Incontinence post Prostatectomy: FIVE MUSTS - by Vanita Gaglani

This article was written by Vanita Gaglani, Physiotherapist and author of the book “Life After Prostatectomy and Other Urological Surgeries: 10 Weeks from Incontinence to Continence”

She has helped more than 2500 men achieve complete continence for the past 20 years. Her protocol (described in full in her book) has a 98% success rate.

There are her 5 most important measures for men to follow diligently on the path to stopping urine leakage. Some are counterintuitive, but extremely effective.

1. Drink More Water.

It’s easy to assume that drinking less water leads to less urination.

This is a myth!

In fact, urine leakage increases due to concentration of lactic acid in the bladder.

Drinking more water = dilution of lactic acid in the bladder = decreased bladder spasm = decreased PFM (Pelvic Floor Muscle) contraction = decreased fatigue of PFM = less leakage of urine

Read more advantages of drinking water for Prostatectomy recovery here.

2. More kegels is not necessarily better.

The pelvic floor is composed of a number of small muscles which stretch like a muscular hammock from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side).

These muscles are normally firm and thick - but also small in size - much like our facial muscles.

Since they are small in size they fatigue quickly.

And when these muscles fatigue, they are unable to bulk up.

If they cannot bulk up, the urethra and rectum cannot be closed properly thus leading to urinary leakage.

So we have to figure out the optimal contraction of these muscles to decrease fatigue, and yet increase the endurance of the PFM to sustain this contraction and prevent leakage of urine.

I usually have my patients do quick kegels (elevating the rectum, scrotum and penile shaft upwards towards the belly button) 10 repetitions, 7-8 sets per day.

As the endurance improves, I have them isolate and tighten only the front muscles

3. Avoid Constipation

It is important to have a regular daily bowel movement - and the movement should be soft

Hard stool in the rectum, which lies behind the bladder, will push on the bladder. This results in leakage during coughing, sneezing, lifting and create urination urgency

4. Avoid Sugary Foods.

These foods aggravate the bladder causing leakage, and also increasing urination frequency and urgency:

• Foods with high sugar.

• Processed salty food with many preservatives added to them.

• Instant potatoes, instant oatmeal, instant rice, cakes, pies, chocolates, potato chips, pretzels.

• All Sodas like Dr. Pepper, Coco Cola, Pepsi among others, Zero water, Crystal Light, Gatorade, Sprite (including decaffeinated versions)

Temporarily avoid these foods or eat them in minimal quantities until continence is achieved.

If you are experiencing constipation, try the following

• A combination of bran and applesauce 1/2 a cup twice a day. 

• Add 5-6 prunes or 6 oz of prune juice to your diet.

5. Focus on Stress Reduction

There is a correlation between the level of stress, and how much you leak.

To get continent most men try to ‘strong arm’ the small pelvic floor muscles by keeping them contracted.

That means these muscles are constantly in a state of tension.

Try a Mindfulness practice to decrease the tension in the Pelvic muscles. You will find becoming continent gets easier.