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Hi everyone, I am a pelvic floor physical therapist and I am compiling a list of the top 10 questions about urinary incontinence. I would love your feedback. It is for a project I am working on. If you have a question or know someone who does, I would love to hear it. I am happy to share my results with you. Thank you in advance for your time!

 

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Post prostatectomy how come some have less or more incontinence. Am disappointed in my continuing leaking when walking. Really thought it was only going to be stress incontinence...keagals and what else will help?

 

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Will minor stress incontinence stop on its own a year post prostate surgery without doing keigles?

 

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Great question. I do not believe that is the case, although for some it could be. There are too many variables. I know that is what most doctors say, but in my experience, there is much more involved. Not to say it is super difficult to address, but there were probably things pre-surgery that have affected your ability to fully recover.

 

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ppods651:

First thank you for all you do for us.

I am a 75 year old who had his prostate removed almost two and one-half months ago (almost 8 weeks). The prostate cancer, I am told by the Veteran's Administration, was caused by exposure to agent orange while I was in the Army in Vietnam.

I should also mention that I had my colon removed about 2 years ago because of a condition called Inflammatory Bowel Disease (IBD). My gastro doctor tells me my IBD may have been caused by a parasite I acquired in my bowels while I was in Pakistan (don't drink the water). The gastro surgeon crafted what is called a J-Pouch.

Consequently I could not have robotic surgery or radiation for my prostate cancer because of concern about damaging the J-Pouch. The prostate surgeon had to cut me open and remove the J-Pouch, which was a complicated operation. Both surgeons (gastro and prostate) work at Johns Hopkins and were in the operating room for my prostate removal.

Since my prostate surgery I have been going to a pelvic floor physical therapist for the past 6 weeks, once per week. She has been instructing me on the correct way to do pelvic exercises each day and when I visit with her she links me up to a biofeedback machine which I assume helps determine the strength of my pelvic muscle.

After about 8 weeks my urinary incontinence appears to be under control. I use, sometimes, one pad per day when I am not active, but use two pads per day when I jog or walk or play golf. I feel very good about my progress, and expect to return to an almost normal urinary life within the next few months. Yes, I am hopeful and will continue Kegel exercises and seeing my therapist for the foreseeable future.

My questions for pelvic floor physical therapists are:

Does the biofeedback determine improvement in urinary continence or incontinence, or does it simply show contractions and releases? How is progress determined for urinary incontinence?

If a person makes early progress for urinary incontinence is it logical to assume erectile dysfunction will also improve earlier than expected?

If the pelvic muscle is so important for urinary continence why isn't this stressed beforehand and recommended the patient go to a pelvic floor therapist before the prostate is removed?

I would be interested in seeing the results of your research.

Nick

 

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ppods651:

First thank you for all you do for us.

I am a 75 year old who had his prostate removed almost two and one-half months ago (almost 8 weeks). The prostate cancer, I am told by the Veteran's Administration, was caused by exposure to agent orange while I was in the Army in Vietnam.

I should also mention that I had my colon removed about 2 years ago because of a condition called Inflammatory Bowel Disease (IBD). My gastro doctor tells me my IBD may have been caused by a parasite I acquired in my bowels while I was in Pakistan (don't drink the water). The gastro surgeon crafted what is called a J-Pouch.

Consequently I could not have robotic surgery or radiation for my prostate cancer because of concern about damaging the J-Pouch. The prostate surgeon had to cut me open and remove the J-Pouch, which was a complicated operation. Both surgeons (gastro and prostate) work at Johns Hopkins and were in the operating room for my prostate removal.

Since my prostate surgery I have been going to a pelvic floor physical therapist for the past 6 weeks, once per week. She has been instructing me on the correct way to do pelvic exercises each day and when I visit with her she links me up to a biofeedback machine which I assume helps determine the strength of my pelvic muscle.

After about 8 weeks my urinary incontinence appears to be under control. I use, sometimes, one pad per day when I am not active, but use two pads per day when I jog or walk or play golf. I feel very good about my progress, and expect to return to an almost normal urinary life within the next few months. Yes, I am hopeful and will continue Kegel exercises and seeing my therapist for the foreseeable future.

