Pelvic floor muscle training for men undergoing/following prostatectomy

Your doctor has recommended pelvic floor muscle training (also known as Kegel exercises) in preparation for or following your prostatectomy (removal of all or part of your prostate gland). Ideally, this training starts at least one month before surgery and continues for at least 3 months after surgery.

What are pelvic floor muscles?

• The pelvic floor is a group of muscles that form the base of the “core” muscles. These muscles are in the pelvis and stretch like a hammock from the front to the back of the pelvis and from the side to side of the bones we sit on.
• The pelvic floor muscles support the bladder and bowel and have an important role in bladder and bowel control, and in sexual function.
• Urine leakage (incontinence) can happen with weak pelvic floor muscles or when you do not “switch on” (squeeze) your pelvic floor muscles in time.
• Urine leakage tends to happen when you cough or lift something because this increases pressure in your tummy. You need to use your pelvic floor muscles to close your urethra (tube that removes urine from the bladder) to stop urine from leaking out of the bladder.

How to do pelvic floor exercises

Step 1: Find your pelvic floor muscles

Watch this video to see where the pelvic floor is, what happens when you switch these muscles on and why it is important to train them:

Now, have a go at finding your own pelvic floor muscles.

• Sit or lie down with the muscles of your thighs, buttocks and tummy relaxed.
• Squeeze the muscles around the base of your penis as if you are trying to stop yourself from going to the toilet. Think “pulling in and lifting up your bladder and scrotum” or “shorten (pull in) your penis”. You may see your penis draw in and your scrotum lift up. Breathe normally. Now let go and relax this muscle.
• Squeeze and let go a couple of times to be sure you have found the right muscles. You should feel these muscles around the front passage and back passage “squeeze and lift up” inside your pelvis.
• If you cannot feel your pelvic floor muscles squeezing, try to change position e.g. seated, lying down or standing up.
• Remember, do not squeeze your thighs, buttocks or tummy or hold your breath. These muscles must stay relaxed and you need to be able to breathe whilst doing these exercises.

For other methods to find your pelvic floor muscles.

Step 2: Exercise your pelvic floor muscles

Once you can do step 1 and can switch your pelvic floor muscles on and off correctly, you can begin to exercise.

Start: You can do this exercise when lying down, sitting, standing or during activity.

Exercise: Squeeze and lift up your pelvic floor muscles and try to hold on for 6-8 seconds. Then, relax and feel these muscles let go. Rest for a few seconds. If you cannot hold for 8 seconds, then just hold as long as you can and try to increase it over time. Each time you switch the muscle on, you should squeeze as hard as you can while making sure your thigh, buttocks and tummy stay relaxed. Make sure you can breathe easily while you squeeze.

Repetitions: Repeat this exercise 8-12 times. You have now completed one set of exercises.

Do this exercise set 1-3 times a day.

As your pelvic floor gets stronger you can make the exercise more difficult over time by:

• Increasing the time you squeeze
• Increase the number of time you switch the muscle on
• Reducing the rest periods

What to look out for

• The exercises may not help if they are not done correctly or done too few times to benefit.
• The pelvic floor muscles are like any other muscle in the body: they become stronger the more you exercise. Try and do these exercises every day. It can help to find a time to practise these exercises as part of your normal routine e.g. when driving to work, watching TV, or when standing in the shower.
• Try and switch on your pelvic floor before and during sneezing, coughing or lifting.
• You can try pelvic floor muscle exercises on your own. However, you may get more benefit from seeing a physiotherapist who can guide and help you with the exercises. A physiotherapist may use an ultrasound sensor on your perineum (the area between your scrotum and your anus) to see your pelvic floor muscles and ensure you are using the correct technique. You will also be able to see these muscles on the screen in real time, which can be helpful when you can otherwise not see them.
• Pelvic-floor muscle training is considered safe. If you have urinary leakage after surgery, talk with your doctor or physiotherapist if you do not see a change in your symptoms 3 months after starting these exercises.
• Other treatment options that may help improve incontinence include general exercise, avoiding coffee and alcohol (they can irritate the bladder), limiting fluid intake at night and reducing weight, if overweight.