Climacturia

[gwhaia]

Anybody else experiencing climacturia? I am. Puts a cramp in the lovemaking. Any ideas on how to deal with it/stop it altogether? 

[DanR3254]

Kegels, lot's and lot's of kegels. mayoclinic.org/healthy-life... // But as an aside, during normal climax some urine was mixed with the ejaculate, now there is only the urine so it may seem [and probably] is more urine. I've had some luck using the kegels.

[gwhaia]

Surgery and follow-up radiation for 8 weeks happened 3 years ago. Started having sex again maybe 4 months after surgery. Started immediately and has not gotten worse or better. 

[ng27868168]

What is Climacturia? 

[gwhaia]

The possibility of this happening was never addressed in any of my pre-surgery conversations with the surgeon or my urologist. Impotence and incontinence were discussed with the cautious assurance that both may not be a problem at all or could be successfully treated should either become reality. 

Incontinence on a daily basis is not a problem except for the occasional heavy-lifting/coughing fit leak. I can only get an erection with the use of Tri-mix injections. But the rather copious amounts of urine passed during climax is a problem for me. Even with emptying my bladder right before sex enough urine remains or enough builds up during 15 or 20 minutes of foreplay to make a mess. We're down to one pre-planned session a week so we can prepare and then throw everything in the wash afterwards. Not spontaneous and that kind of process and planning tends to take the "fun" out of it. Recently we've gone for weeks without any sex. Not enjoyable. 

[ng27868168]

Thanks Bob,  interesting that in my 23 years of dealing with and being active in our support group, no one has ever brought that issue up, including any of the Docs and other medical people we had speak. 

[gwhaia]

Perhaps it's not the kind of thing that one wants to admit to. Or, did my surgeon do something so wrong that actually caused this condition? I could be that one in a million lucky guy who's doctor sneezed during the surgery. I'm trying to be a little funny here but if you have truly never heard of this in your 23 years then something is not right. Of all the men who have had prostate cancer surgery I can't be the only guy out there who has this problem. 

[pjoshea13]

"Climacturia is a common clinical entity, occurring in almost half of all patients after radical prostatectomy." [1]

I'm tempted to add that those who haven't experienced it have given up on sex. LOL

"Orgasm associated incontinence occurs in a fifth of men (96 of 475) following radical pelvic surgery. The incidence of orgasm associated incontinence is ... unrelated to the type of prostatectomy performed (open vs laparoscopic)." [2]

"The climacturia incidence came to 20%."  [3]

"Overall 412 surveys were returned and available for analysis, and of these respondents 75.2% were sexually active or experiencing orgasms. Climacturia was reported by 22.6% of these respondents, and by 28.3%, 5.2% and 28.6% of those treated with surgery, radiation, or both, respectively"  [4]

RP eliminates the sphincters (valves) that prevent/allow urine to leave the bladder.  These are normally closed during sex (the ejaculate enters the urethra downstream.)

After RP, the remaining sphincter at the base of the penis has the job of preventing inappropriate urination.  Climacturia is controlled the same way we prevent seepage when suddenly standing, sneezing or laughing.  Difficult to do when the mind is distracted.

-Patrick

[1]  ncbi.nlm.nih.gov/pubmed/170...

J Urol. 2006 Dec;176(6 Pt 1):2562-5; discussion 2565.

Climacturia following radical prostatectomy: prevalence and risk factors.

Lee J1, Hersey K, Lee CT, Fleshner N.

Author information

Abstract

PURPOSE:

Following radical prostatectomy urine leakage during orgasm is a poorly defined entity. We defined the prevalence, quantity, bother and coping mechanisms associated with this complication, called climacturia.

MATERIALS AND METHODS:

A self-administered questionnaire was given to a cohort of sexually active men after radical prostatectomy. We inquired about the frequency, quantity, bother and coping mechanisms associated with climacturia. We also recorded uroflowmetry and an American Urological Association symptom score (International Prostate Symptom Score) in each patient.

RESULTS:

Of the 42 patients enrolled with a mean age of 58.9 years and average time since radical prostatectomy of 23.6 months climacturia was reported in 19 (45%). Of the men 68% reported that it happened rarely or only occasionally, while 21% reported that it occurred most of the time or always. In terms of urine quantity 58% of respondents reported only a few drops but 16% reported a loss of more than 1 ounce. Of the patients 52% percent reported no or minimal bother but 48% reported that climacturia caused significant bother. Only 21% of respondents thought that it was of significant bother to their partners. Of the respondents 84% emptied the bladder before intercourse and 11% used condoms. Age, Gleason score and time since surgery were not predictors of climacturia. No association between peak urine flow on uroflowmetry or International Prostate Symptom Score and climacturia was found.

CONCLUSIONS:

Climacturia is a common clinical entity, occurring in almost half of all patients after radical prostatectomy. It can be a significant problem with respect to urine volume loss, associated bother and condom use. Patients must be informed about this complication before undergoing radical prostatectomy.

PMID: 17085160 [PubMed - indexed for MEDLINE]

[2]  ncbi.nlm.nih.gov/pubmed/175...

J Urol. 2007 Jun;177(6):2223-6.

Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors.

Choi JM1, Nelson CJ, Stasi J, Mulhall JP.

Author information

Abstract

PURPOSE:

Orgasm associated incontinence, that is the inadvertent leakage of urine at orgasm, has received little attention in the literature. We evaluated the rate of occurrence of orgasm associated incontinence following radical pelvic surgery as well as its associated factors and predictors.

MATERIALS AND METHODS:

From January 2005 to March 2006, 696 patients were evaluated for post-radical pelvic surgery sexual dysfunction. A database was created, and descriptive statistics, chi-square analysis and logistic regression analysis were used to evaluate associated factors and predictors.

RESULTS:

Of 475 patients 96 (20%) reported orgasm associated incontinence following radical pelvic surgery. The incidence was significantly less in the cystoprostatectomy group than in the open and laparoscopic radical prostatectomy groups (p <0.05). Orgasm associated incontinence was more commonly found within 12 months following surgery vs greater than 12 months (RR 0.81, 95% CI 0.72-0.92, p <0.01) and in patients with orgasm associated pain (RR 1.09, 95% CI 1.01-1.16, p <0.01) and penile length loss (RR 1.32, 95% CI 1.09-1.59, p <0.01). On multivariate analysis all factors associated on univariate analyses remained predictive. Orgasm associated incontinence was not associated with patient age, the degree of nerve sparing, surgical margin status, seminal vesicle or lymph node involvement, preoperative erectile function, nocturnal erections, libido level or daytime continence.

CONCLUSIONS:

Orgasm associated incontinence occurs in a fifth of men (96 of 475) following radical pelvic surgery. The incidence of orgasm associated incontinence is greater with radical prostatectomy than with radical cystectomy and it is unrelated to the type of prostatectomy performed (open vs laparoscopic). Orgasm associated incontinence is more likely to be reported within year 1 following surgery and in men who complain of orgasmic pain and/or penile shortening.

PMID: 17509325 [PubMed - indexed for MEDLINE]

[3]  ncbi.nlm.nih.gov/pubmed/176...

Actas Urol Esp. 2007 Apr;31(4):345-8.

[Climacturia, a symptom to take into account after radical prostatectomy].

[Article in Spanish]

Loizaga Iriarte A1, Paz Díaz-Romeral JL, Arciniega García JM, Arceo Santiago R, Pérez Fernandez A, Unda Urzaiz M.

Author information

Abstract

INTRODUCTION AND OBJECTIVES:

Patients after radical prostatectomy describe sexual dysfunctions such as orgasm-associated incontinence also termed climacturia. Our aim is to analyse incidence and data in relation with this symptom.

METHODS:

119 phone surveys carried out to patients after radical prostatectomy to Know about climacturia incidence. We are trying to show the relationship between this symptom and the degree and type of incontinence, affectation at bladder neck and apex, and the age.

RESULTS:

The climacturia incidence came to 20%. The average age of the patients with this symptom was 59 years, the same as for those without it. The patients with both, incontinence and climacturia perform stress incontinence basically but urgency-incontinence to a greater extent (20%) that those with no climacturia (5%). Most patients with climacturia suffer a light leakage (87%) and a 62% always associated to orgasm. Negative effect of the symptom in the patient's and partner's sexual life appeared only in 2 cases (13%).

CONCLUSIONS:

We suggest the same term in Spanish than in English. Age and affectation of the bladder neck and apex do not have an effect on climacturia. Stress incontinence is more often related to patients with climacturia and the degree of incontinence is higher than in those without it.

PMID: 17633919 [PubMed - indexed for MEDLINE]

[4]  ncbi.nlm.nih.gov/pubmed/240...

J Urol. 2014 Jan;191(1):159-63. doi: 10.1016/j.juro.2013.06.122. Epub 2013 Sep 16.

Climacturia after definitive treatment of prostate cancer.

O'Neil BB1, Presson A2, Gannon J1, Stephenson RA3, Lowrance W3, Dechet CB3, Tward JD4, Myers JB1, Brant WO1.

Author information

Abstract

PURPOSE:

Prostate cancer treatment results in several sexually related side effects beyond the well studied erectile dysfunction. Climacturia (leakage of urine during orgasm) has been reported after prostatectomy but studies have been limited by multiple factors. In this study we examine the prevalence, causes and impact on orgasm function of climacturia after definitive treatment of prostate cancer with surgery or radiation.

MATERIALS AND METHODS:

A total of 906 anonymous surveys were sent to patients with prostate cancer treated with surgery and/or radiation. Respondents were asked about the presence of urinary leakage, climacturia and various elements related to sexual and orgasmic function. We estimated the prevalence of climacturia, evaluated the differences between those with and without climacturia, and assessed the impact of climacturia on orgasmic function.

RESULTS:

Overall 412 surveys were returned and available for analysis, and of these respondents 75.2% were sexually active or experiencing orgasms. Climacturia was reported by 22.6% of these respondents, and by 28.3%, 5.2% and 28.6% of those treated with surgery, radiation, or both, respectively (p <0.001). The use of aides to obtain an erection (OR 2.24, 95% CI 1.08-4.93, p = 0.035) and the presence of urinary incontinence (OR 3.09, 95% CI 1.66-5.88, p <0.001) were also associated with climacturia in a multivariate logistic regression model. Climacturia had no significant impact on orgasmic function and satisfaction.

