I had my first experience of urinary incontinence last night. It came not from coughing, sneezing or standing up as the literature would have you expect. For me, it came from farting. Twice! I had noticed over the past few days, a small dribble of urine from where Cathy (the catheter) enters my penis, when I had a bowel movement. At first it was exceedingly uncomfortable but at least it was confined to times of defecation. Over the days the discomfort of this slight dribble diminished but now, it seems, it is no longer confined to the throne.
This is the start of it – urinary incontinence. Cathy probably held it at bay to some extent but today is my last day of wearing a catheter, thankfully. It has been a very long two weeks since my radical prostactomy. The pain, discomfort and diminished mobility have all been tough going, though improving slightly each day. Wearing a catheter is a damn nuisance and somewhat demeaning, especially at night when you have to hook up a second bag to take the 1.5 to 2 litres passed during sleep.
Cathy is a necessary evil, however, to allow the urethra time to heal from the surgery. The urethra is a tube that carries urine from the bladder to the genitalia and outside the body. It passes right through the middle of the prostate gland. A bit of a design flaw there, methinks! When the prostate is to be removed, the urethra has to be cut on either side of it and the ends joined together. Obviously, if urine continues to flow over the wound it would not heal. Hence the need for a plastic tube to temporarily take its place, inside the urethra. So urinary incontinence is not, in my case, a product of prostate cancer per se but a side-effect of the treatment.
The good news is Cathy goes tomorrow and I will be able to pee normally again. Hooray! I will also be able to resume the pelvic floor exercises, which had to stop while I’ve been wearing Cathy. I’m going to need them too, now that incontinence is a reality. One person who will not be too put out by my incontinence is TLC, who no doubt will derive some satisfaction if pissing myself is to be the penalty for farting. It is TLC’s silver lining and I don’t begrudge her. I’ve had the joy of morphine and tramadol so now TLC gets to enjoy some peace and quite and clean air.
I am still quite sore from the surgery, though it is getting gradually better. I can get in and out of bed more easily now than two weeks ago. Mornings are the worst part of the day because the medication has worn off during the night. So I have the unpleasant routine of emptying Cathy and disconnecting the overnight bag before I go downstairs and take my meds. That’s the first order of business every day. I was never one to pop pills for every little complaint, trusting my body to repair itself when necessary. But even I must concede that pharmaceuticals are necessary at times like this. I have quite the little array of tablets to take in my morning routine.
One of them is an antibiotic I started on this week, due to a suspected bladder infection. On going to my GP, a urine test showed up a lot of white blood cells, confirming what I had thought. For several days I had the increasingly persistent feeling that I needed to pee. Despite Cathy taking care of that for me, the sensation kept getting worse. It was like when you stop urinating mid-stream and try to hold it. Well, that’s what it was like for me all the time. It was horrible, with no prospect of relief. Thankfully, though, the antibiotic sorted this out within a day and it has been much more tolerable.
Cathy’s removal will mean resumption of the pelvic floor exercises I had just started a week or so before surgery. I got more information about these exercises from a physiotherapist at the prostate cancer conference I attended at the weekend. For one thing, they don’t involve any lying on the floor – ‘pelvic floor’ is the name of the muscle itself. Everybody has it and it’s like a sheet of muscle across the bottom (or “floor”) of the pelvic region. What this muscle does is basically supplement the sphincter muscles that were on either side of my prostate gland. I lost one of those in the surgery so the pelvic floor muscle needs to be trained to take up the slack. My relatively young age should be in my favour as I train my pelvic floor muscle to take over the duties of a sphincter. With time and training, hopefully it will become second nature and I will have no issue with incontinence after a few months.
Losing Cathy is a major milestone in my treatment and recovery. It marks the healing of my urethra and near resumption of normal urinary service. It also marks the beginning of the serious work of rehabilitation. My daily walks have been hindered to a large extent by Cathy, so they will be longer and more vigorous. As the 4” wound on my abdomen heals, I will soon be able to resume weekly yoga classes in the ARC cancer support centre in Eccles Street. In the meantime, the pelvic floor exercises I had described as “tedious” before the surgery are now anything but, since the reality of urinary incontinence has begun to kick in. Motivation will not be a problem there!