7 weeks after Prostatectomy and still waking up a lot to pee.

I spent my entire professional life in health care, but only learned of this during my prostate journey: My urologist said that as we get older, our bladders get "smaller." So, if you are 60 "+" years old, your bladder doesn't hold what it used to, and...the prostate provided "physical support" to your bladder. It sat under your bladder like a little base unit. But now it is gone, and your bladder no longer has tat extra support. And of course, the most important of your two sphincters that control urination was removed with the prostate. Your body is learning to control urine retention with the one remaining, weaker/secondary sphincter. Also...
If you haven't received such an order, ask your urologist for 8 sessions of Pelvic Floor Physical Therapy (PFPT). Most insurance companies pay for it...usually initially, approving just 2-3 sessions, but all it takes (per my PFPT therapist), is for the therapist to submit the need/request for additional sessions to your insurance company which should be approved. I was approved for two sessions, and after submission for more, I was approved for eight sessions. There are MANY more pelvic floor exercises than the basic Kegel exercises...all very similar to strengthen and control those small pelvic floor muscles, but the therapy does help. Part of that therapy will include a conscious modification of your consumption of liquids. I never even thought about how much I drink, what I drink, and the frequency of drinking. My/your PFPT therapist will tell you to make absolutely sure that you urinate very two hours whether you think you need to or not, and to only consume "8" ounces of liquid at a time. That has been the hardest for me since so many drinks are bottled/canned in 12 oz sizes. I discovered the 8 ounce mini size sodas as a result. My therapist also said it is best to consume the 8 ounces immediately after you urinate...but only if you are thirsty. She also laid down an absolute rule for my first 6-12 months post-op: No caffeine, no acidic beverages like O.J. and other juices that tend to be acidic, and try to avoid carbonation as well. Carbonated drinks ultimately become acidic in your body, and of course, if you read the label, almost all contain citric acid, phosphoric acid, etc. Those are all bladder irritants, and your bladder is kind of "angry" right now having lost some physical support to support the urine. The surgical trauma left your bladder kind of "pissed off" (pun intended) and angry...it is in recovery mode, so be kind to it. The retraining to drink only 8 ounces was easier than I thought. I am almost 8 months post-op now, and I am slowly re-introducing orange juice to my liquid consumption, as well as my 8 ounce 7-Up Zero, Fresca, Diet Decaf Coke, etc., all with no caffeine. Good luck with it, but you have a ways to go. Lastly, I wouldn't drink anything after dinner, and of course, urinate before you go to bed. Being flat/prone on your back while you sleep, should help alleviate any gravitational influence on your bladder while you sleep. Even now, I still get up between 4:30 - 6:00 a.m. to urinate, especially if I went to bed between 10:00 - 11:00 p.m., instead of, say, midnight. I don't have great urgency...I am actually just starting to wake up, and realize: "hmm, I guess I should get up to urinate...I kind of feel like I could/should." Everyone is different though. The good news is that you will regain continence. Good luck.

@jeffmarc Warning: SSRIs (common drugs for depression or anxiety) often cause lack of libido, ED and/or anorgasmia (the inability to have an orgasm). As mentioned, exercise does wonders for depression and meditation and breathing exercises help anxiety. Stopping alcohol and caffeine also help.

10 months out still incontinent however I see steady ( but slow progress)

see
https://www.auanet.org/guidelines-and-quality/guidelines/incontinence-after-prostate-treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC9917389/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3034651/
(check out authoritative research)

some of the main points include
1. 'Clinicians should inform patients undergoing radical prostatectomy or transurethral resection of the prostate after radiation therapy of the high rate of urinary incontinence following these procedures. (Moderate Recommendation; Evidence Level: Grade C) this is from the American Urological Association
2 most men experience incontinence,.
3 most get better around one year ( 50-58 weeks depending on the research)
4 the jury is out in terms of Pelvic Floor retraining. There is a definite lack of agreement regarding how many Keegles to do what protocol to follow Still Pelvic Floor re-training is supported by research ( in other words science still needs to recommend a good number per day )
I wish I was told this prior to RARP. I still would have gone forward but would not be so taken by surprise.

Certainly some men get better faster and some do not have incontinence at all. Conversely, some men have persistent incontinence and may then try different elective interventions
Incontinence sucks...

@jeffmarc
He’s right exercise, something as simple as walking will lift your spirits. Some get lucky with little lasting side effects. Others are not so lucky. Besides their cancer they’re enduring other ailments. I read recently that one person was up 25 times due to a bladder problem. I get up 5x a night and thought I was the Lone Ranger I feel lucky.

@rlpostrp Thanks for the detailed post ripotrp

you noted "make absolutely sure that you urinate very two hours whether you think you need to or not,"
I was also told to do this but not for how long. I was also told that re-training my bladder involved slowly being able to increase this interval . When and how did you start working on increasing perhaps 10 minutes longer?

thanks

@edinmaryland
Thanks for your message and question: I just sort of "fell into" compliance with what my PFPT Therapist told me to do. I didn't "set an alarm", but I was, and have been, very close to 2-hour intervals since she told me to urinate, and then drink no more than 8 ounces of liquid thereafter if I really needed it. She was a bit more adamant (my word) about ensuring that I urinate every two hours, than she was about drinking every two hours. I think I have fallen back into what was almost my old routine of "drink when thirsty", but not to excess. Previously, I would have opened my 16 ounce bottle of water, or a 12-ounce soda, and drank the whole thing within minutes. I now now buy 8 ounce "mini" size soda's, and I keep my empty Fiji water bottles, and fill them to an approximate "half-full", 8-ounces with the cool water dispenser from my refrigerator. I have several in my refrigerator. But...
I start every morning actually breaking that rule. It takes my 8 ounce Boost drink, and my little bit of OJ to swallow my vitamins. I probably consume 12-14 ounces total. But then the rest of the day, I follow the plan, minimally consciously. And...
Two things are at play as a result: Because I consume just the 8 ounces, I have less urgency to urinate that "every two hours", but I still do try to urinate every two hours. That automatically keeps me from having a full bladder. The other thing is, I have regained "99%" of my urinary continence (drinking less surely minimizes urgency). I now just use Depends "Shields" in my undershorts. I have little quarter-sized spot-leak accidents, usually when getting into or out of my car, or standing/sitting from my family room couch. When I walk and move around I never leak now. If I squat in the yard, or come up from a squat, I might leak a little. Other than that, and to answer your question directly, I do find myself exceeding the "urinate every two hours" rule a lot...but not consciously, but more just circumstantially. I never set a goal to incrementally increase the span of time between urination. I might be out for 3-4 hours doing errands and "whatever", and when I get home, I realize that I have a little urgency, so I go to the bathroom, then grab my 8 ounce bottle of water to drink. I hope this helps.

Thanks again so much for the detailed response. I really appreciate it. I am still uncertain how to proceed with my bladder retraining. I did not pay terrible attention to the two hour rule even though my urologist recommended it early on.(It was initially hard to get to two hours) I thought that was sort of a starting point to get my bladder back in shape. Shouldn't I (we) want our bladder learning to hold contents more than two hours at some point? Prior to RARP, I would go half a day without emptying ( I really was bad about not drinking enough water though) Do you plan to remain with the two hour rule indefinitely or is this part of rehab, getting back to normal?

How far out from RARP are you? I am about nine months ( going from when catheter was removed). I am making progress and feel like I am close to you but a little behind.

I also would love to resume coffee but it is not the end of the world if I wait until the one year mark. Thoughts??

And thanks very much for sharing with me I really appreciate it