Do those Kegels!

Posted by kjacko @kjacko, Nov 19, 2023

I needed to discuss my current situation regarding Kegel exercises. In September I met with my surgeon for the first time to discuss my November RP. He emphasized the need to do Kegel exercises and showed me how to do them. From that point on I did them everyday. After my surgery and removal of my catheter I was told to do 2 exercises, ten reps of each, every hour. The result: I have had ZERO leakage. I decided to wear a day brief and then a night brief at bed just to be safe. NOTHING! They told me the ultimate test is when I sneezed or coughed. I sneezed: nothing again! There is no doubt in my mind that doing the Kegel exercises religiously is why I regained my continence so quickly. My advice to you is DO THOSE KEGELS!!!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Interestingly, there is more controversy about pelvic floor exercises than one would think. (My p.t. is adamant that she is not calling exercises primarily designed for and by post-partum women by the K name.)
One explanation is that it depends on how strong the muscles were (and perhaps their autonomic triggers) before we started and repetitions are ineffective at changing that.
Another explanation is that they are hard to learn and coach. My PT doctor (yes, they generally get doctorates of physical therapy now if they have a terminal degree) gave me two physical exams to actually measure the strength of the squeeze/maneuver internally, one before for a baseline and one afterward. Weird but not really intolerable, especially with my wife in the room. Since we're looking for an autonomic action/reaction, it is quite hard to tell by looking at external cues of any kind.
A third explanation is that the muscle strength/conditioning is not only one of various factors, but also the muscles can be overtight as well as too loose. It's postpartum women, after all, for whom the pelvic exercises are primarily designed, and they have a very different type of trauma which involves muscle injury, not surgery and nerves. I suspect, but don't know, that my ongoing nuisance-level pelvic floor pain might have to do with overtight muscles always on alert?
A fourth explanation is that post-RP men are all dealing with a variety of nerve-sparing and nerve-traumatizing particulars, which we can't see from the outside and don't have any way to compare, so there is no "normal" population of post-RP men.
So what do I take away?
1) I'm glad I had so little incontinence, but I can't really take credit for it other than drinking lots of water as instructed and taking initiative to find and go to a pelvic floor specialist PT before the actual RP.
2) I only wish the erectile function nerves had been similarly successful, and I have no idea why they weren't?!
3) Nerve-sparing is a goal, not a specific outcome. I'm thankful surgeons figured it out and it's become common. Surgeons these days can actually tell you on a 1-4 scale how much nerve sparing they think they accomplished if you ask, but apparently since it's always imperfect reporting about the degree of failure is not considered good client relations?!
4) We can all be respectful and appreciative of each other's journeys, even as they vary in such important respects. Also, does anyone want a large bag from Costco of men's briefs, of which I used only one or two ;-). All things considered, I'd rather have the unused bag than the alternative, and where your experience has differed, you have my empathy no matter the details.

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Great thread. I kind of have fallen into a gap w/urologist but that's a bigger post.

My Q is, beside K's do you have any other observations / recommendations? I read where the underwear makes a difference (snug vs loose)

I am driving ~8hrs to/from my RARP so tips for comfort in this leg of the journey is esp. welcome.

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@web265

Not really advice so much as what I've read over time. Although kegels absolutely help a lot of folks, myself included. Sometimes, according to reading I've done, it comes down to how much, if any, damage is done around the prostatic apex during the surgery.

Here's one article that gives a quick explanation of some research done in this regard.
https://pubmed.ncbi.nlm.nih.gov/7815577/
" Injury to these nerves may explain several features of post-prostatectomy urinary incontinence."

There are links to other articles there which may have more information, possibly there'll be some info there folks can use.

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Thanks 'web265' for that link. Very helpful. Since my prostrate was quite large it's probable that I had nerve damage contributing to my total incontinence. Now I have an Artificial Male Sphincter and it works well. No leaks as long as I don't try to wait too long after the urge.

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@perrychristopher

Hard to explain Kegels. I am sure your doctor would write a script for you to have several weeks of PT with a Pelvic Floor physical therapist. They will actually connect a probe to you and verify the kegels are being performed properly. It is more of a feel thing than an exercise. Also the therapist will likely set you up on a program to do more traditional very light exercises that strengthen your pelvic floor muscles. I added them to my gym routine for a few months. Now I just do a few minutes of Kegels each morning. Good luck with everything and definitely ask for a script for PT. You won't regret it.

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perrychristopher, I am going to do what you recommended. I tried to research but really could not understand the process.

Mayo Jacksonville has a very good PT section and meeting with my PCP soon so will asked for the PT referral.
Thanks
jc76

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If helpful, I met with a urologist at Mayo recently and asked his recommended approach to Kegels. He tells his patients to squeeze for as long as then can, then release, and count to 10. Do the same thing 10X, 3X a day. It seems to be helping verses the prior way I was doing them (hold for 3 seconds, release, and do 10X 4-5 times day). Although I definitely saw benefits from each approach. It terms of squeezing the cheeks, I have always done them whereby you squeeze as if you are trying to stop a hypothetical urine stream.

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@jrobitai

Great thread. I kind of have fallen into a gap w/urologist but that's a bigger post.

My Q is, beside K's do you have any other observations / recommendations? I read where the underwear makes a difference (snug vs loose)

I am driving ~8hrs to/from my RARP so tips for comfort in this leg of the journey is esp. welcome.

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As I stated earlier, I had no incontinence issues after my RP. However, just to be safe, since it has been less than a week since I had my catheter removed, I wear briefs during the day and an evening brief when in bed. I also wore a pad on two different occasions. I would high recommend briefs. They are easy to use and always fit comfortably. I purchased Depends brands at Target. Pads didn’t fit as comfortably and you had to have pretty snug underwear to make sure they fit snuggly. Good Luck!

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@kjacko

The easiest way to explain a Kegel is to squeeze your cheeks. DO NOT use your stomach. I do a set of ten quick ones and then a set of ten where you hold each one for 3-4 seconds. After my catheter was removed I did them every hour I was awake. As soon as I finished my two sets I set my timer for 1 hour so I never forgot.

You can also go on-line and type in Kegel exercises and many sites and demonstrations come up. The ones I described were recommended by my surgeon. Best of luck to you. KJ

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My wife yelled at me. “You don’t squeeze your cheeks!”
She said, “tell them to ask their wives”. I’ll explain it another way: try to shorten your penis by pulling it in toward your body. You will also feel it in your sphincter.
Do not use your stomach. Hope this helps

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@jc76

perrychristopher, I am going to do what you recommended. I tried to research but really could not understand the process.

Mayo Jacksonville has a very good PT section and meeting with my PCP soon so will asked for the PT referral.
Thanks
jc76

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You're welcome. I'm sure the PCP will give the script but if any issue your Urologist certainly will. That's where I got mine from.

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@jc76

kjacko, I have seen many post talking about Kegel exercises. I am not familiar with them. Can you explain what they are and how to do them or recommend at web site that gives that information?

I had 30 rounds of proton radiation for my prostrate cancer. I experienced increased need to urinate, urgency, and leaking. Most of that has improved but I have read the post of how much these help and would like to do them.

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I heard an Aussie PT use the phrase "Pull your nuts up to your guts."

Alsp, work for slow and fast...eg 10 x holding for 10 sec each then try to do 10 x fast within 10 sec.

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@trusam1

I heard an Aussie PT use the phrase "Pull your nuts up to your guts."

Alsp, work for slow and fast...eg 10 x holding for 10 sec each then try to do 10 x fast within 10 sec.

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That’s perfect. I’m going to use that phrase if anyone asks. Health and happiness!

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