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Which to treat first --stress incontinence vs. over-active bladder?

BD
Posts: 14
Joined: Dec 2010

I've posted on another topic -- Interstim vs. Botox -- but want to inquire now about the order in which treatment should proceed for stress incontinence AND over-active bladder (I've been told that I have both, and that they should be treated separately (because the treatments are different). It hasn't become clear (at least to me), however, WHICH ONE SHOULD YOU DO FIRST?

Had my radical robotic prostatectomy in Jan. '09, and the severe incontinence is presenting me with a maze I am not sure how to get out of.

By the way, BDHilton, if you read this, my apologies for selecting the first two same initials for my user name . . . . Didn't know I had done that until I saw yours . . . hope it didn't confuse anyone.

BD

VascodaGama's picture
VascodaGama
Posts: 1526
Joined: Nov 2010

Hi BD,
I am happy to know that you made a decision of a treatment for your incontinence problem.
Though I do not know which type of treatment you have chosen, Behavioral interventions or Surgery, it may be possible to try a treatment for both (Stress and Urgency incontinence (OAB). Here is a site with links that may help you in your decisions; http://www.mayoclinic.com/health/overactive-bladder/DS00827/DSECTION=treatments-and-drugs

I wish you the best.
VGama

Trew
Posts: 891
Joined: Jan 2010

almost 2 yrs after surgery and 1 yr after rad my nite time sleep pattern has settled down from 4- 6 nite trips to now I only get up once and a few nites I sleep 6- 7 hrs thru.

The 2 areas of concern seem to go together- they did for me. But in the last 4- 6 weeks at least I am sleeping well. Incontience is still a serious problem. I am hoping to get a AUS installed in May.

I had a PA who wanted to put me on Flowmax right after rads for bladder urgency but flowmax gave me a lot of problems while I was getting radiation and the PA wouldn't listen to me. So I changed docs and got rid of the PA. I never saw the doc again after surgery anyway. 1 year later- no appointments with the doc- just a very strange way to treat a stage iv ca patient.

I am in MI, and Dr. J. Latini at U of MI is very good with AUS surgery. I can hardly wait for May to get here.

JR1949
Posts: 230
Joined: Jun 2009

Trew, I have not been on CSN for a while and I am glad to read now that you sound like your situation is better if you only get up once during the night and sleeping 6-7 hours.
That is good news I believe.

I have been taking Vesicare to help bladder urgency and I am going to ask my uro about the Flomax.

Hope you had a good holiday Christmas and News Year and hope that the new year brings you good fortune in your struggle with the incontinence.

JR

Trew
Posts: 891
Joined: Jan 2010

Hi JR, I am still around. I am just being a bit more quiet recently. I do not like life after PC, but those negative feelings were really compounded by the eligard.

Like a bad memory, I am just trying to let this pc thing settle down in my life. And yes, I am sleeping better. And the number of pads is down from around 15 a day to somewhere between 6- 10 or so. 8- 9 pads a day has been my average for a few weeks. Maybe that will settle down more, too. Maybe I might dry up. But if I am not dry by May 9 I hope then the doc will go ahead with the AUS.

I think time is a better healer than flowmax. while on flowmax I had trouble voiding at times and in the morning my vision was blurry. So I quite and gave my remaining supply of pills to another man who did not have the same side effects I had.

Life goes on in different ways for all of us.

JR1949
Posts: 230
Joined: Jun 2009

BD, My understanding of the two is stress incontinence is you leak urine anytime you put stress on the bladder because the sphincter muscle in your bladder is not as strong now since the prostatectomy. Kegels help this somewhat. Over active bladder is when you have to urinate frequently.

I had radical prostatectomy Mar. '09 and I still have problems with stress incontinence. It is better now than it was for the first 12 months post surgery. Since early summer 2010 I am now able to wear briefs (the real cotton briefs, Fruit of the Looms) and a pad and use an average of 4 pads per day. Strangely enough, I use a thinner pad overnight and only have to get up 1-2 times during the night and barely wet the overnight pad. I have found if I try to urinate every 2 hours during the day, that I have a lot less leakage. I keep hoping that the incontinence will get better over the next year.

What kind of treatments is your uro suggesting for you? My uro does not give any treatment options, only have an AUX sling implant. Personally I don't prefer the sling at least not yet.

Good luck to you with your incontinence and overactive bladder.

JR

BD
Posts: 14
Joined: Dec 2010

I'm very grateful for each of your replies (VGama, Trew, and JR1949) . . . each one of you shed just a little more light for me on what has become a puzzling subject.

Your Mayo Clinic citation was VERY helpful, VGama . . . I went immediately to it and found one of the most complete set of answers and things to consider that I have ever seen. I straightaway made a copy and will be taking it with me to my appt Jan. 14 at The Cleveland Clinic (Florida) . . . fodder for all sorts of questions re options. (Although one is Mayo and the other is Cleveland Clinic, I'm sure they talk with and respect each other.)

Thanks to you, too, Trew and JR1949, for introducing the subjects of Flomax and disciplined urination patterns . . . will try to raise those, too.

Wish me luck and say a little prayer for me that the best treatment course for me will come out of the upcoming consultation . . . .

BD

JR1949
Posts: 230
Joined: Jun 2009

You're welcome, BD. Glad to help. That's what this CSN is all about, friends helping friends. It is truly a brotherhood and sisterhood. I have received a lot of info and support from the discussion boards for both myself and for my wife.

Wish you luck and you are in my prayers. Keep the faith and go forward with a positive attitude. This cancer beast can be beat. I can attest for the power of prayer. I praise God that my wife and I are both cancer survivors, she had stage 4 recuring melanoma that metastisized after 18 years June 09 and I had prostate cancer March 09.

JR

mrspjd
Posts: 688
Joined: Apr 2010

Just a quick note to thank you for the "sisterhood" acknowledgement. As one of the few women posting on a mostly male PCa discussion board, it's nice to see that our presence is known, perhaps appreciated, by some, in support of husbands, male family members and friends.
All the best to you and your wife.
mrs pjd

tdorman
Posts: 21
Joined: Jun 2010

Ihave a consult set up with Dr Hakim at the Cleveland Clinic in Feb. Can you let me know how your appt went and any decisions you made regarding your visit.

Thanks

Ted

BD
Posts: 14
Joined: Dec 2010

My appt at The Cleveland Clinic Florida) two days ago was one of the best and most complete I have had. TDorman (or Ted), I know you specifically inquired about this. I saw a physician other than Dr. Hakim, but I did hear his name mentioned when I was there.

Mine suggested trying the external electrical neurostimulation of the nerve endings around the bladder first (for one who has both stress incontinence and over-active bladder), and he specifically answered the question which one should you address first, by saying one should address whichever one is more predominant. In my case, it is the over-active bladder (or the urge incontinence). Because of this, he recommended the external electrical stimulation first (I don't know whether it has an ancillary accompanying effect on stress incontinence), but it is principally for the overactive bladder. I hope to start the 12-week, once-a-week application of this soon.

Good luck to each of you and, Ted, I hope your appt at The Cleveland Clinic (Florida) with Dr. Hakim goes really well for you.

BD

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