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Pelvic Floor muscle training post-prostatectomy

Prostate Cancer | Last Active: Apr 5 8:35am | Replies (19)

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@frankjohnson1

I had prostate removal 2 weeks ago at Celebration clinic, Dr Patel. I am disturbed with the incontinence. Nothing makes sense. I never feel my bladder being full or empty. I have sensitivity toward the end of my penis when I start leaking, and it seems as if urine goes into my bladder, then right into the penis. As soon as I stand up, I can feel the drainage through my penis.

When I do Kegel exercises, I feel the penis flinch with tickle like sensation, usually with leakage. WTH. I have been walking 2 miles a day, and trying Kegel exercises each day throughout the day.
Im not sure how I could be doing the exercises wrong. Seems like you could only do it one way.

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Replies to "I had prostate removal 2 weeks ago at Celebration clinic, Dr Patel. I am disturbed with..."

1. sometimes the burning irritation at the end of the penis is blood, it may be very faint but that was what I experienced. I passed blood for up to two months off and on. Sometimes this corresponded to days in which I was trying to do more

2. two weeks is very new in my experience. You will find some men have zero problems with incontinence however from what I have come across most do. Two weeks is not much. I am 71 and am 11 weeks out. I i have stress and urge incontinence. I have seen some progress for which I am thankful but I have quite a ways to go.. I hate it but it is better than cancer

3. in terms of Kegels I love going to a specialist and getting very good expert care . I am paying out of pocket for this but I hate incontinence so much. It really is important to learn how to do them correctly and not to do too many. You may want to check out Michele Kenway's you tubes She has many; here is one to get you started: https://www.youtube.com/watch?v=c0aDJrSiR1A
please be aware that even in the field of urology there is no agreed upon recommendation for how many sets of kegels to do a day. I have heard enough and believe it very much, that you can do too many. I really recommend resisting the urge to do a ton of them. Right now I am doing some very specialized sets of 5 staggered, 5 regular (longer hold) and 10 quick ones X4 I do this twice a day plus stretching and core training all aimed at pelvic floor recovery. In my experience I can sometimes feel that my pelvic floor muscles are tired and sometimes even stuck ( not relaxing all the way). If you get the chance and get to an experienced pt with pelvic floor muscle expertise, biofeedback can help

4. you will also have to retrain your bladder. I was told to start with two hours if possible. In other words I try to hold it and go every two hours regularly- while drinking more water than usual and then try to increase this incrementally., I stop drinking water around dinner time to limit problems at night I am not offering medical advice just my own experience as a patient.

5 I hate incontinence however, what choice do we have? , it is better than cancer and for most men it will go away- but not all. There are more factors like the surgery itself, our conditions prior to surgery, etc

6. I really wish more urologists would alert patients that this likely lays ahead ( and ED). life will likely be different following prostratectomy, From the good research (from pubmed and not urology clinics or practices but from peer-reviewed research)- absolutely the majority of men experience incontinence, many resolve between 3 and 18 months; of course some do much better and unfortunately some have long term issues.
I wish you good luck

There is a wrong way, and it can be damaging. I assume you are seeing a pelvic floor therapist? If not, you should consider doing it.

A couple ways to describe proper engagement of BOTH front and back muscles:
- "Nuts to guts" - when you engage you should feel your testicles pull in towards your belly button and if you do this when standing, say over a toilet, you should actually see your penis and testicles pull in (front pelvic muscles)

- "Stopping the stream" - this is the most common analogy for front pelvic floor work, but it takes a very tiny amount of effort to actually do this. The above method is far better. You will use the lighter method as you mature in your exercises as this smaller method is what is used to stop the flow. This "Stopping the stream" method is not what you should focus on until you master "Nuts to guts".

- "Pinch a loaf" / "Stop a fart" - This engages the rear pelvic floor. Your butt should NOT move or clinch during this, put your hands back there to verify. It will SEEM like your butt is clinching but really it should only be pulling your anus in towards your stomach, feeling that your cheeks don't clinch is how you know you've done it properly.

Releasing is also massively important. If you fail to learn how to properly release you can actually cause more problems. You should always release for the same amount of time you engage - and you should never engage more than 15-20 seconds ever. To guarantee a release, take a long slow deep belly breath in, this forces the pelvic floor to relax, then let it stay relaxed for at least as long as you engaged it.

You should be able to work BOTH front and back simultaneously and effortlessly. Don't focus on just the one you think is more important, you want ALL of your floor healthy, not just part of it. One way to start getting muscle memory is engage front and back each time you stand and each time you sit - the more you do this the more you learn to auto engage for other things like lifting.

While there are varying studies on what is too few or too many of these, the generally accepted practice is to do do 10-12 quick engagements (1-2 seconds), followed by 3-5 long engagements (10-15 seconds). Think of the first as a pulse and the second as a hold. This set of 10 + 3 (or 12 + 5) done 3-5 times throughout the day should improve your pelvic floor health.