Pelvic Floor muscle training post-prostatectomy

Posted by edinmaryland @edinmaryland, Mar 13 12:43pm

I hate incontinence and have been spending some time researching treatment
one issue that has come up has to do with how many Kegels a day (not to mention, form, relaxation, methods, using a trained PT etc_)
I really like Michelle Kenway and , Vanita Gagliani They have some very good advice and tips

but they both recommend between 50 and 100 kegels a day

. My PT who specializes in Pelvic Floor muscle therapy told me to slow down, get my technique right, besides learning to activate and strengthen it is equally important to learn to relax and de-activate. She has me doing less than five long ones and ten short ones twice a day. Not once did I see this recommended in the literature. But it makes sense/ However, I wanted to find out if there was an authoritative recommendation. it turns out -seemingly- there is not.

Most recommend several sets, some advocating doing sets every hour when possible. The variance is significant.

In the only non-commercial study I found only one big study titled: Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions
(this is a Pubmed publication from the Frontiers in Oncology )

I found this paragraph near the end

The pelvic muscle floor training (PMFT) is the first treatment to offer to patients with UI after RP.23 However, a standardized regimen is not yet available. Various studies observed significant differences among the PMFT regimen adopted: number and duration of contractions, session frequency per day, and the presence or absence of therapist. Manassero et al used 15 contractions repeated 3 times per day,118 whereas Patel et al proposed 10 contractions lasting 10 sec.115 Filocamo et al used 10 contractions lasting 5 sec with 10 sec of muscular relaxation 3 times a day.119 Nilssen et120 al and Overgard et al121 used 10 contractions lasting 6–8 sec followed by 3–4 fast contractions. A specific procedure for PFME after radical prostatectomy is needed because this would reduce the heterogeneity of the data.

It makes sense to avoid over-training. For those like me, if you told me the more I do the faster I would get better, I would try to break a record (and likely would break something internally)
Like strength training or perhaps learning to swim a new way. technique, slow progression, attention to rest have to be part of the rehab.

I wish I could take a pill, do 1,000 push ups and put a dent in incontinence, but in the meantime, I am sticking with being careful and following professional counseling. even the scientists do not yet agree on frequency.

The article can be found at https://pmc.ncbi.nlm.nih.gov/articles/PMC9851058/

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

survivor5280 | @survivor5280 | Mar 13 1:36pm

I've read a lot of sources talking about pelvic floor work and some of them are very inaccurate. Not only do you not want to do that many in a day, but you need to learn to do them properly before you do them at all or you can prolong the problem or make it far worse, perhaps uncorrectable.

The one thing I keep telling people across these sites I post on is that it's more important to do them right than to do them a lot. There is a wrong way and it's harmful, particularly if your goal is to prevent/fix incontinence rather than use pelvic floor exercises to improve sexual function.

My routine for four months prior to surgery was 3 times a day I would do a couple 10 rep sets of quick engagements of 1 second, one set of long engagements of 10 seconds and a few sets of partial engagements (the one that is what is actually used to squeeze off the urethra). Then when I did workouts I would engage with core exercises, such as squats and kettlebell swings - this is what I credit my extremely health pelvic floor with because that strengthened it significantly whereas the daily routines were just to train it to engage and disengage.

edinmaryland | @edinmaryland | Mar 13 3:13pm

Thanks Survivor
How long were you incontinent post prostratectomy?

survivor5280 | @survivor5280 | Mar 13 3:45pm

In reply to @edinmaryland "Thanks Survivor How long were you incontinent post prostratectomy?" + (show)

Zero seconds. I never had a single drop of incontinence nor any ED, I had an erection hours after surgery - uncomfortable with a catheter but almost happy to tears when it happened. Even my urologist told me that it was super rare to have an erection that fast, even with nerve sparing (which I was mostly spared, and that is key).

edinmaryland | @edinmaryland | Mar 13 3:47pm

I really am happy for you and appreciate you staying on this list even though you are continent
do you do kegels differently for ED versus incontinence?

survivor5280 | @survivor5280 | Mar 13 3:50pm

In reply to @edinmaryland "I really am happy for you and appreciate you staying on this list even though you..." + (show)

No, you shouldn't because right is right and wrong is wrong, but many people just do partial Kegels for sexual endurance (not orgasming as fast). But for ED in general, I would say both need to be equal as there are two primary pelvic floor muscles, four in total and they are connected to all your core muscles. On men they are the most underworked muscles, typically.

