Incontinence - Pelvic Floor (Kegel) Exercise
After prostatectomy a significant number of men experience degrees of incontinence, ranging from complete lack of bladder control to a few drips. This is because the external sphincter has suffered considerable trauma or even damage during surgery. The lucky ones regain control immediately after the removal of the catheter, but many are advised to ‘retrain’ their sphincter by doing pelvic floor (Kegel) exercise.
In my opinion - following my personal and other men's experiences - I think that what is a matter of common sense and intuition, the impression men are given is that pelvic floor exercise is difficult and they have to be trained to do it. Sometimes they spend considerable sums of money visiting physios, some of whom insert probes or even a gloved finger into the anus/rectum to teach you find your pelvic-floor muscles and show you how to exercise them..
I am afraid I am an outrider on this: you don’t need to be trained to do pelvic floor exercise.
On the removal of my catheter (nearly six weeks after my surgery!) I was totally incontinent. A couple of nights after returning home I was so exhausted with changing pads that when I woke up I went to our bathroom and sat on the toilet with the urine flowing freely. Quite intuitively I tried to stop the flow by what I realised was that I was squeezing my pelvic floor muscles. I noticed a tiny but perceptible reduction in the flow of urine. It was a eureka moment for me! From then onwards I would sit on the toilet and do the following, regularly in the morning, afternoon and the evening:
- Sit on the toilet and let the urine flow or drip.
- Try and stop the flow – this is completely intuitive – you may have done this in your life before your surgery successfully
- Initially you may and may not experience any change
- Squeeze your pelvic floor muscle – this is intuitive - for the count of ten and let go
- Rest for the count of ten
- Repeat and squeeze to the count of ten and let go
- Repeat the process ten times, three times a day
- Patience is really a virtue; you may or may not experience any change for days but don’t lose heart
- Don’t, I repeat, don’t overdo it
Within a week I was beginning to see some difference and after about three weeks the flow turned into continuous drips and a couple of months later, waking one morning I was completely dry but continued to leak during the day, particularly when sitting up from a sitting or squatting position. For me the bad news, after 14 years since surgery, is that I still suffer from arousal climacturia - leaking when sexually excited and/or when I orgasm.
Of course I understand why some may feel they need help and training and encouragement: everyone is different.
Unfortunately quite a significant number of men - particularly the older ones - have to learn to live with some level of incontinence. I have. This can have a devastating effect on your sex life. However with imagination, good communication with your wife/partner and desire to pleasure each other, it is possible to adapt to the new normal and have a good sex life, sometimes - as we have discovered - with unexpected benefits!
Those experiencing permanent incontinence may like to follow the following link:
https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life