Leaking after a prostatectomy can present in several ways. Leaking associated with urge is treated by the Bladder Retraining program including diet and behavior changes. Leaking due to movement, activity, or sneeze/cough/laugh, lifting or exercise may take a little more time. This can be due to weakness of the pelvic floor muscles as well as coordination with the bladder. In addition to the bladder retraining program, treatment is as follows:
EXHALE WITH EFFORT
When exerting effort we tend to hold our breath to create stability. Unfortunately, what this also does is increase your intra-abdominal pressure. Basically you’re trapping the air in your abdomen by closing your epiglottis (throat) which increases the pressure (and increases blood pressure!) to a level that your pelvic floor cannot counter-act against. If the abdominal pressure is greater than the counter pressure of your pelvic floor the result is stress incontinence. This can happen with sneeze, cough, laugh, bending over, exercise, picking up or lifting something, as well as every day activities such as getting in and out of a chair or car.
EXHALING WITH EFFORT is a technique used to decrease the intra-abdominal pressure so that the pelvic floor muscles can maintain continence during that activity. Ideally the pelvic floor will also contract for counter pressure.
Practice with sit-to-stand first. Once you’ve mastered this you can start utilizing it with any activity that causes leakage. Remember if you ever find yourself holding your breath immediately exhale even if you don’t leak! NEVER HOLD YOUR BREATH for any activity including and most especially during defecation (See ….
SIT-TO-STAND EXHALE WITH EFFORT:
- Scoot to the edge of the chair
- Before you start to rise gently inhale and then exhale through your mouth. Start your exhale first then begin to rise from the chair. You should be able to hear your exhale. The biggest mistake people make is starting the movement first then exhaling or exhaling once the movement is almost complete. By this time the intraabdominal pressure has already increased and you haven’t trained the pelvic floor to contract first.
Another example is lifting. Before you begin to pick up a heavy object, start your exhale first then lift. Remember, if your epiglottis is open (by having your mouth open during exhale) then the pressure will not get trapped and the pelvic floor has a chance to activate and counter pressure against the activity resulting in continence.
One other example is getting out of bed. Do not ‘jack-knife’ out of bed. When laying flat on your back, bend your right knee if you’re rolling to your left, roll on to your left side, then use your hand to push up to sitting while exhaling—remember to start the exhale before pushing up to sitting position. Once sitting follow steps listed above. If you have a strong urge to urinate before getting out of bed. Practice performing 5 quick Kegels before you stand and then walk slowly (do not rush) to the bathroom. See …
This activity will be a conscious one at first but the more you practice the sooner you will be able to do this automatically.
Even if you don’t leak during activity, you should never hold your breath. Continuing this bad habit will eventually lead to incontinence so retrain your brain and pelvic floor now for prevention!
Once you’ve mastered the exhale with effort, try adding a simultaneous pelvic floor contraction (Kegel) with the exhale to increase the pressure of the pelvic floor even more. This is most important for those with stress incontinence to maintain closure of the urethra during the activity.