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Pelvic Floor muscle training post-prostatectomy
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/
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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.
After the surgery, doing Kegel exercises occasionally worsened my incontinence. I'm not sure if the muscles became fatigued or what happened. Still, it's worth doing them.
You probably wore them out. Pelvic floor muscles wear out super fast on men because we've never had to use them as actively as women do. Lower your sets a bit if you need to - while the number of sets is important, it's more important to just be consistent in doing them at all.
For me, I know my pelvic floor is done pretty quickly. I incorporate kegels into all my normal exercises, like weight lifting and squats and kettlebell swings, so I wear them out pretty fast - usually about 30-50 reps of those things at most and they are toast for several hours.
But, because I incorporate them into other exercises, I'm pretty sure I can crush a full sized truck with those muscles at this point 😀
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2 ReactionsSurvivor thanks for still hanging around here and helping < 3. I like reading your posts - they are always upbeat and full of good advice.
I have one question - do you maybe remember what special technique your urologist used around your urethra after doing RP ? I think you mentioned that in one of your previous posts and I can not find that info now :(.
Urethropexy. It is 95+% effective in repairing stress incontinence and can impact general incontinence as well. My surgeon does it automatically during surgery and it was declined by my insurance because they require an established history of stress incontinence to approve it, so I told my surgeon I’d pay out of pocket for it - but he said he’d do it regardless of being paid by insurance because he felt it was the best way forward.
Whether it made a difference or not I can’t say since I haven’t had any incontinence, but maybe that’s why. But, since he was in there and everything is literally RIGHT THERE, there’s just no sense not doing it.
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3 ReactionsThank you Survivor : ). I will ask our surgeon (when we finally meet him) if he knows how to do it and I agree, it is absolutely worth an out of pocket expense.
If insurance guys had any common sense (or intelligence) they would not only cover that procedure but would require it ! They would save tons of money by avoiding patients coming for post op visits over and over again, than paying for PT sessions , than paying for sling or artificial sphincter surgery which I am sure would cost far more than doing "one extra adjustment" while in there ! Everything is already payed for: surgeon, nurses, anesthesiologist, technicians, operating room, recovery room, etc. , etc. Oh well, one can not straighten crooked river, I guess.
Once more, thank you very much for giving me this info. again.
Thanks....
"sometimes the burning irritation at the end of the penis is blood"
It's more of a sensation, not burning or irritation.
Thanks for replying!
you can check with your urologist
are you drinking a good amount of water? this helps flush things out and will help re-train the bladder