Worsening Stress Incontinence 20 Months After Surgery?

[jazj]

I had my Robotic Prostatectomy 20 months ago at age 54 and everything went really well. Good post surgery pathology (no positive margins or extracapular extension). I didn't need pads about 5 months after surgery. I of course experienced stress incontinence after but at 1 year it was virtually non-existent (or at least to a point I didn't notice). Recently I could swear I have much more noticeable stress incontinence doing certain activities (mainly things I have to bend over to a large degree while standing or sitting or squat down. It's not a ton of leakage but definitely seems worse than it was say 3 months ago. My health seems the same except in the past 6 months I've been exercising less frequently and temporarily stopped doing weight lifting as I had too busy of a schedule (and admittedly gotten a bit lazy.)

I'm wondering if anyone else experienced what seems to be sort of a stress incontinence 'rebound' and if it's fairly normal and transient, or if it could be an early sign of other issues? My PSA is 0.02.

My best guess is that physical shape has a direct impact on incontinence post-surgery and it mainly because I'm not as in as good of shape as I was when my continence was better?

[jazj]

I'm a research fanatic so this was a rare case I posted before doing a search. As my gut suspected, it's most likely due to not being in as good of physical shape as before.

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

"Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52–1.06)."

[allie2020]

I had my RP in 2018 and have had virtually no incontinence issues other than the first several weeks after surgery. I'm a lot older than you and I continue to do a set or two of kegels daily. My uro/ surgeon told me when he was in medical school they were taught to have the post-RP patients perform their kegels for a few/several months. Now, they've learned it's best to advise patients do continue their kegels for the duration.

[Still_in_shock]

Exercise your kegels ALL the time.

I do it all day long!!

[Don717]

28 months post RP, no leakage, never did a kegel. I do run 2 miles a day and lift every other day so maybe I've been doing kegels without knowing? Anyway, looks like it's linked to exercise and patient comorbidities.

[andy_diggs]

The obvious Kegel's and core body strength exercises are really important.. I had an RP coming up to three years ago, with some nerves taken, but all is good these days with the leakage. One thing I have noted though is it can rear its head for me in two situations

1) Tired and generally rundown

2) If I eat a lot. I have been actively putting on weight and muscle the past couple of years, so I eat more normal from time to time. The full stomach puts extra pressure on the bladder and can cause a problems.

[London441]

Kegels are enthusiastically promoted when this subject comes up with good reason-even though they require diligence, they can work well.

Not for everyone though. If you continue to have problems there are various other solutions.

Obviously, regular exercise, both cardiovascular and strength training, also requires diligence. However, nothing in your control is as important for your ongoing health. Being more fit and strong is better for your incontinence issues and literally everything else.

[Break60]

incontinence is a bummer and makes exercise more difficult so it’s a double edged sword.