Mets Day 56 - PT for neobladders

I had my first appointment with the physical therapist today.  I was expecting to receive the collective wisdom of the medical community on training neobladders, how best to fully void, and all of the secret tricks to mastering continence.  I should have known better.  According to this PT, there are no one-size fits-all set of rules to neobladder training.  Each patient is different, and I need to find what works for me.

As for the tricks of draining a neobladder, the PT said that techniques include squeezing the stomach and abdominal muscles, holding my breath and lightly bearing down, relaxing all muscles and letting gravity do its thing, sitting and raising the feet to further relax the muscles, and externally pushing on where the neobladder is located.  I'd already tried most of these, and found that not all work for me.  I have found that I need to sit while voiding, since whatever muscles I'm using are no replacement for the detrusor muscle in the bladder, and the days of a strong flow are gone.  That apparently is typical of neobladder patients.

As for mastering continence, she said that would be improved by strengthening the pelvic floor muscles.  Apparently, I need to work on both the ability to stop my flow in mid-stream, and generally strengthening the duration of my ability to squeeze those muscles.  The exercise is the male equivalent of the kegel exercise - clenching, then releasing, the pelvic floor muscles.  I am to do exercised about 5 times a day consisting of a series of 10 quick clench and release (tighten for 2 seconds, relax for 4, repeat 10 times), then a series of long clenches (tighten for at least 5 seconds, then relax for 10, then repeat 10 times).  Eventually, I am to work my way up to clenching for 10 seconds.

And how do I know which muscles to clench?  She explained that the pelvic floor muscles are are not my stomach, or abdomen, or buttocks, but are instead the muscles that are used to tighten my anus.  I had the lovely experience of this PT inserting her finger in my anus and measuring how much and how long I could tighten myself around it.  She told me to clench, then relax, and then told me that I was using too many muscles.  She kept at it until I was using only the pelvic floor muscles.  It took a while to figure that out.  To paraphrase LeBron, not 2, not 3, not 4, not 5, not 6 . . .  

To give me incentive to do it right, the PT threatened me with biofeedback, in which she would insert some kind of evil-looking probe that would measure my clenching power and let me know how I was doing.  Uh, no, I'm good, I get the idea, I'm ready to go home now.   I never thought that training this neobladder would literally be a pain in the -- well, you know.

I also am supposed to keep track of when void, and each incident of leakage.  She also suggested that I keep track of how much urine I am outputting each time, so I figure out if my capacity is increasing.  She gave me a handy little chart to keep track.  I feel like I'm three years old and am back in potty training.  I hope she gives me gold star for the next visit.  If all of this helps me become continent at night, and lets me get more sleep, then it will be worth it.