I'm not a doctor, consult a pelvic floor therapist for definitive answers, but I hammered my floor repeatedly and properly and came out unscathed. I had nerve sparing surgery, and I was on tadalafil 5mg for a month ahead of time and even took L-Citriline supplements on the advice of the penile therapist (another urologist) because "it might help but absolutely won't hurt".

edinmaryland | @edinmaryland | Mar 13 5:15pm

In reply to @survivor5280 "No, you shouldn't because right is right and wrong is wrong, but many people just do..." + (show)

Thanks so much
I am mainly focusing on incontinence.
I am seeing my pelvic floor therapist tomorrow. My big deal is that for pretty much 6 weeks I have the constant urge/feeling that I need to urinate even after just emptying. This is very difficult as I am thinking about it all the time. I also have stress incontinence so getting up sometimes just walking causes leakage. So I have to think about leaking and I have to try not to think about emptying my bladder. The stress incontinence many times compromises my bladder training. I am supposed to shoot for every two hours, however if I am moving around some days, my bladder is not even getting partially full
My urologist prescribed gemtesa to help and I sure hope it does. Meanwhile, I will stay with the program and hope I can turn a corner in the weeks ahead.
I had the robotic assisted prostratectomy so hopefully I am one of the ones that gains continence but it just takes time. Being over 70 means things take a bit longer to heal I would rather have a broken leg but the good news is that this is better than cancer spreading

survivor5280 | @survivor5280 | Mar 13 5:24pm

In reply to @edinmaryland "Thanks so much I am mainly focusing on incontinence. I am seeing my pelvic floor therapist..." + (show)

I'm sure age plays a big factor in regaining continence, and pelvic floor therapy will help with stress incontinence as well. My therapist had me proactively train myself to engage my floor when standing from a seated position and when sitting from a standing position since those are the most frequent things we do and in doing that regularly we start to train our body to engage automatically for things like sneezing or lifting too.

Regarding the bladder urgency, I was prescribed oxybutynin as a short term solution and mostly as a preventative measure since most men experience this to some degree right after RARP. This was mostly to overcome the changes to your body that cause this right after surgery and I was warned to wean off them as soon as possible as your body can become reliant upon them to prevent urgency. I got off them after a couple days because I feared this side effect but it might be something worth exploring as a short term relief as you train your body to deal with the new normal - or at least a discussion to have with your urologist.

edinmaryland | @edinmaryland | Mar 13 6:22pm

In reply to @survivor5280 "I'm sure age plays a big factor in regaining continence, and pelvic floor therapy will help..." + (show)

Re bladder urgency this is exactly one of my concerns about gentesa. I do not want a medication taking care of my bladder when time and healing should be doing that. I am hopeful that the Gentesa will help act as a bridge, maybe give me a little relief as I work on pelvic floor training and bladder training , I am right with you I want off of it as soon as possible. I want my system to be as close to it how it was prior to surgery. I guess this is uncharted territory as there are many factors ( how really close the surgery stayed to the prostrate, how I heal given my age, ) on top of that use of Gentesa is relatively new- it is approved by the FDA but there do not seem to be any studies for post-prostratectomy incontinence treatment. I was hesitant to take it but I need to get my bladder trained

I appreciate the tips about getting up out of chair and I am working on that. These little tips help.I know one thing I was doing wrong was holding my breath when there are problems which is the opposite of what I need to do with pelvic muscles, I need to relax and exhale as I get out of chair or lift something. Prior to surgery, I was climbing on roofs, going for two hour walks, riding an exercise bike every day,playing with lots of grandchildren, working fie days a week now I am just trying to get back to something like my old normal

I am optimistic as it seems many males start to turn a corner around the three and four month mark which for me, is April-May
thanks survivor

frankjohnson1 | @frankjohnson1 | Apr 2 10:34am

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.

edinmaryland | @edinmaryland | Apr 2 11:28am

In reply to @frankjohnson1 "I had prostate removal 2 weeks ago at Celebration clinic, Dr Patel. I am disturbed with..." + (show)

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