Doc: Post-surgery incontinence takes time to improve
Dear Dr. Roach: I had a DaVinci prostatectomy 11 months ago. I can sit or stand for hours with no problem, but then sitting on the floor to play with my dog causes me to leak. I realize that getting on the floor or any other bending squeezes my bladder, thus causing a leak. So does a cough or a sneeze. A heavy lift also can trigger leakage. I sleep all night with no leakage, although I do urinate two or three times a night.
I have done Kegel exercises, but have been told to cut back so that I don’t overtire the muscle. Do you know of any procedure by a doctor or anything I personally can do to help alleviate this problem?
My doctor says, “Just wait — it takes time,” but I’ve experienced no further improvement since about six months post-surgery.
Is this something that I may have to deal with permanently?
Dear K.F.: Incontinence in men following prostate surgery is a common problem, even in robotic (DaVinci is a robotic system) surgeries. In a large study, about half of men after prostate surgery will have some incontinence two months after surgery, but this decreases to 15 percent at one year. At two years, only 7 percent of men felt that incontinence was a moderate or big problem. A separate study showed that urinary function continues to improve for up to four years after surgery.
So I agree with your doctor that time is likely to improve your symptoms.
Pelvic floor exercises have been proven in multiple studies to benefit incontinence symptoms. I am surprised that you are getting advice to cut down, but I would listen to the advice of the therapist helping you, who must have vastly more experience than I do.
If you continue to have symptoms, there are drug treatments and surgical treatments, the most effective of which is probably the artificial urinary sphincter. However, since only 1 percent of men after prostate surgery will require it, I do counsel patience, although I recognize how frustrating it must be for you.
Dear Dr. Roach: I am a 77-year-old man in good health. An issue has been gnawing at me for going on close to three years. When I am sitting in the driver’s seat and traveling over a hundred miles, I gradually develop a pain that starts in my right buttock and radiates down to my knee and foot. Ortho doctors have said that they did not see arthritis.
Dear D.W.: Although pain in the hip, buttock, and thigh can have many causes, whenever I hear that a pain is “radiating,” I think of nerve pain. The fact that the pain begins after sitting for a long time suggests that the nerve is being compressed by your body weight. I often see this in people who have recently gained weight (presumably there is more pressure against the nerve), but also in people who have recently lost weight (possibly because the nerve has been placed into a new position against a bony prominence).
Unfortunately, the only advice I can give that I have found consistently effective is to avoid excess pressure. This may mean getting out of the car before the pain starts and walking about to relieve the pressure. Sometimes a more comfortable seat or cushion can help. Although there are medications you can take, I don’t recommend them due to their side effects. I also think the pain is a useful reminder that you are beginning to damage the nerve and should stop what you’re doing.
Email questions to ToYourGoodHealth@med.cornell.edu.