A few incontinent moments while sleeping, that caught me off guard, but otherwise doing generally well!

[TJ326]

Hi everyone. This is my first post here. I just wanted to check in, say hello, and ask a couple of questions.

A little background about myself. I was diagnosed with PC in March of 2018 at 46 yrs. old, I had a RP (DaVinci) in June of 2018. Based on all reports thus far, I'm doing very well! I can perhaps give more details in another posting, but for now just wondering about a few things.

I have a couple of questions regarding the bladder and incontinence. I should say that I don't regularly wear pads, actually I had stopped altogether, but recently just started wearing them occasionally if I am out for a long day, or just for extra protection. Also, the erections, although not completely back, are returning. I am very thankful for all of this.

However, these are my concerns/questions right now.

1.) About three times now, over two/three months ( I know it's still early) , and always while I'm sleep, I have awakened in the morning to find out that I basically wet myself at some point during the night. Most of the time I am alerted that I have to go and I wake up but these three times I didn't.

2.) Within the last month, I'm usually going an avg. of two times overnight or early morning. Sometimes, recently this has been accompanied by some pain in the bladder area. Is that normal after a RP?

3.) Also, and maybe a little weird, and please excuse the descriptive nature, but if I sit on the toilet to use the restroom, after the main full stream of urine, there is an intermittent stream of urine that will keep coming out for a while if I sit there long enough. Generally once I stand it stops.

So, just wondering if anyone has had any of these experiences, and I'm particularly concerned about the three times when I was sleep because they are so random. I will say that it seemed to be times when maybe I was really tired or something. The doctor mentioned that it could be a sign of sleep apnea, and of course they also want me to come in to have a urinalysis to rule out infection, and then from my own reading some say it could even be an early sign of diabetes.

So, I'm going to have all the tests done, but again just curious if anyone has experienced any of this.

Do you think kegels can still help with any of this?

Thanks guys for any help or thoughts you have.

[Hidden]

I might have some suggestions.

First, incontinence usually first occurs when you're lying down then as it improves it also happens when you're sitting down, then standing. I.e. a measure of how incontinent you are is not just the amount, but how vertical you are when it happens. So, by this measure if you're continent when standing, you should be continent when lying down and conversely if you're incontinent when lying down, chances are it will be worse when standing.

So, if you're continent most of the time, excluding other factors, you should be continent when asleep (=lying down). However, if you've started having erections firstly because of the shortening of the urethra following RP you can leak when having an erection. This is because during an erection, the lower sphincter opens. This is normally to allow seamen to be ejaculated from the prostate. The upper, (bladder neck) sphincter normally stays closed. However after RP, the erect penis stretches the urethra which because it's shorter may pull the bladder sphincter a bit open. Hence 'erectile incontinence". You may even find that in orgasm, you ejaculate urine. This is "climacturia"

Second, when men dream, they always have erections unless they have physiological ED. Men with psychological ED WILL have erections when dreaming.

Hence, sleep = dream = erection = leak!

I have been continent for years apart from occasional erectile leaking when awake. I have never wet the bed. However a few weeks ago I finished a two month course of Naproxen. When I stopped taking it, (if causes water cc retention), I found I was peering a lot, about every 2 hours whereas normally I only pee about 3 or 4 times a day. The second night I woke up from a dream to feel myself leaking, I'd wet the bed!

I"m now back to normal peeing frequency and it hasn't happened again.

This may be what's happening with you, except you're still recovering from the surgery. So keep doing Levels and don't drink anything for about 3 hours before sleeping.

If you were diabetic, which is possible, you would pee more. It . Wouldn't just be more often, it would be a greater amount i.e. total over a 24 hour period. You would also feel more thirsty and would drink more. If you just peeing more often, but small amounts, but not any more thirsty then it may not be diabetes.

You could ask your doc for a Hb1ac blood test.

Next you could possibly have an infection. However in this case it usually hurts in your penis when you pee. You would also feel a more v urgent need to pee more frequently. An infection, higher up, e.g. your bladder is possible however. That might cause bladder pain.

Another possibility is that following RP you have a "stricture", this is a narrowing of the urethra due to scarring. In this case, you v would find that it's difficult to start peeing and it's not a good stream. In fact a sure sign of a stricture is a bifurcating stream, I.e. 2 streams. Awkward since they go in different directions. A stricture might cause some pain when peeing.

If a structure then it may naturally resolve after a time.

Unfortunately, a structure may need further treatment. Also unfortunate, if you have the good luck to have erections you may have climacturia. This will never get better. It can be managed, e.g.make sure. You always pee just before having sex, don't drink whilst having sex and don't have sex whilst standing up!

Do see your doc to address all your concerns.

[Hidden in reply to Hidden]

P.S. CONTINENCE first occurs when your lying down NOT incontinence, stupid predictive text!

[TJ326 in reply to Hidden]

HI Tim, Thanks for this information and your suggestions. I am going to follow up with my doctors as well. I had a blood glucose test in May and all was within normal range. That was pre-surgery. Perhaps this is all still a part of the healing process!

[TJ326]

Thank Bob for this info! Congrats on 3 years post PC.

[Hidden]

As a later comment, I also experience that after "the main event" sitting on the WC, I can squeeze out another few drops of pee. Then after a minute or so, another few drops. Then again and again and again. And so on. It finally stops when I get up. I''m pretty sure that I could go on like that all day if I had nothing better to do.

However, I used to be the same BEFORE RP, so don't think it's related.

[TJ326 in reply to Hidden]

Tim2131, thanks again.

[MelbourneDavid]

I think the gradual trickle after urinating is a combination of gradually draining the last dregs from the bladder - there's always a little left - and continued production by the kidneys. I noticed is well before my cancer diagnosis.

3 1/2.years after surgery I still wake to urinate 2 or 3 times a night. I think it's because, lacking the automatic sphincter at the base of the bladder (it is always lost with the prostate) uring gets into the urethra and triggers my pelvic floor tensing pattern that gives me continence. Either the urine in the urethra or the tensed muscles then wake me up, even if there is bot a lot of urine in my bladder. Frustrating, but at least I have very strong daytime urine control.

Keep up the kegels - my continence was getting better and better up to about 18 months.

[TJ326 in reply to MelbourneDavid]

Hi MelbourneDavid,

Thanks for this info as well. It's encouraging that things continued to improve up to 18 months after.