How to Do Your Kegels
Kegel exercises strengthen are extremely effective in restoring continence after a radical prostatectomy. You should do these exercises before your surgery and continue them after the probe has been removed. With regular exercise, you should see a difference after five or six weeks.
Sitting, standing, or lying down, knees slightly apart, imagine you are fighting the urge to urinate or defecate. Contract the muscles you would use in this situation.
- Contract the muscles for 5 to 10 seconds.
- Relax your muscles for twice the length of the contraction time.
- Repeat contractions 12 to 20 times.
- Do these exercises 3 times a day.
To know if you are contracting the correct muscles, look at your penis, it should tighten and contract inward. You should also feel your rectum muscles (the muscles you tighten to hold in gas or stool) tighten.
When your muscles are stronger and you can hold it in yourself, you can reduce the exercises to a series of 10, two or three times a week. Remember that each man is different. It may be useful to consult a physiotherapist who specializes in perineal therapy (read below) for a few sessions in order to properly isolate these muscles when you exercise.
Physiotherapy in pelvic floor rehabilitation is recommended by doctors and aims to strengthen the pelvic floor muscles in order to contribute to a better closure of the urethra. Your physiotherapist, an expert in perineal reeducation, can advise you on good hydration habits (water resources), constipation control, urinary desire control techniques and the integration of good perineal contractions at the appropriate times. Several men who opted for radical surgery reported the benefits of pelvic physiotherapy after 10 sessions with a physiotherapist.
Treatments for incontinence
Some medications with anticholinergic properties can reduce bladder irritation and decrease spasms which can alleviate the urgency and frequency of urination (severe incontinence) and some forms of incontinence.
Surgical treatments are mainly aimed at correcting urinary stress incontinence. If surgery is suggested, your doctor will perform tests, such as cystoscopy, to identify a blockage or narrowing of the urethra (stenosis). The choice of treatment is based on your background (general condition, age, diseases already known), your clinical situation (leakage characteristics), the surgeon’s experience, and your level of motivation.
There are various surgical options
Suburethral Strips – This type of surgery is primarily intended for patients with low (one daily protection) or moderate (two or three daily protections) urinary incontinence. The surgeon installs a strip to support the weakened muscles (muscles used to control urinary flow from the bladder) and prevent urine leakage.
Artificial urinary sphincter – In cases of severe urinary incontinence, the placement of an artificial urinary sphincter may be proposed. It is most often used for patients with severe urinary incontinence (more than 4 daily protections). A sleeve is placed around the urethra to compress it. This sleeve can be deflated when urinating by activating a mechanical valve that is installed in the scrotum. This surgery is the most effective, but is more complex and requires constant maintenance by the patient.
Eliminate blockage of the urethra – Scar tissue can sometimes accumulate in
the urethra, causing it to narrow, reducing urinary flow, and preventing the
bladder from emptying completely. This issue can be corrected by making
an incision in the scar tissue or by stretching the urethra.
Correction of bladder neck constriction – This problem can be easily corrected. It then requires an enlargement surgery through natural means.
Radiation therapy used to treat prostate cancer can irritate the bladder lining and urethra and cause inflammation.
Possible signs and symptoms:
- Urinary infection
- The need to urinate more often, at night especially
- Urgency to urinate
- Bladder spasms
- A burning sensation when urinating
- Difficulty urinating
- Presence of blood in the urine
The appearance of symptoms associated with radiation cystitis differs from man to man. Symptoms may begin within a few days after the first treatment. Usually, symptoms diminish once treatment is completed. On the other hand, some men continue to have symptoms for several months after treatment, while others will have no symptoms until several months after their last treatment. It is important to talk to your doctor about your symptoms.
Way of life
You can change your lifestyle to prevent or reduce symptoms associated with cystitis. Drink plenty of water (between 1.5 and 2 litres per day) and avoid soft drinks, drinks containing caffeine – such as tea, coffee and cola – and alcohol, as they can irritate the bladder.
This is a liquid treatment that covers and protects the bladder mucosa, reducing irritation. A small tube (catheter) is passed through your penis and fills your bladder with the medication. Then you go to the toilet and empty your bladder.
If radiation cystitis is severe, you may need surgery to control urinary bleeding.
More extensive treatment
This may include oral medications or other interventions (hyperbaric chamber, etc.). There are pain medications that can also relieve your symptoms.
Urinary control devices
There are many products available in pharmacies and home health stores that can help you manage the loss of urine, though they are not considered to be treatments or a cure.
Many types of diapers and pads are now available in pharmacies and general stores. Many of these have been adapted to comfortably fit male anatomy.
Texas condom catheters
Texas condom catheters resemble a condom, with an opening at one end so that it can be connected to a bag attached to the leg. When the bag is full of urine, it is emptied manually. You can talk to your urologist to see if this is an option.
Urethral compression devices (external clamps)
Both clamps apply light pressure on the urinary canal, located on the underside of the penis, and prevent leakage. Proper tightness of the clamp is important in order to avoid pressure sores on the skin underneath the device.
N.B.: These clamps should not be worn for excessive periods of time. Some urologists suggest using them for only an hour or two at a time. You can ask your urologist for advice.
You are not alone
Just like prostate cancer itself, you do not have to suffer the effects of incontinence alone. Although it may seem like a delicate issue that is hard to share with others, there are many people that can help and support you. There are many resources at your disposal that can help make it easier for you to manage this problem from amongst both health professionals and various other groups.
Many people in the medical community, including your urologist and doctor, can help treat incontinence caused by your prostate cancer treatment and provide you with options or a plan to manage this issue. Your pharmacist can also provide you with the appropriate medication or products to limit the unpleasant side effects of urinary leakage.
A physiotherapist can be an excellent resource in helping you retrain you bladder. The website Ordre professionnel de la physiothérapie du Québec can help you find a professional close to you.
Organizations and other groups
It is difficult to live through with a health problem when we are all alone, especially after undergoing treatment for prostate cancer. Fortunately, you can manage your incontinence by contacting specialized institutions or with other people who are going through the same thing as you.
Urinary continence clinics such as the Clinique de continence urinaire de l’Institut universitaire de gériatrie de Montréal, offer a therapeutic follow‑up focused on urinary control in persons over the age of 65 who have bladder problems. There are also associations that you can consult for more information to help you manage your incontinence, including:
- Centre de Stomie du Québec (French only)
- The Canadian Continence Foundation
- Canadian Urological Association
- Canadian Nurse Continence Advisors Association
In addition, you can visit blogs and discussion forums on sites like Sphère-santé and PasseportSanté.net, to share your difficulties anonymously with people suffering from similar problems. The methods that they found worked for them will no doubt work with you too!
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1 855 899-2872 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures and webinars, our section on available resources, the support that is offered to you, our events and ways to get involve to advance the cause.
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Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- American Society of Clinical Oncology (ASCO)
- Prostate Cancer UK
Last medical and editorial review: July 2019
Written by PROCURE. © All rights reserved – 2019
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