Pelvic Floor PT, post RARP. How many sessions?

Your Pelvic Floor Physical Therapist (PFPT) will likely tell you that despite your physician writing an order for the customary "8" sessions, your insurance company or Medicare only approved "2" sessions. But...your PFPT will tell you that all (s)he needs to do is write/submit a justification for 6 more sessions to total "8", and your insurance company should easily approve it. That was my experience with my Medicare Advantage Plan. I actually only went to 7 sessions, the seventh quite reluctantly, because I felt that I had "peaked" at what I could do.

The therapy is actually quite involved...easy in one sense...but was difficult for me because...My PFPT explained how the entire core abdomen below the diaphragm is involved with how your bladder functions, therefore, your "breathing" during the exercises will affect your success. I somehow was a problem child. I breathed the exact opposite way of what I should have, or I actually held my breath to my therapists exasperation ("Breathe... BREATHE....NO NOT THAT WAY!!!). . The breathing you are to do "while" doing your exercises, is the exact opposite of what nature would have you do while breathing. It was frustrating. BTW...these exercises go well beyond the traditional Kegel's you see online. They are not strenuous or difficult, just "counterintuitive" in terms of when you breathe and how you breathe. I flat out gave up after the 6th session. As mentioned, I reluctantly went to the 7th session like the school kid who didn't do his homework. I had done it, but with no effective results. But...bottom line...the good news is that those exercises - for the time that I did them many months ago - and time itself, restored 98% of my continence. I still have accidental little leaks like when sneezing, coughing, or squatting, but they are minimal. I do still wear a thin "Shield" to avoid embarrassment in public. I am retired, and I often experiment with how long I can just wear undershorts without a Shield at home. Sometimes I can go 6, 8, or even 10 hours before I have that first little leak. I am hoping for 100% continence within the next month or two. It will be a lifestyle game changer. Lastly, your PFPT will also coach you on your "new" habit and pattern of liquid consumption. During therapy and a few months after: no more than 8 ounces at one time; go to the bathroom every two hours to urinate whether you feel you need to or not; drink that 8 ounces of WATER right after you urinate (so you are drinking 8 ounces of water every two hours); For several months: no caffeine of any kind from coffee, tea, sodas or energy drinks. No "acidic" beverages like orange juice, pineapple juice, etc. No sugary drinks. Sugar, caffeine, and acid are all bladder irritants. In your post-surgical assault and recovery, your bladder is really "pissed off" (pun intended). It is irritated and bothered by the least little thing while it too heals from the surgery. I did well following my therapist's directives, and it helped tremendously. Don't fall prey to cave in because you "need your morning coffee" (switch to decaf for a few months). Similarly, don't say "I need my afternoon Diet Coke (or whatever your caffeinated drink is). Try to force yourself to drink water only. That drive me nuts, but it really helped. I would break the rule and have my morning OJ or an afternoon Diet Coke, then initially be angry as to why I was leaking so badly, until I realized: "Oh ya...the OJ and that Diet Coke I had messed me up." Good Luck!

@rlpostrp Great advice, thank you very much! I fear I will be a problem student too....but hearing from you that even problem students can benefit is encouraging. thanks, again!

I forgot to add: In your first session, part of your initial assessment will require the PFPT to insert a gloved, lubed finger into your anus to assess the condition and strength of your pelvic floor muscles. My PTPF was elderly...over 60 years old, and I kind of thought: "Is she getting some perverted thrill here under the guise of treatment or is this really needed?" But I was wrong. I researched it, and it is part of every initial assessment. So, if you haven't had your first session yet, you should expect the gloved, lubed finger exam. Grin and bear it.

@jeff1963
I am wishing you great success with your PT sessions ! Many are very happy with them and have great results : ))) - I am sure that you will too. I also think that passage of time itself helps with healing . And yes- insist on getting what you want from your doctor - his approach is really ridiculous : / ! My husband got PT referral before surgery , not to mention after. For some reason he found PT exercises boring since they are so simple and easy but he did them at home for a while and added a bunch of exercises that he thought would be beneficial.

PS: His PT was at a major hospital where he had surgery at a department that specializes in prostate cancer and there was no "finger" exam or training that involved any "probes" as others mentioned - just saying that it is not always involved.

PPS: The recovery is not a strait line - there were days that were better and days that had some reversal of success but the TREND was going steadily in the right direction. Also, there were big jumps in improvement literary over night !
For no particular reason O_0 ! It would be "same amount" for 2-3 weeks and than all of the sudden much less. Than that amount for 2-3 weeks than all of the sudden less , and so on and so on. Just be patient < 3

In my first session they did a lot of testing for range of motion in different positions, etc and did a lot of testing for flexability etc.

then they got to the part about how to do Kegels and they need to assess if I could constrict the proper muscles to do a Kegel. Since my scrotum was still swollen from surgery/drainage etc they asked me to give my scrotum a good tug and get the boys out of the way and then they did some feeling around in the general area and asked me to constrict and I was able to constrict the proper muscles to do a correct Kegel. They stayed on their side of my underwear, gloved no lube, no probes no exploring just touching the necessary muscles and asking me to constrict in different positions.

My suggestion wear gym shorts and very well fitting underwear for the first and all sessions of PT.

I took a couple of months. My therapist said I took longer than most. I had a proatatecotomy 12 years ago, I am 81. If I don't do Kegels now I can start to leak, so I do them twice daily when I remember! 🙂

I am glad you are getting to a specialist. why waste time and perhaps why get started doing things incorrectly?

I did.
I am at the one year mark (RARP Jan 25) still incontinent but about 85% better

Research supports PFM rehab (Kegels + and bladder retraining) however, the research points to an absence of metrics in other words there is no standard protocol for how many to do daily and what kind.
My PT had me do two sets daily of 5 warm ups, five progressive and five longer ( 10-15 second) then four sets of quick ones ( slow muscle and fast muscle workout) I also worked on core and using Kegels with different types of movements like standing lifting kids etc.

I really believe you can do too many Kegels and you can do too much straining. It seems from the research most are recommending about two sets of ten or so daily certainly not sets every hour as I have heard some do.

The American Urological Association put out a fact sheet for urologists to share with patients. In it- more or less, it advises that most men are incontinent and most take up to about a year to get better. Certainly some men experience no incontinence and some get better in weeks. I am very happy for them Some do not get better. I would rather learn about the trends and go from there than be misled that it is usually a quick turn around. It has not been for me.

I would do it all over gain as I hope to be cancer free, but incontinence is horrible

Thank you so much!

@grehenn , how did you find someone who specializes in male pelvic floor exercises?

My hospital found a physical therapist for me.