Incontinence Improvement with Pelvic PT?

Thanks again,. I am using diapers at night and I do three sets of Kegels every day. I guess part of my issue is that this is new to me and I had hoped for quicker progress. I still want to learn from others that are ahead of me, I certainly want a good plan. I am now seeing a specialized PT every week , She advised me to work on form and not so much strength at least for the first few weeks that she and I are working together on this. Stress incontinence ruins my bladder training. If I go for a walk every step I take, I leak which means my bladder stays close to empty. When i do the slightest thing like get out of a chair sometimes just roll over, I have stress incontinence. I am just a month out from the surgery and 2 1/2 weeks past catheter removal but I sure want to put this stage behind me as soon as I can
I appreciate any feedback and advice

Your pelvic floor therapist nailed it: learn to do them properly before doing them, because improper kegels can cause problems. And one of the most important things is the release, if you don't release then you aren't training anything. I presume your therapist has had you engage and release with a digital exam (finger in the bum)?

she did not do the digital finger or recommend it She did feel my pelvic floor muscle contracting and confirmed that I was activating the right muscle group.
What she is training me on now is doing the kegel contraction while exhaling (I was doing it like I do many exercises, while inhaling or holding my breath.) which is wrong. She showed me how the pelvic floor muscles open up (release) more when I take a deep (belly) breath. So I try to relax my pelvic floor muscles as much as I can; take a few deep breaths; and then take a deep breath and while exhaling do the kegel. This provides that the muscle has a wide range of motion compared to what I was doing. She has me doing three sets of ten each day ( along with some other exercises)
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In terms of a digital exam (or probe) I am not opposed to this. however, my perineum area is still somewhat sore ( I guess from the surgery), I can feel it if I sit to much ( like what you would feel if you were on a hard bike seat for a long time) and my surgeon told me to take stool softeners so I do not get constipated. I took this to mean in some way that I did not want to disrupt or irritate my anus while healing from the surgery. This is an assumption but the therapist tended to think it makes sense

I really was not doing the release right so you are 100% right about that. I was advised to start the kegels a month prior to surgery . I did that with a vengeance. However, I did not have any instructions and found some sources on line, many of which pretty much said do them with strong exertion so I was surely doing them wrong and perhaps too much When i got my catheter out I was doing them wrong until I ran across Michelle Kenway who has some good videos and good information.

I am very glad I have an individual therapist now. I will absolutely do the work including relearning how to do Kegels with better form.

It would be nice if I could just steadily build up mileage like swimming or running or biking (up my workouts 5-10 % a week and get better results,. but I think this journey is going to be a little less linear.

You are getting the hang of kegels and you'll be fine in some time. That book, that I bought along with a lot of other guys: 10 WEEKS to continence, so you aren't behind the curve by much. Better to do them right and see if you are continent afterwards than do them wrong and screw yourself.

I was fortunate that I sought out a pelvic floor therapist immediately upon diagnosis - she even commented that she wished this were recommended by every doctor because you get ahead of the curve. To date she said she'd seen only three guys beforehand, me included, and countless others after the problem was there.

The digital exam may not be what every doctor does, but mine did. She can feel the elasticity, hydration, engagement, knots and everything else to know precisely what is happening on engage and release. At first it's an "interesting" feeling (lots of nerve bundles in that area) but turned into be relatively uncomfortable at times as she really presses on weak spots - but none of these things impact the perineum so you might be fine (if your Dr does the digital).

Also: You can do TOO MANY KEGELS. Guys probably get overly into doing this because it's the only control they have over this disease but you can overdo it EASILY and wreck your pelvic floor.

Thanks so much. If she (Vanita) was In Maryland I would go and see her. I just ordered the book so hopefully I can get some more insight and tips

I really appreciate the comments

Hmmm…sounds like you went to her JUST to get that digital exam…not saying there’s anything wrong with that…😂😂

Well, I didn't... That's not an area I want fooled around with in, well, any way.

But I was already, as a leader into surgery, on 5mg of tadalafil daily along with L citrulline with zero, not even the slightest hint of, ED prior so you can say that I was ultra sensitive at that point and the initial fooling around did produce a result - which she told me was completely natural and why they put a towel on your little buddy during this procedure. I was mortified when it happened, in two sessions, but I can assure you that it goes away the instant they find a weak spot and start probing it aggressively, it's quite uncomfortable and borderline painful!

how does it help with incontinence? If my Pt can confirm that I am getting the right Pelvic Floor muscle then what else is there to the exam?

A basic evaluation isn't testing the elasticity, hydration, weak spots, tension - all things that indicate a HEALTHY pelvic floor rather than one that is properly engaging and disengaging.

Plenty of folks just learn to do a proper Kegel and they are good to go, so if you feel you are doing them right and your PT says you are doing them right and you are satisfied with the progression then that's all you need.

I tend to take things to the extreme and understand the science of what works and doesn't - this doesn't have to translate to "you must do this" because that's up to you to decide - sort of like the discussions here on if you should eat chicken or eggs, it's all personal belief and preferences.

But if what you are doing does NOT work, perhaps look at ways to do it differently and maybe you'll find that butter zone that works for you.

I love your response. I am really with you and if my PT or someone else wants to get into things deeper including a digital exam that is fine with me. Not so much that I want to understand things as much as possible but more so that I really want a good outcome and again, do not want to waste any time doing things less than optimally. I want to do the kegels as best I can. I really appreciate the support and comments.