New. Post prostatectomy PFM therapy, ... - Advanced Prostate...

Advanced Prostate Cancer

20,782 members25,885 posts

New. Post prostatectomy PFM therapy, sling,

Iupiter profile image
26 Replies

Hello! I’m new to this community. I had a RALP (Robot Assisted Laparoscopic Prostatectomy) 11 months ago. I had a Gleason 8 prostate cancer. That problem was solved, my PSA has been zero since then. However, I was left with significant urinary incontinence. I have been doing Kegels ever since the surgery as recommended by my surgeon, but still leak a lot. As I was not improving, four months after surgery I started therapy with a PFM (Pelvic Floor Muscles) therapist. She has told me that my problem is that my PFM are not sufficiently relaxed. We have been working on that for many months, they have relaxed some, but still are too tense. She is not a fan of biofeedback, but is not an enemy of it. We have tried with biofeedback a few times. Bottom line, I have made little progress during all this time. More recently I have seen a voiding specialist. He did a urodynamic test and a cystoscopy, told me I have stress incontinence and talked to me about a sling. So, I have two questions: 1. What experience has anyone had with PFM therapy? Recommendations? Results? 2. What experience has anyone had with a sling? Recommendations? Risks? Successes? Failures?

Thank you.

Written by
Iupiter profile image
Iupiter
To view profiles and participate in discussions please or .
Read more about...
26 Replies
Fightinghard profile image
Fightinghard

Welcome.

Great results with the zero PSA. Enjoy that major success and keep it rolling.

Not able to help with answering your question about a sling, etc. kagels worked for me.

Good luck

j-o-h-n profile image
j-o-h-n in reply to Fightinghard

Correction: It's not Kagels it's Bagels....... (you're fighting too hard)

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/14/2020 8:05 PM EST

Fightinghard profile image
Fightinghard in reply to j-o-h-n

Hi John

Had to back off the bagels so I could keep my trim figure. Plus Kagels can be good exercise.

j-o-h-n profile image
j-o-h-n in reply to Fightinghard

Next time try your Kegels with your Begals..........Dogs are good company...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/15/2020 8:21 PM EST

tango65 profile image
tango65

This link has information about the sling for urinary stress incontinence after prostatectomy.

ncbi.nlm.nih.gov/pmc/articl...

researchgate.net/figure/Whi...

The success depends on how much the the membranous urethra is elevated in to the abdominal cavity by the sling and for how long the sling maintains the new position of the urethra. The rate of "cure" is between 45% and 70%.

Iupiter profile image
Iupiter in reply to tango65

Thanks tango65. You gave me a lot of reading!

tango65 profile image
tango65 in reply to Iupiter

Best of luck!!

jimreilly profile image
jimreilly

Glad to hear about the 0 PSA. I had an RP some years ago now and a year and a half later had the sling surgery after significant incontinence...filling three diapers every day was a real drag. The surgery itself was a breeze and I had very good results; I'm not perfect and for a long time wore a pad, but now don't even do that most of the time. I know that not everyone has results as good as mine, but I am pleased, would do it again. The only negative is that it was a further interruption in the progress I had made toward better sexual functioning, but that was temporary, maybe six months to get back to where I was. Since constantly pissing makes sex kind of a mess and a bother anyway, it was a good trade to make.

Iupiter profile image
Iupiter in reply to jimreilly

Thank you. I hope I might end up as well as you.

jimreilly profile image
jimreilly in reply to Iupiter

you're welcome; my only advice to improving your chances is to pick a surgeon with a lot of experience doing the procedure

Bethpage profile image
Bethpage

Pelvic floor therapy was a godsend for my husband, particularly the biofeedback. He was on a catheter 4 full months before RALP, so his bladder had lost its memory. PFT worked for him within two weeks.

Iupiter profile image
Iupiter in reply to Bethpage

You cant imagine how I envy him! Thank you.

MNFarmBoy profile image
MNFarmBoy

PFM Therapy: For me, urinary incontinence improved significantly during the course of physical therapy that included pelvic floor muscle (PFM) therapy with bio-feedback from an electrode in the rectum. Regarding PFM relaxation, going through the relaxation routine prescribed by the therapist, "Physiological Quieting" by Janet A. Hulme was the most effective part for me: Before beginning the routine, I usually thought my body was fully relaxed, but in the course of that routine, I often found that my jaw muscles weren't fully relaxed. Later, during bio-feedback with the therapist, the monitor indicated PFM relaxation coinciding with jaw muscle relaxation. ("Physiological Quieting" is available for streaming from Amazon Music, at no charge for Prime customers. After the end of the therapy series I continued to use it to help me fall asleep.)

Of course, I have no way of knowing whether the improvement would have occurred without PFM therapy. I was physically fairly fit at the start of the therapy, having worked my way back to running ~3 miles/day by that time, first with pad, then wicking undershorts, now just lined running shorts. (One month post-RALP, the physician's assistant told me it would be okay for me to run until I peed blood, then back off, but to continue to adhere to the restrictions on lifting. However, I never did push running to the point of peeing blood.)

