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incontinence post robotic

Posted 04 Aug 2017 at 20:48

3 weeks post robotic surgery- my catheter was removed on day 10. I have started to be a bit more active the past few days and noticed leaking is increasing a lot. Today I have felt like I don't need the toilet, its just leaking. 

Anyone any advice on how long this will last? Doing pelvic floor exercises 3 x daily but had to stop them for a couple of days as they were giving me bad pains but been informed this is normal. 

Posted 04 Aug 2017 at 22:23

In my experience (personally) and reading posts on here the answer to your question is 'slow' . . . i.e. the progress from where you start (degree of continence on day 1) to where to get to (total continence) is going to be a long time . . . 1 or 2 years. But I hope for you it will be quicker.

Posted 04 Aug 2017 at 22:33

re-reading my post I would like to qualify my somewhat negative reply . . . I define 'continence' as absolute unqualified control. In my case I have 'control' whilst I am conscious but if I have had a 'decent' drink and go to bed with a full bladder I sometimes have unconscious lack of control. That is getting better but slooooooowly.

Posted 05 Aug 2017 at 09:15

Continence is an issue which dominates my life and I have contributed a few posts on this forum on that subject (some quite detailed) and thinking through my (scant) post replies above here I considered what I could contribute that might help and so here goes .

To some extent what follows is stating the obvious but . . . continence depends on three factors:
1. The capacity of the bladder before it alerts the brain to think about a toilet.
2. The volume (how loud) is that alert alarm that rings in the brain.
3. The capacity of the muscle to hold back a certain weight/volume.

Before the operation it was:
1. 250ml+
2. Extremely loud (even in the deepest alcohol induced semi coma)
3. 500ml

One month after the operation it was:
1. 150ml
2. Quite dull
3. 200ml

Six months after the operation it is:
1. 200ml
2. Loud enough whilst awake and loud enough whilst asleep unless in a very deep sleep in which case the alarm is not loud enough to wake me and the muscle holding back the weight gives up.
3. 300ml

I have learned how to adjust my eating a drinking of an evening so that I go to bed on ‘empty’ and can get through the night (albeit waking a dozen times wondering if I need to go). I will not consider myself fully continent until the muscle can hold back the flow until the alarm gets loud enough to wake me from the deepest alcohol assisted sleep, at the current rate of progress, IF that is achievable, I suspect it will take years.



Edited by member 05 Aug 2017 at 09:17  | Reason: Not specified

Posted 07 Aug 2017 at 10:36

If it is any consolation, my experience is also similar. After the catheter came out my bladder was clearly holding a small amount successfully, but beyond that it leaked constantly without me feeling any warning. Very slowly over the following months the number of pads I needed per day reduced as the capacity grew any my awareness of fullness improved. (Night time was much better, it only took a couple of weeks before I stopped leaking, becoming aware of the need to get up and wee reasonably reliably).

As I have commented here before, for me the psychological breakthrough was when I stopped needing more than 2 pads a day and could confidently do anything I wanted just taking a spare in my back pocket. That took me about six months though, and now at over a year I only need one pad which sometimes hardly gets wet (unfortunately the need is difficult to predict). I am told that most men get control somewhat quicker.

The pattern was just as Nomad describes, which makes sense from the anatomy and physiology textbook explanations. The bladder is something like a balloon, which you can blow a certain amount of air into before the rubber starts stretching after which it exerts a back pressure from the rubber elasticity. The average bladder holds about 150 ml without stretch, after which there is extra pressure from its expansion which requires a stronger sphincter. The nerves actually do signal to the brain that the stretch is occurring but right from the point of potty training as an infant we have learnt to ignore the signal until a considerably greater volume is reached. I remember pub sessions when younger needing the toilet roughly as often as the rounds were bought, in other words implying a capacity of 500-600 ml.

In my case I had poor urinary flow before the operation due to prostate enlargement (assumed initially to be benign and helped with the drug tamsulosin). That means my bladder never emptied fully so I was using it all the time at levels of stretch which I had learned to completely ignore initially. That may have explained why I so readily leaked without warning. Since then my awareness of the need to go to the toilet at lowish volumes has improved while at the same time the stretch my sphincter will work against has become better - just as Nomad describes. I find that what I am doing is a factor, if I am mainly sedentary I easily notice my expanded bladder, whereas when I am doing something moderately active (even as trivial as walking round the shops) the awareness is reduced and possibly the movement also works the sphincter harder so it starts to leak sooner.

So hold on in there Pugs, the leakage is a real frustration at your stage but little by little it will improve!

Posted 07 Aug 2017 at 11:28

I had a similar experience with generally leaking after catheter removal but about a week afterwards something changed and I had complete continence again and have since. I was using 2/3 pads a day but now don't use any at all. I've even managed to learn not to leak when sneezing and coughing but I do get caught out occassionally when something makes me laugh unexpectedly!

Posted 12 Aug 2017 at 20:15
No one can definitively tell you how long it will last. It may be perfect by tomorrow, it might improve slowly, it might never change. My oh had his surgery in Dec 2014. He has had a very slow recovery, and has largely accepted that he is unlikely to be able to go 'padless' again. He has a physical job, and this doesn't help. Being tired doesn't help. Marstons pedigree doesn't help. However, his salvage radiotherapy did help!

Try not to focus on it. Just go with the flow (sorry!). It takes as long as it takes. No amount of worrying about it will change it.

(However, I asked exactly the same questions as you on a regular basis...)

Posted 14 Aug 2017 at 08:35

Following robotic surgery last December I was using 2-3 pads for the first month, then down to 1-2 pads for the next couple of months and finally one thin pad after 6 months. Now I am almost dry but just wear a thin pad for insurance.

I know that after my op I felt I had no control and it was a slow recovery to something like full continence. Pelvic exercise helped I am sure and I guess i will continue that for evermore.


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