My questions for pelvic floor physical therapists are:

Does the biofeedback determine improvement in urinary continence or incontinence, or does it simply show contractions and releases? How is progress determined for urinary incontinence?

If a person makes early progress for urinary incontinence is it logical to assume erectile dysfunction will also improve earlier than expected?

If the pelvic muscle is so important for urinary continence why isn't this stressed beforehand and recommended the patient go to a pelvic floor therapist before the prostate is removed?

I would be interested in seeing the results of your research.

Nick

 

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Hi Nick,
Thank you for your questions. First question: Biofeedback tells us how the pelvic floor muscles are working/responding to our requests during biofeedback. There is usually also an abdominal sensor to show if you are assisting with your abdominals, which is not what we want. Love your progress - keep up the excellent work! Second question: ED progress is necessarily aligned with bladder leakage progress. Strengthening the pelvic floor muscles (pfm) definitely can help with ED. That could definitely take longer though. Third question: Bingo!! I have been doing this for 21 years. My question exactly. From what I can gather over the years, most physicians/surgeons/practitioners were not taught about the pfm. However, there is plenty of information and research on the subject. I often wonder why these practitioners don't research more about the pelvic floor. The information is there. Whether they are urologists, proctologists, GIs, GYNs, etc., every one of them needs to go through the pelvic floor muscles to get to their specialty organs. There is no reason in my mind why they wouldn't learn it post-schooling to get better results. The information and research is out there. I have been trying to spread the word for the past 21 years. I'm just happy that you found a pfm PT who knows what they are doing. Everyone with bladder issues should see a pfm PT!! But, if someone doesn't have great luck with the first one, they should try to find another one who gets great results.

 

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Thanks for spreading the word about PTs who specialize in pelvic floor. They are invaluable in conjunction with prostate removal. Mine was removed Aug 2018. I had good results with pelvic floor PT. I had radiation of prostate bed and lymph nodes in Feb-Mar 2020. The radiation affects both urinary and bowel continence. My after effects showed up about 6 months after radiation was finished. The radiation effects are harder to overcome. Pelvic floor PT has not been as successful in overcoming radiation effects, which seem to be very persistent. I am left to wonder if additional procedures such as uretheral bulking or the sling procedure are worth doing and how effective these procedures may be.

 

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Post prostatectomy how come some have less or more incontinence. Am disappointed in my continuing leaking when walking. Really thought it was only going to be stress incontinence...keagals and what else will help?

I can stress this strongly enough. I recommend you seek out a pelvic floor physical therapist in your area. There is more than just kegels, such as fluid changes, pelvic alignment, assessing the pelvic floor muscles to see if they are in the proper position and the proper length, body mechanics, etc. It really if very effective in stopping your bladder symptoms.

 

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Thanks for spreading the word about PTs who specialize in pelvic floor. They are invaluable in conjunction with prostate removal. Mine was removed Aug 2018. I had good results with pelvic floor PT. I had radiation of prostate bed and lymph nodes in Feb-Mar 2020. The radiation affects both urinary and bowel continence. My after effects showed up about 6 months after radiation was finished. The radiation effects are harder to overcome. Pelvic floor PT has not been as successful in overcoming radiation effects, which seem to be very persistent. I am left to wonder if additional procedures such as uretheral bulking or the sling procedure are worth doing and how effective these procedures may be.

Did the pelvic floor PT check your pelvic floor muscles internally?

 

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Can Pelvic Floor Therapy help overcome urine retention in spinal cord injuries? I am an incomplete paraplegic who had some PFT before my spinal cord injury (caused by radiation). I had creeping paralysis over about five months before I became confined to a wheelchair. And it was another year before anyone even mentioned urine retention to me! I now cath twice a day, but would love to think this won't be necessary forever. I have been told that with proper therapy, I could walk with a cane or walker. But I haven't found the duration/intensity/modality of therapy I feel I need as of yet. (We can dream. And I do!) I am a 71 yr. old woman.