However, for me, incontinence was fortunately mild: At the beginning of therapy, ~2 months after RALP, I was no longer using a pad at night, but typically had a number of "short squirt" releases during the day, most often when making sudden unplanned changes in motion such as side-stepping. If I replaced a pad during the day, it was due to concerns about odor, rather than saturation. By the end of therapy, I was no longer using a pad, but did sometimes have a very short squirt release, typically when tired, true to a lesser extent to this day. And, all along to this day, I cannot force passing of gas without releasing a short squirt, and I cannot stop urine flow after it begins. "Jockey boxer" weakly elastic undershorts made from wicking fabric (e.g. "Champion SmartTemp") have been sufficient to absorb the now-rare short squirts. And, I carry a disposable wide-top drink bottle in my vehicle and backpack in situations where there might be need to "go" with no bathroom available. Also, I get up to go to the bathroom nearly every night, but that was also true before RALP.

So, all in all, I've been fortunate, with only slight incontinence, PSA still below the limit of detection (<0.014 ng/mL) 23 months post-RALP, although still significant ED issues. (Urologist says not to give up hope, he as seen improvements in ED up to three years post-RALP.)

Best wishes for progress and a good outcome for you!

Iupiter profile image
Iupiter in reply to MNFarmBoy

Thank you MNfarmboy! I will look for that Physiological Quieting video. Sounds like it may help. BTW, I am also a runner (19 marathons). However have not been able to run since the RALP. Running with a diaper just doesn't work. I really miss it. Good luck with your ED.

MobilityTech profile image
MobilityTech

I had a prostectomy, and had incontinence. It came and went even when I did the exercises like they said. The exercises helped me, but was when I didn't do them enough, I had issues. What worked for me, was just keeping my mind aware of it. The exercises were like a daily constant thing, not doing them and quitting. I mean treat them like they're not exercises, they're how it works now. Train the mind to keep the muscles holding. After a while my mind was trained to just keep things held, and I didn't have to think about it consiously anymore. After learning that, it was automatic again. Kind of like accepting a new feeling in your body, only you gotta train it to happen.

Its been years now for me, and the only time I have an issue is when I lift something heavy from an awkward position, tensing my abs real hard that overpowers it. I get a spurt of urine until I catch it an flex my urinary muscles harder.

Now when I stand next to a guy in the restroom at the urinals, and he's been there when I came in, I'm there for seconds, and gone, I say a prayer quietly for that guy cause I remember what he's going through. Then I praise God because I can out pee a 20 year old!

Hope this helps

Tom

j-o-h-n profile image
j-o-h-n in reply to MobilityTech

20 years old is nuttin....... I pee like a two month old..........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/14/2020 8:10 PM EST

Iupiter profile image
Iupiter in reply to MobilityTech

Thank you. I will keep your recommendation in mind and try it. I have wondered if the thing is to hold the Kegel like constant. Seems to have worked for you. All the best!

Engraver68 profile image
Engraver68

Hi

I also suffered from Stress Incontinence post radical prostatectomy followed by radiotherapy.

I was and am still very active and cycling, running and general DIY and a lot of walkingf.

As a result my QOL was really compromised and so my Urologist recommended a Artificial Urinary Device be fitted.

This is the 'Gold Standard' solution and I can say safely after 8 years it has been a life changing solution for me.

Iupiter profile image
Iupiter in reply to Engraver68

Thank you. I've read about that solution. I still hope I don't have to go there. Time will tell.

NevsMates profile image
NevsMates

G'day lupiter

We are all different as you know.

As Engraver 68 said , the Artificial Urinary Device is gold standard. Again, they don't work that well for everyone.

I have had a sling since October 2010 and it is still working today. And I sure did need it.

If you do go ahead, it is extremly important to follow the medical advice after the procedure.

Best wishes.

Iupiter profile image
Iupiter in reply to NevsMates

Thank you. Specifically what was the advice that your surgeon gave you?

NevsMates profile image
NevsMates in reply to Iupiter

No lifting for 3 weeks. Take it very very quietly during that time. This is very important to let the healing do it's job to keep the sling in the correct position.

Iupiter profile image
Iupiter in reply to NevsMates

Will keep this in mind. Thanks!

Fairway profile image
Fairway

Hi,Had exactly the same problem. Nothing worked. Eventually went for the artificial urinary sphincter which works. It requires surgery and the recovery is not pain-free, but tolerable. If you decide on this route, let me know. I have further advice.

Fairway

Iupiter profile image
Iupiter in reply to Fairway

Thank you! If and when I need it, I will get back to you.

Fairway profile image
Fairway

Okay. Best of luck.

You may also like...

Hormone therapy for post prostatectomy cancer recurrence.

I have been reading that hormone therapy, including Lupron, can cause cognitive decline. Has anyone

0.53 post prostatectomy

time last year, my brother had radiation, post prostatectomy. His numbers have been going up with...

Salvage Surgery - Post Prostatectomy, Radiation and ADT

PSA 35. Gleason 4 + 3. Have had \\"The Big Three\\" - Jan 2015 total prostatectomy. Thirty-one...

After Radical Prostatectomy PSA and Radition with/without Hormone Therapy

with a 14 PSA Score. 2 Months ago he had a robotic radical prostatectomy surgery. Patalogy report...

post prostatectomy psa

hello. I Had surgery June 13 2023 biopsy showed Gleason 8. Psa 13 perineal invasion seminal vesicle