On the Mayo Clinic Prostate Cancer Chat, someone wrote:
“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?”
I responded:
A few thoughts on what might be going on and what to do about it. As background, I’m ten years retired as an Ob-Gyn doc, and had my own RALP for Gleason 7 (4+3) a year ago April.
1. During the surgery, the bladder is cut into and repaired. The healing process causes increased sensitivity in the repaired areas. This sensitivity after the surgery, when urine is splashing around in there, is the source of the increased sensation of needing to void. We give in to that, and over time, the bladder loses some of its elasticity as it becomes accustomed to smaller volumes of urine.
2. IMO, the immediate increased sense of need to urinate after voiding (for me, that happens about 5 minutes after I go) is caused by, as others have said, bladder spasms, not unlike a cramp after a muscle is used to it’s extreme. Those spasms, I think, are the result of the first spurts of “new” urine coming into the bladder from the kidneys. Of course, there is no real need to void, as the bladder is pretty empty at that point. So ignoring the sensation is my “treatment” of choice.
3. The ongoing sense of urgency can be treated by “bladder training”. As some have said, Kegel’s are a necessary component of that But alone, they are not sufficient.
4. Key Point: THE BLADDER IS A MUSCLE, partially under voluntary control, and as such can be trained, just as we would train other muscles in a gym. The goal is to train the bladder to accept increasingly larger volumes of urine without setting off signals of need to void. Don’t forget, all of us trained our bladders to do this when we were 2-3 years old. So, even a child can do it!
5. So how do we train this muscle? It takes discipline and persistence. Not be using weights or reps, though. My preferred method involves following a regimented plan to urinate by the clock, not by sensation, and record both the frequency and the amount of urine produced.
6. First, though, you need to be sure that you are sufficiently emptying your bladder. Your Urologist can do an in-office ultrasound the document your residual urine volume after voiding. If it’s less than 50-70 milliliters, you’re good to go to start training. If you are not emptying completely, you need to discuss Plan B with your Urologist.
7. Plan A: Identify how long you can “hold it” before the urge to void becomes demanding, This may be 30-90 minutes, I hope. Subtract 5-10 minutes from that time, and start going to the bathroom after, say, 25 minutes no matter whether you need to or not. Every couple of days, add a few minutes (2-4) to the frequency.
8. Engineers and scientists will tell us we only can improve what we can measure. So keep track of when you void in a little diary. And, for extra credit, pee in a container which can measure the urine volume and record that. Watching both those numbers improve over time can be very re-assuring.
But how to deal with that irritating sense of needing to go? To go back to the weight training analogy, when we go to the gym and lift weights, or when we go out for a run, we ignore the sensation that “this is uncomfortable”, and persist through the negative sensations because we know that some good will come of it. “No pain, no gain”. As long as you are not actually losing urine – urge incontinence – it’s better to persist with the training plan than giving in to the sensation.
In summary, trying to “hold it” is counter productive. Your bladder needs to “work out” in order to increase its elasticity. That takes time, just as it takes time to go from bench pressing, say, 70 pounds to 150.
A final note. I don’t like to take drugs that affect my whole body for a localized problem. I found the bladder drugs’ side effects to be not worth the supposed benefit they gave.