Restoring Bladder and Urinary Function
As you have undoubtedly heard, restoring bladder function revolves around regular exercise to improve the musculature of the urinary sphincter. Post-prostatectomy patients will be instructed to perform Kegel exercises, the gold standard in restoring urine control. By squeezing the muscles of the pelvic floor, and doing so regularly, patients can restore continence more quickly and more fully. Following is a step-by-step guide for performing Kegels:
1. First, find the pelvic muscles. The easiest way to do so is to pretend that you are holding back gas or trying to stop an active urine stream. If you find the right area, you will feel constriction and contraction toward the back of the pelvic area. In the beginning, it may be easier to do this while lying down on your back. Once you can routinely isolate these muscles, you should perform these exercises laying down, sitting, and standing up.
2. We must isolate these pelvic floor muscles, and we don’t use surrounding muscles to compensate. This allows your pelvic muscles to get stronger more quickly. You may not be able to do this right away, but it will get easier with practice. You should hold a muscle contraction for about 3 to 5 seconds followed by relaxation for another 3 to 5 seconds. This should be repeated 10 times. If you feel contraction in your abdomen, legs or buttocks, you may not be isolating the pelvic muscles fully.
3. Once you have the hang of it, you can increase the duration of the contractions. If you started at 5 seconds, you may now wish to hold the contraction for 10 seconds. You can also start doing more repetitions. Eventually, work your way up to 30 to 40 exercises per day. The beauty of these muscles is that they do not show outwardly, and you can perform these contractions anytime and anywhere. We suggest that you spread your exercises throughout the day.
Kegels are also helpful if you experience leakage after a cough, sneeze or laugh. This is known as stress incontinence. Try to perform some Kegels before the event – this will help you hold back urine. If you need to rush to the bathroom to urinate, doing Kegels may give you some extra time to get there.
When Should I Start Performing Kegels?
Kegels can be performed as early as two weeks before surgery and should be resumed immediately after your catheter is removed after surgery.
Beyond Kegels
Kegels are an excellent strengthening exercise for the pelvic floor and urinary sphincter. However, if you are still experiencing leakage at the first follow up after surgery, we may suggest pelvic floor physical therapy. This involves more advanced and targeted exercises that go beyond Kegels. If you have any questions about these advanced exercises, please contact Dr. Kapadia for more information.