Bladder Control

[vcarkeet]

My 26 yr old son was in an auto accident 5 months ago. Along with a lot of other injuries he had a torn urethra which was reattached at the time of the acccident but unfortunately carred shut. Three weeks ago he had surgery to remove the scar tissue and again reattach. He has had a catheter since the accident. It was just removed and he is trying to deal with getting control back. He still has a super-pubic cath (capped off) as a precaution and has had to resort to using it some. It has only been a few days, but he is having a hard time urinating and getting a good "stream" and is having a lot of leakage. His doctor has not really given him any guidance in what he can do to help get his control back. He knows he did lose the lower Spincter(Sp) muscle but still has the top one and the doctor lly mentioned retraining it tocontrol urination. My question is what can my son do to help make this get better? I should mention that his other injuries were such that in this time he was bedridden and wheelchairbound, but he is now walking and trying to get back to a normal lifestyle.

[Planetoid]

Usual disclaimer!! I am a BPH patient who has had a PVP, so am by no means an expert on the types of problems your son is experiencing, but offer the following: As I understand things, the outer sphincter is the voluntary sphincter, which controls urination/micturition. Damage to this sphincter could result in blockage (poor or no flow), or leakage (limited or no control). The inner sphincter is involuntary, and its primary function is to close off the bladder during male orgasm, to direct the flow of ejaculate out the penis, vice flowing back into the bladder (retrograde ejaculation). Damage to the inner sphincter can result in deminished or no ejaculate during orgasm (dry orgasm), but usually doesn't result in incontinence; it is common during prostate surgery (RP, PVP, TURP, etc.), with the associated retrograde ejaculation resulting in fertility issues, but so long as the outer/voluntary sphincter is preserved, incontinence is not usually an issue. I was unaware that the inner sphincter could be retrained to control urination; interesting concept! Anyway, loss of control of the outer/voluntary sphincter could be addressed by surgical replacement with an artificial sphincter, or simply addressing the incontinence issues with use some sort of urine collection device (UCD), such as external cath (condom cath), Mcguire urinal, absorbant products, etc. Which works best depends on the individual and their lifestyle. I'm not certain what retraining exercises (kegals or whatever) could be effective for the damaged outer/voluntary sphincter, but certainly the uro or an incontinence nurse should be able to provide your son with options. You might try checking on one of the incon forums, such as incontinentsupport.org or incontinencesupport.org, or others; there may be someone familiar with this process who can provide advice/anecdotes. Reguarding retraining of the inner/involuntary sphincter to provide primary control, certainly the uro must have some form of therapy in mind, if he/she is talking about retraining it. Sorry this isn't much, but I hope it helps. Best wishes to you and your son for a successful search and recovery.