All patients experience some incontinence after radical prostatectomy surgery. Urinary incontinence ranges from leaking a small amount of urine to having no sense of urge control. You may need to use pads and/or disposable absorbent underwear until continence improves. Strengthening the pelvic floor muscles may help decrease urinary urgency and incontinence. Pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. Pelvic floor muscles exercises are also called Kegel exercises. These exercises consist of contracting and relaxing the muscles that form part of the pelvic floor.
You must exercise the correct muscles to ensure optimal success. Sit in a chair with your knees slightly apart. Imagine you are trying to stop gas escaping from your rectum. Squeeze the muscle just above the entrance to the rectum. If you feel a pulling sensation in your buttocks and rectum, then you are using the right muscles. Hold the squeeze for 10–15 seconds each time. It can be very easy for men to ensure they are doing the appropriate pelvic floor exercises. You should see a slight lifting up movement in the penis when contracting your pelvic muscles appropriately. It is the same movement you would see when you abruptly stop urinating. You should not be tightening your buttocks or stomach. You can initially practice the Kegel movement by interrupting your stream while urinating, to ensure you have the right muscles isolated. However, Kegels should not be routinely done while urinating as this can lead to infection. You can practice by standing sideways in front of a mirror while practicing Kegel exercises to ensure you are doing it correctly.
Initially, the quality of the Kegel exercises is more important than the quantity. You should do each Kegel exercise by holding the squeeze for 10–15 seconds and then relaxing for the same duration. You should do this 15–20 times to complete one set of Kegels. We recommend you do 3–4 sets over the course of each day.
All participants enrolled in Prostate 8 will be at least 3 months post-surgery (if choosing radical prostatectomy for treatment), but keep in mind that you should not practice pelvic floor exercises while a Foley Catheter is inserted, as it can cause some discomfort, and trigger bladder spasms. If your urine stream is weak, doing the pelvic floor exercises may increase inflammation and cause you to go into urinary retention. The key point is that it is important to have a strong urinary stream before starting Kegels.
It takes time, effort and practice to become good at these exercises. You should start to see benefits after a few weeks. However, it often takes approximately 8 weeks for most improvement to occur. Excessive amount of Kegels can lead to muscle fatigue, and urine leakage.
A lower number of long contractions is ideal (e.g., 15 second hold 40 times a day). If you are unable to hold the contraction for 15 seconds, then do a shorter number of contractions but increase the amount (e.g., 5 second hold 100 times a day).
For those of you who might benefit from an app, we’ve developed a product Kegel Nation. See http://urology.ucsf.edu/news/all/201601/ucsf-urologists-develop-kegel-app#.V1Bv28clbSE