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Persistent urgency even after urinating, 3 months after prostatectomy

Posted by bcer85 @bcer85, Aug 20 6:48pm

My prostatectomy was 3 months ago. My incontinence has been complicated by an unrelenting urgency to pee. Oddly, it's most acute right after emptying my bladder. Throughout the day I can't help feeling the need to rush to the toilet, so I think about it all the time. I fall asleep only with a sleep medication. It seems to be getting worse. It's debilitating. I never had this problem prior to surgery. I've been told this kind of urgency is not normal. My urologist performed a cystoscopy but found no physical cause and had no explanation. He recommended I double my dosage of Mirabegron for an overactive bladder. I'll do that, but frankly I've noticed little, if any, relief from this med. He also suggested seeing a pelvic floor therapist (I've already been doing kegels) and considering botox injections for the bladder. Has anyone else had a similar experience? Did you find a way to get some relief? Should I seek a second opinion from another urologist?

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trusam1 | @trusam1 | Aug 25 5:24pm
In reply to @markdebeach "Thanks Trusam1 for this detailed post! The training plan makes sense to me and jibes with..." + (show)
@markdebeach

Thanks Trusam1 for this detailed post! The training plan makes sense to me and jibes with what my urologist told me.

I’m confused at your summary: “In summary, trying to "hold it" is counter productive.” It seems like the goal of the training program is to extend the time between voids. So I’m not clear why you say that “holding it” is counterproductive. Will you please explain? Thanks.

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The nuance I neglected to include is: trying to "hold it" *without a plan* for progressively increasing the time between voids is counter productive. The bladder will fight back, and probably start a cycle of urge incontinence. Starting out voiding on a timed basis, with the initial interval being shorter than what your bladder can currently handle is better then simply trying to bull one's way forward. That latter strategy is what I meant by "holding it". The idea is to teach the bladder who's in control...

Maybe a little review of how I understand the bladder to work would help. The bladder muscle is unusual, in that it is under both voluntary and involuntary control. The voluntary aspect which we learn when young is to increase our intra-abdominal pressure (hold your breath and bear down). This increases the pressure within the bladder, triggering an involuntary reflex causing the bladder muscle to contract, squeezing the urine out. Things can start to go haywire when something triggers that reflex without our conscious desire to have it happen, like an infection, or surgery, or the increasing inelasticity in the bladder which goes along with aging.

Before our prostate was removed, and the bladder neck (the area where the urine exits) was operated on, we had three ways to stop the urine flow in situations like those. Now, we only have one, our "Kegel" muscles. So those have to be strengthened along with teaching the bladder not to be so hyperactive.

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2 replies
Moderator
Colleen Young, Connect Director | @colleenyoung | Sep 7 1:35pm
In reply to @trusam1 "The nuance I neglected to include is: trying to "hold it" *without a plan* for progressively..." + (show)
@trusam1

The nuance I neglected to include is: trying to "hold it" *without a plan* for progressively increasing the time between voids is counter productive. The bladder will fight back, and probably start a cycle of urge incontinence. Starting out voiding on a timed basis, with the initial interval being shorter than what your bladder can currently handle is better then simply trying to bull one's way forward. That latter strategy is what I meant by "holding it". The idea is to teach the bladder who's in control...

Maybe a little review of how I understand the bladder to work would help. The bladder muscle is unusual, in that it is under both voluntary and involuntary control. The voluntary aspect which we learn when young is to increase our intra-abdominal pressure (hold your breath and bear down). This increases the pressure within the bladder, triggering an involuntary reflex causing the bladder muscle to contract, squeezing the urine out. Things can start to go haywire when something triggers that reflex without our conscious desire to have it happen, like an infection, or surgery, or the increasing inelasticity in the bladder which goes along with aging.

Before our prostate was removed, and the bladder neck (the area where the urine exits) was operated on, we had three ways to stop the urine flow in situations like those. Now, we only have one, our "Kegel" muscles. So those have to be strengthened along with teaching the bladder not to be so hyperactive.

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@markdebeach, I hope you saw @trusam1's helpful explanation in response to your question. How are doing with Kegel exercises and urination urgency?

REPLY
1 reply
northoftheborder | @northoftheborder | Sep 7 2:06pm

I'll also repost this link from Cancer Research UK, which was the most helpful mainstream online resource I could find last summer for dealing with incontinence after prostate-cancer treatment:
https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/bladder-problems

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jasonfarmer | @jasonfarmer | Sep 8 7:08am

Bcer update when I hit week 6 on Gemtesa it was a game changer for me. Up to that time I was still looking for some other way to not having to run to pee way to often. But now after 6 plus weeks on Gemtesa wow life is much better not peeing but 7 to 9 time a day. My next step would be Botox but I am happy not to do that now. Gemtesa is $95 a month with discount card my insurance will not cover it but it didn’t cover mybertic either. Hope you find relief faster than I did. Don’t give up keep up trying. Patience is a lesson I am learning to hard way but I suspect I needed to be thought.

REPLY
kjacko | @kjacko | Sep 8 10:36am
In reply to @trusam1 "The nuance I neglected to include is: trying to "hold it" *without a plan* for progressively..." + (show)
@trusam1

The nuance I neglected to include is: trying to "hold it" *without a plan* for progressively increasing the time between voids is counter productive. The bladder will fight back, and probably start a cycle of urge incontinence. Starting out voiding on a timed basis, with the initial interval being shorter than what your bladder can currently handle is better then simply trying to bull one's way forward. That latter strategy is what I meant by "holding it". The idea is to teach the bladder who's in control...

Maybe a little review of how I understand the bladder to work would help. The bladder muscle is unusual, in that it is under both voluntary and involuntary control. The voluntary aspect which we learn when young is to increase our intra-abdominal pressure (hold your breath and bear down). This increases the pressure within the bladder, triggering an involuntary reflex causing the bladder muscle to contract, squeezing the urine out. Things can start to go haywire when something triggers that reflex without our conscious desire to have it happen, like an infection, or surgery, or the increasing inelasticity in the bladder which goes along with aging.

Before our prostate was removed, and the bladder neck (the area where the urine exits) was operated on, we had three ways to stop the urine flow in situations like those. Now, we only have one, our "Kegel" muscles. So those have to be strengthened along with teaching the bladder not to be so hyperactive.

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One other thing my urologist/surgeon told me. When I asked him if that”urge” to urinate would decrease after my enlarged/cancerous prostate was removed, he answered that it may or may not because some people just naturally produce more urine than others. I may add that I had NO incontinence issues after surgery((I attribute that to religiously doing kegels AND an excellent surgeon). However, I still do pee a lot. I’ve been a pee-er since grade school. My former general physician told me it can be psychological. I believe that. Best to all!

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docasio1734 | @docasio1734 | Sep 9 7:52am

I per normal since my prostate surgery no problems at all

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markdebeach | @markdebeach | Sep 9 9:04am
In reply to @colleenyoung "@markdebeach, I hope you saw @trusam1's helpful explanation in response to your question. How are doing..." + (show)
@colleenyoung

@markdebeach, I hope you saw @trusam1's helpful explanation in response to your question. How are doing with Kegel exercises and urination urgency?

Jump to this post

Hi Colleen,

Thanks for checking with me. I’m about 2 1/2 months post surgery, and I’m slowly increasing the amount of time between urinations and the urgency has also decreased. I started kegels before surgery and do them faithfully several times a day. Thankfully, incontinance has not been an issue.

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