hard to learn because you wouldn't be getting the feedback that says, "I did it." On the the other hand, stopping your stream is a definitive sign that you have engaged the Kegel muscles and gotten the result you want. That's how I was taught about doing Kegels correctly. Do you know what the relationship is between a Kegel contraction and engaging your voluntary sphincter? I wonder if they are the same thing or just related.

 

[slimjimbest]

Outstanding explanation. Thank you. What you have said makes it clear why when I get aroused, I sometimes get a little spurt of pee.

Always a little squirt! Cracks me up. I even get them when I hug my wife!

 

[slimjimbest]

Hi Sandiego,

The internal sphincter is part of the bladder neck that merges into the prostate. With a complete removal of the prostate, this muscle is almost always affected. However, the internal sphincter has only an indirect influence on continence. Its main task is to prevent ejaculate from entering the bladder during ejaculation.

Therefore, a retrograde ejaculation is a common side effect of radical prostate removal. However, the problem of incontinence has another cause. The prostate functions as a constriction and acts as a pressure reducer. The larger it becomes, the less the actual sphincter has to work against the pressure. As a result, it loses strength, similar to any other muscle that is not trained.

When the prostate is removed, the sphincter is suddenly exposed to full bladder pressure. He can no longer hold this pressure because he lacks the strength to do so. This strength must first be rebuilt, which can take some time, depending on the endurance and effectiveness of the training.

If a radical prostate operation is imminent, it is advisable to start training in advance. This can shorten the duration of incontinence after surgery.

Caution is advised when interpreting the numbers mentioned. After a radical prostate operation, almost everyone is initially incontinent. However, targeted training significantly improves incontinence. After one year, only 3-10% of those affected have a continence problem. If the problem persists, for example, an artificial sphincter can help.

cu
Michael

Really helpful, Michael, thanks! How do you know this stuff?

BTW, going off what you said, I found this to be helpful to me:

Urethral sphincters - Wikipedia

en.wikipedia.org

 

[sandiego]

Wow! Lots of empathy from your doctor! Thanks for the info. I think mine said the same, that the sphincter at the bladder is gone. I wonder if it's just your affective nerve (sensory) that's impacted but the effective nerve (controls the voluntary sphincter) is untouched? That would mean that you could possibly learn to control it, although it would be hard to learn because you wouldn't be getting the feedback that says, "I did it." On the the other hand, stopping your stream is a definitive sign that you have engaged the Kegel muscles and gotten the result you want. That's how I was taught about doing Kegels correctly. Do you know what the relationship is between a Kegel contraction and engaging your voluntary sphincter? I wonder if they are the same thing or just related.

Kegel contraction is exercising the voluntary sphincter. They are the same.

 

[MichaelDahlke]

Hello Santjego,

I would like to try to answer. The doctor is right when he says that the lack of perception of the urine flow after this operation is not normal, even if he may not have provided the explanation.

As with any operation, success depends on the experience and skill of the surgeon who performs it. This also applies to operations in which robot-assisted assistance systems such as DaVinci are used.

During such operations, there is a possibility that nerves will be damaged. Of course they will try to avoid this, but it can happen. There are both motor and sensory nerve pathways, and it is possible that they have damaged a sensory nerve. Fortunately, nerves in this area can recover depending on the severity of the damage, so don't give up hope yet.

The good news is that perception is only part of the problem. Unfortunately, it gets a bit more complicated here. In general, it is said that the outer sphincter can be controlled arbitrarily, but the inner one cannot. This is 100% true for the internal sphincter, but only partially for the external sphincter.

If you look at the image in Wikipedia that Slimjimmy linked to, you realize that there are two muscle groups in the external sphincter: one cross-striped and one longitudinally striped. The transversely striped muscles can be controlled voluntarily, but the longitudinally striped ones cannot.

Therefore, you can also train only the striated muscles directly, although both muscle groups are responsible for the continence.

The main difference between the two groups lies in the way they exert strength. The longitudinally striped muscles are actually permanently tense and ensure the "tightness". It can exert permanent strength for a long time and does not tire - but cannot be controlled voluntarily. The cross-striped muscles are controllable and can apply significantly higher force in the short term, but tires much faster.

In fact, the longitudinally striped muscles are indirectly trained during pelvic floor training, but as I said, it takes a while until something happens. The good news is that you are not dependent on perception, because the actual continence is produced by the inadribly influenced muscles.

People who suffer from urge incontinence probably know this quite well. Because if the bladder contracts during the urge, the longitudinally striped part of the sphincter automatically opens. The cross-striped muscle is then the last bastion against the wet pants, only that it often loses against' the bladder muscle, because it can press longer and often does not tire so quickly.

Long story short: I think the matter is certainly disappointing, but not hopeless. I would continue to train there first and see what happens.

After the operation, trying to pull everything together with all your might when it's running is counterproductive anyway, because it tightens the pelvic floor rather than training it and influences the healing rather negatively. That's like sports - you don't put on 100 kg right away if you've never stamped.


Best regards
Michael