Urinary incontinence

Oh dear - I am always saddened to read posts like this and wonder whether it is about men not understanding the implications of their treatment or specialists glossing over the things they think their patient won't want to hear.

You can reassure your OH that he is making good progress in comparison to many. The NHS - who make surgeons report their success rates these days - regard success after RP as using 1 pad or less per day by 12 months post-op. Some men are fortunate to be continent the minute their catheter is removed but these are by far the minority - you will find plenty of conversations on this forum about men regaining proper continence around the 3 - 6 month mark or later. Some never regain it but there is no need to freak him out with that nugget right now as the fact that he is dry at night suggests that he will eventually be dry during the day as well. Men who are left with permanent problems tend to have no control night or day.

Was it explained to him why he might leak? When they removed the prostate, they had to cut his urethra, remove a section along with the prostate and then stitch the cut ends of the urethra back together. This makes the urethra shorter (which may also make his penis shorter) by about the same length as his prostate was. Often, the valve that starts and stops urine flow is in the section that has been cut so it has to be replaced and stitched in near the new join which means that after the catheter is removed, the urethra can be a bit like a sieve - urine leaks through the holes until they heal and he learns to control the valve again. Controlling urine flow is not a reflex or automatic body action so the relearning after surgery is similar to the process that a toddler goes through during potty training - it has to be concentrated on for quite a long time before it stops being an effort for the brain to work out which bit of the body needs to be flexed or relaxed. It is also very tiring for the brain having to concentrate on this so you probably find that the leaking gets worse as the day goes on.

There is nothing he can do to solve the sieve issue, just time for the wounds to heal, but do you know that he is doing his pelvic floor exercises a) properly and b) often enough? Also, is he drinking cranberry juice to soothe the bladder and avoiding caffeine?

As far as impotence goes, has he had his first orgasm yet? That tends to cheer a bloke up, the realisation that orgasm can happen without an erection. Has he been referred to an ED clinic or andrology clinic by his surgeon or GP? And has he been prescribed Cialis (often a small dose of 2.5mg or 5mg to be taken every day) not to get an erection at this stage but to increase blood flow to the nerve bundles and help with repair. It is also important that he stimulates the penis regularly during the day - this increases oxygen to the penis to prevent atrophy (the technical term for permanent damage to the penis which makes it get smaller and makes full erections less likely in the future). At some point in the near future, he needs to ask either his ED nurse or GP to prescribe a vacuum pump but while he is still leaking a lot he may not be very motivated.

Hello Louise and welcome.
Very wise words from Lyn as usual. Men are a funny breed, they listen but they don't hear.

To some extent mine was the same. I had all the info but he wasn't interested and like your husband John's was discovered when he complained of a bad back.

We didn't go the surgery route so I can't comment but even though, for us, our treatment was simpler, the after affects take some getting used to.

Personally, I was under the impression that sildenadfil was used more for gaining an erection and Cialis for repair for those men who have had surgery as it helps to repair the damage caused.
I expect Lyn or somebody will tell you about that..

What is important now is that you look after you! It can be very wearing dealing with a husband who wants an instant result and is impatient. As you say there is a very fine line between wanting to help and making it look like you are pressuring him.

My husband was one of those for whom incontinence was a big no no. When it came to it though he accepted it as part of the ongoing process of healing.

If your other half is normally a very positive person then these results will have come as a big shock to him.
How would he feel about seeing his GP for help with mild depression since it's possible that his sleeping isn't just confined to being tired.

Love him, let you know you love him no matter what and point out that you are on this journey together but it would be easier for both of you if you talk things over. The more he bottles it up, the bigger his demons will become. He needs to talk his fears over with somebody to get perspective on it.

Hopefully, there will be many members on here at some stage to provide that support because they too have been there.

Best Wishes Sandra

Edited by member 18 Jan 2015 at 09:31  | Reason: Not specified

Hello Louise,

Like your husband, I originally saw my GP for something completely unrelated to PCa ( see my profile )

When my catheter was removed I ( like many others ) had no control whatsoever ....

Although it was explained to me that there would be a good chance that I would be incontinent to some degree for a while after surgery, the reality of this did not really register until after the event.

For the first few months I made very little progress and was using between 6 to 8 pads a day ( very expensive! )....

Slowly but surely things started to improve gradually after about 3 to 4 months post op.

I am an active person and found life very restricting having to worry about pads filling up when out and about so I did get despondent like your hubby.
Reading some stories on here reminds me of how lucky I was compared with some less fortunate people.

I am now 7 months post op and still need to use 2 pads daily on average, but am hopeful that I will improve more over the next 6 months or so....

I've found that using a 'Conveen Sheath ' connected to  a 'Conveen Active Thigh Bag' enables me to have good long walks with the dogs without me having to worry about pads etc........ I managed to get these items on prescription after talking  with my consultant at my last review.

I also purchased a vacuum pump to help with ED issues and help prevent penile atrophy.

Every person will have their own recovery times and so it's not always good to compare progress with others. 

It's very early days yet, but I'm sure hubby will improve over time with regular pelvic floor exercises and a little perseverance.

Best Wishes

Luther