CONCLUSIONS:

Climacturia is experienced by a substantial proportion of men after undergoing definitive treatment of prostate cancer. We found a complex relationship between stress urinary incontinence and climacturia, and noted that the presence of climacturia does not necessarily negatively impact sexual satisfaction.

Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

orgasm; prostatectomy; prostatic neoplasms; radiotherapy; urination disorders

PMID: 24050893 [PubMed - indexed for MEDLINE]

[gwhaia in reply to pjoshea13]

O.K. so we agree there's a problem. And nobody's really talking about it. How do I fix it? Bladder sling? Electro therapy? Physical therapy? Or just Kegel my brains out? 

[pjoshea13 in reply to gwhaia]

The latter, I'd say.

[jeddirks]

Have had some problems with Climacturia.  I have managed it by emptying my bladder before sexual activity.  Kegels will also help with this.

[gwhaia in reply to jeddirks]

I have been Kegeling but not on an aggressive basis. I will try and increase to the recommended 3 sets of 10, 3 times a day. Thanks all. 

[Superrobotman]

This is the best description of a kegel exercise I have seen since my RP, and the only description that included both anal and penile contraction. Also the only one that suggested a slow controlled release. I'm a little disappointed that it took me 9 months post RP to encounter a good kegel description. I had been doing just penis clenching, like a 9 year old trying not to pee his pants. The had some effect but not nearly as good as I had hoped and to be honest I was starting to give up on kegels because of the unimpressive success rate I was experiencing. I will try again based on the description above. 

Has anyone been able to completely regain bladder control this way or is it always just marginal improvements? 

Also how does one find a physical therapist who does this kind of PT? I can't imagine my PT from my knee surgery recovery or tennis elbow recovery trying to help me control my penis muscles. It seems exceptionally specialized.

[kappy]

Sorry to be slow in commenting, as i am also blessed with organic brain syndrome and that kills my initiation to action.

Since April last year I have had to deal with 'blue balls' or 'lovers nuts' . When I saw my Urologist surgeon in August (who did my RP a few years ago); he had a nurse Practitioner (male) debrief me, i told him of this and he had never heard of it, so i was too embarrassed to bring it up when the doctor came in with his students. When I orgasm, I squirt urine, and as I take vitamins, urine is bright yellow.. that's how I noticed ; and its also painful. I usually use one large pad daily and rarely leak overnight but IF I have an active day IE. exercising , walking (9000 steps) and riding bicycle, when i sit and relax I just piss myself without warning. I don't feel the urge to go anymore, just a pain in the groin, which wakes me up at 4 or 5 am. During the day I have learned to time myself to go. Sex is embarrassing with ED and if I kiss wife or hug her I leak... if i even think of sex I leak.

from what I read tonight I now must find a physiotherapist and get back to kegels

thanks for help

[kappy]

had surgery 2012

[Heid123]

ITEM METADATA RECORD

Title: Pelvic floor muscle training for erectile dysfunction and climacturia 1 year after nerve sparing radical prostatectomy: a randomized controlled trial

Authors: Geraerts, Inge ×

Van Poppel, Hendrik

Devoogdt, Nele

De Groef, An

Fieuws, S

Van Kampen, Marijke #

Issue Date: Jan-2016

Publisher: Smith-Gordon

Series Title: International Journal of Impotence Research vol:28 issue:1 pages:9-13

Article number: 10.1038/ijir.2015.24

Abstract: This study aimed to determine whether patients with persistent erectile dysfunction (ED), minimum 12 months after radical prostatectomy (RP), experienced a better recovery of erectile function (EF) with pelvic floor muscle training (PFMT) compared with patients without this intervention. Second, we aimed to investigate the effect of PFMT on climacturia. All patients, who underwent RP, with persistent ED of minimum 1 year post operation were eligible. The treatment group started PFMT immediately at 12 months post operation and the control group started at 15 months after RP. All patients received PFMT during 3 months. The sample size needed to detect with 80% power a 6 points-difference regarding the EF-domain of the International Index of Erectile Function (IIEF), was at least 12 subjects per group. Patients were evaluated using the IIEF and questioned regarding climacturia. Differences between groups at 15 months were evaluated with Mann-Whitney U-test and Fisher's exact test. As a result, the treatment group had a significantly better EF than the control group at 15 months after surgery (P=0.025). Other subdomains of the IIEF remained constant for both groups. The effect of PFMT was maintained during follow-up. At 15 months, a significantly higher percentage of patients in the treatment group showed an improvement regarding climacturia (P=0.004).International Journal of Impotence Research advance online publication, 5 November 2015; doi:10.1038/ijir.2015.24.

URI:

dx.doi.org/10.1038/ijir.201...

ISSN: 0955-9930

Publication status: published

KU Leuven publication type: IT

Appears in Collections: Research Group for Neuromotor Rehabilitation

Department of Rehabilitation Sciences - miscellaneous