Kegel Exercises: Am I doing them correctly?

Posted by tango32652 @tango32652, Jan 14 3:24pm

Would like some advice on kegels. I started doing some kegels several weeks before my RP in mid-December, and then resumed them when catheter was removed about two weeks ago. I'm experiencing quite a bit of leaking during the day and getting up around 5 or 6 times at night so that has also been a bit tough. Perhaps my age is a factor (72). So, just to clarify, I am only two weeks past catheter removal so still pretty early on. I am told regaining continence can take months, so the kegels sounded like a really good idea if it would help. I do about 100 of them a day, and was given a program by one of the pelvic floor experts at Mayo. She showed me how to do these and I THINK I'm still doing them right, but they don't seem to be helping any. When I do them, I can see my penis rise very slightly, and as she explained it's also like trying to hold back gas or stopping your urine stream. I can do all that, but I can't isolate these actions using three separate pelvic floor muscles, if that makes any sense, I can't do each of these in isolation. One movement has all three effects. From everything I see and read, that is good. But so far, I'm not seeing much benefit.
Am I doing these correctly, and how long does it usually take before you start seeing a bit of relief with the leakage?

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I was told by my Urologist to get a book called "Life after Prostatectomy and other urological surgeries: From Incontinence to Continence in 10 weeks" by Vanita Gaglani. It's available on Amazon. It is written by an experienced pelvic floor physical therapist. She is very detailed giving you a daily program to regain continence. The key is to get your pelvic floor muscles working in concert with the other core muscles (pelvic floor is part of core -didn't know that). The process also gradually weans you off pads because you can become reliant on them. Just very detailed and well written with specific daily instructions. BTW, I used probably all the major brands of pads during the process and the best, IMO, is Tena-also on Amazon. They make different sizes/thicknesses/absorbancies. I now only use the lightest, thinest pad when I go out for the occasional stress incontinence , like wile playing golf. Don't need one around the house or sleeping.
Seemed to work for me. I'm 70 years old and had a RP a little over 2 years ago. Good luck.

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@retireddoc

I was told by my Urologist to get a book called "Life after Prostatectomy and other urological surgeries: From Incontinence to Continence in 10 weeks" by Vanita Gaglani. It's available on Amazon. It is written by an experienced pelvic floor physical therapist. She is very detailed giving you a daily program to regain continence. The key is to get your pelvic floor muscles working in concert with the other core muscles (pelvic floor is part of core -didn't know that). The process also gradually weans you off pads because you can become reliant on them. Just very detailed and well written with specific daily instructions. BTW, I used probably all the major brands of pads during the process and the best, IMO, is Tena-also on Amazon. They make different sizes/thicknesses/absorbancies. I now only use the lightest, thinest pad when I go out for the occasional stress incontinence , like wile playing golf. Don't need one around the house or sleeping.
Seemed to work for me. I'm 70 years old and had a RP a little over 2 years ago. Good luck.

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Also, interestingly, most people with incontinence tend to limit fluid intake with the thought "less in, less out". She explains why this is actually opposite of what you should be doing. Limiting fluid intake eventually reduces bladder capacity which means you have to go more frequently because you feel full more quickly and it's harder to hold the urine. Also, limiting fluid intake makes the urine more concentrated which causes more leakage. I got to where I could hold 400-500 cc before I had to go without leakage. I drink a lot of water! She also discusses in detail the various foods and fluids that promote leakage by bladder irritation. Her explanations are sound and scientific which appealed to me.

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Visiting a person who is specifically trained in Pelvic Floor health is best as the person will put hands on your body, in specific private areas, to ensure that you are doing these exercises for maximum benefit!

As you lie on your back, the therapist will put finders between the scrotum and the anus to check for muscle constriction.

The therapist will also instruct you on muscle usage to empty fully the bladder.

You also must learn about your "triggers," that make you want suddenly to void your bladder. My therapist, a DPT, told me that her mother's trigger was putting her key in the door lock - immediately she felt the urge. For me, at home, it's walking into the bathroom. I feel the bladder "releasing" or something like that, and I contract to hold it in. Checking my boxers for a wet spot, I find none, thankfully. I'm not certain of the "physiology" of what I felt, but it sure felt like I was wetting my pants. I will try to remember to ask her next week - she is now working on one arthritic and misaligned knee joint. She is so good, she first worked with me to overcome Rotator Cuff surgery.

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@tango32652

Thanks for your reply. What medication do you take for bladder control? Is it over the counter?

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Prescription. Sample mybeteric 50 mg. But insurance did not cover cost @ 480 a month . It is a new drug but helped . Insurance did cover tolterodine ext witch is helping me now. It is older drug not as good but is working to help with less frequent urination.

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@colleenyoung

@jc76, I believe they do for both men and women. I would confirm and ask about a referral via the patient portal.

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Thanks!

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@maxvt

Visiting a person who is specifically trained in Pelvic Floor health is best as the person will put hands on your body, in specific private areas, to ensure that you are doing these exercises for maximum benefit!

As you lie on your back, the therapist will put finders between the scrotum and the anus to check for muscle constriction.

The therapist will also instruct you on muscle usage to empty fully the bladder.

You also must learn about your "triggers," that make you want suddenly to void your bladder. My therapist, a DPT, told me that her mother's trigger was putting her key in the door lock - immediately she felt the urge. For me, at home, it's walking into the bathroom. I feel the bladder "releasing" or something like that, and I contract to hold it in. Checking my boxers for a wet spot, I find none, thankfully. I'm not certain of the "physiology" of what I felt, but it sure felt like I was wetting my pants. I will try to remember to ask her next week - she is now working on one arthritic and misaligned knee joint. She is so good, she first worked with me to overcome Rotator Cuff surgery.

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I can say I am glad to hear about triggers but certainly explains I was not losing my mind thinking I had them. Running water causes me to need to urinate. Drinking hot coffee.

Doesn't matter if just went I get a signal to urinate.

I have been doing the kegels per instructions I found on line and the helpful post I have read on MCC. Will talk with PCP next visit to see if need to see PT. Seems to be better with less dripping prior to urnination but seems I don't get all out and some still leaks after I finish.

Again I thought I was the only one with triggers. This MCC is a great tool given to us by MCC as such things like this would never be known to me.

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@jc76

I can say I am glad to hear about triggers but certainly explains I was not losing my mind thinking I had them. Running water causes me to need to urinate. Drinking hot coffee.

Doesn't matter if just went I get a signal to urinate.

I have been doing the kegels per instructions I found on line and the helpful post I have read on MCC. Will talk with PCP next visit to see if need to see PT. Seems to be better with less dripping prior to urnination but seems I don't get all out and some still leaks after I finish.

Again I thought I was the only one with triggers. This MCC is a great tool given to us by MCC as such things like this would never be known to me.

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I heartily recommend PT with a DPT, who can feel the pelvic floor muscles, feeling between the scrotum and the anus, to provide guidance on your exercising.

IMO, ALL prostate surgical candidates should have "proper" PT for several weeks with a DPT prior to surgery. This could be a big step to building continence, and would be a big morale booster for the patient in recovery.

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I'm a little over a year since my RARP and still leak. Weighing my pads show only 10 or 12 ml leakage but my bigger concern is the feeling of wetness around my butt! All of my adult life, I've gone "commando" so the concept of wearing any kind of underwear is relatively new to my body. I almost think the wetness is more from sweat than anything else but I'm probably being.....optimistic?

Thoughts,

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