September Is Prostate Cancer Awareness Month
In Part 1 of this blog series, we went over what Kegels are (the contraction of your pelvic floor muscles), how many to do (aim for 30-80 reps a day in sets of 10), and how to coordinate them with movement and breathing (perform a kegel while you exhale and during the exertional or harder parts of a movement). Read Part 1 if you haven’t already for more information on Prostate Cancer and kegels! While kegels are very important for regaining continence following a prostatectomy, there are more steps you can take to help with your path to continence. Keep reading for more advice and tips I give my patients who are post-prostatectomy!
- Fluid intake
A lot of people with urinary incontinence will restrict their fluid intake in order to decrease their leakage. This makes sense in theory, however, did you know that more concentrated urine can actually irritate the bladder lining and cause more leakage and urgency to urinate? Additionally, restricting your fluids can lead to constipation which can also increase urinary incontinence (along with being quite uncomfortable). It is so important to keep your fluid intake up for bladder and bowel health, healing, and energy levels even though it may feel like you want to drink less. My recommendation for adequate fluid intake is to aim to drink about ½ your body weight in ounces daily with at least ½ of that being plain water. For example, if you are a 160lb person, aim for about 80 ounces of fluid daily. 40 ounces of that should be plain water. Be sure to sip your fluids throughout the day rather than gulping them down all at once.
What you drink can also affect your urinary leakage. Things like alcohol, caffeine, acidic beverages, and carbonated drinks such as soda or beer are known bladder irritants and can make urinary leakage worse. They do this by irritating the lining of your bladder causing your bladder to send urge signals to your brain that you need to pee even when your bladder isn’t full. During these urge signals, your bladder muscle may contract and urine can dribble out. To limit this, try limiting the above irritants 1 at a time for about a week and see if it changes your bladder behavior including your urgency and your leakage. You can also try altering your routine in different ways to decrease the amount or concentration of an irritant you’re consuming, such as drinking a cup of water with your coffee in the morning or reducing your coffee intake by 1 cup if you’re a heavy coffee drink
It is important to stay active following a major surgery like a prostatectomy. Your goal should be to work to slowly return to your previous function and activity level. A good starting point is to build up to walking for 30 minutes a day. It is important to avoid saddle activities such as cycling or horseback riding for 8 weeks following your surgery to allow for tissue healing. In general, there are lower rates of incontinence in men who are physically active and not obese (Wolin 2010).
- Bladder habits
Normal urinary frequency is going to the bathroom to urinate every 2-4 hours and only 0-2 times a night. This is your goal to return to this cadence of urination with a normal fluid intake. It can be easy after being catheterized and when trying to avoid leakage to use the restroom too frequently. Unfortunately going to the bathroom too often can teach your bladder that you like going to the bathroom this often and in turn cause more urgency (feeling like you need to pee even though there isn’t much in the bladder). Remember, the bladder is one of the most easily trained organs in the body which means it ‘learns’ bad behaviors quickly. Though this can be frustrating, this also means that we can train it for the better!
Try and suppress urges to urinate if they are coming too frequently by distracting yourself and waiting 1 minute prior to calmly walking to the bathroom. You can also take diaphragmatic breaths (see my blog post on breathing if you have questions on how to do this!) or perform 5 kegels in quick succession. These are quick kegels meaning that you are fully contracting and relaxing your pelvic floor muscles one or even two times in the time it takes you to say ‘one one-thousand.’ Wait until the urge passes prior to calmly walking to the bathroom or calmly moving on with your day and wait for another urge to come (they usually come every 30 minutes or so). Remember, your first urinary urge is just a notice that your bladder is filling, not a command to rush to the bathroom. Throughout the day, try to avoid ‘Just in Case’ trips to the restroom unless you are about to leave the house for errands or travelling.
- Celebrate the victories
When recovering from a prostatectomy, it is important to be able to track and acknowledge progress. The path to continence will look like this: no leakage during sleeping → no leakage with static sitting or laying → no leakage with standing → no leakage with functional movements such as walking, bending, or lifting. Continence is also likely to come easier in the morning than when your muscles and body are more fatigued at night. Counting your pad, incontinence underwear, or guard use can also be a dependable way to track your progress. At first, you might count how many pads you need to use during the day, and then eventually graduate to not needing one at night while sleeping (a great milestone indicating your bladder is actually holding urine and not leaking constantly!), and then finally what time of day it is prior to needing to wear a pad (meaning you don’t need one at all during the morning hours!). Other great victories to take note of are a whole day without leaking when going from sitting to standing, or not experiencing leakage during yardwork or sexual activity. Generally this is a long healing process so it’s important to track your progress so you stay motivated.
Urinary incontinence can be such a frustrating side effect of a life saving surgery, but as you can see, there is a lot you can do to help yourself along the journey to continence. Above all else, remember that it takes time to recover and for your muscles and bladder to learn their new normal. If you are experiencing urinary incontinence, bladder urgency, pain with urinating, or overactive bladder, please call Life’s Work PT at (503)295-2585 or send us a message at firstname.lastname@example.org. If you aren’t in Oregon, visit PelvicRehab.com to locate a pelvic floor physical therapist in your area and ask if they have experience treating men.
Stay tuned for Part 3 of this series where we will talk about another common symptom following Prostate Cancer treatment: sexual dysfunction.
Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS. Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity. J Urol. 2010;183(2):629-633. doi:10.1016/j.juro.2009.09.082