Continence Following Prostatectomy

By Dr. Brooke Meinema, DPT, FAFS

While there may be many things beyond your control when it comes to having a prostatectomy, focusing on the things you can control can be helpful. Most men undergoing surgery to remove the prostate have been informed they may have reduced urinary control, which can result in leaking. There are multiple factors in charge of bladder control, some of those factors being pelvic floor strength and muscle function as well as pressure management and breathing coordination. Working on these factors both before and after prostatectomy can help reduce issues with incontinence following the procedure.

What are pelvic floor exercises:

The muscles within the pelvic floor work to allow continence as well as sexual function. Just like our other muscles, these muscles can be trained to have improved strength and endurance to better function. Early-on exercises, such as Kegels, are meant to be gentle pelvic floor contractions, not necessarily squeezing as hard as you can. As you progress along your journey, exercises may get more demanding and physically involved such as lifting, jumping, running, or whatever other activities you are hoping to return to.

How do I know what muscles to contract

Acquaint yourself with the muscle groups you are contracting.

1. Contract the muscles you would use to stop the flow of urine and squeeze.
2. Lift the testes aka “nuts to guts” as well as “shorten the penis”
3. Tighten the muscles around the anus as if you are trying to prevent passing gas.

To start, you may need to perform these in sitting with shorter holds and fewer reps before building up from there. The goal is to be able to do higher reps (some studies suggest doing 120 contractions a day!) of these contractions in upright standing as well as fast twitch contractions (going for speed) and short, sustained holds. Not only are these muscles important for continence, but studies have shown a reduction in erectile dysfunction by doing these muscle contractions!

When do I start

You should work on these contractions before surgery to improve strength and endurance and set yourself up for success following the procedure. That being said, it’s never too late or too early to start!

Abdominal pressure management

Most urinary leakage occurs with upright activities and poor abdominal pressure management. To avoid this, make sure you are breathing during activities and exercise as holding your breath increases pressure in your abdomen and pelvic floor and can lead to worsened urinary control. When exercising or doing a hard task: exhale on exertion. During the heavy part or when you would normally strain, make sure you exhale. Similarly, before coughing or sneezing try to take a deep breath. This allows your diaphragm to take more of the pressure and less strain will occur on your pelvic floor allowing for greater urinary control.

Bladder irritants

Certain foods and drinks can lead to increased leakage including, but not limited to: coffee, tea, carbonated beverages, alcohol, acidic foods and drinks, spicy foods, artificial sweeteners, etc. It can be helpful to assess your diet to cut out potential irritants if you are continuing to experience leakage.

*For further info on this, see my previous blog titled “Are your favorite summertime drinks irritating your bladder?”

Returning to sport/exercise

Studies have shown that men who are physically active have better outcomes following surgery than those who are sedentary. That being said, it is important not to rush back into higher-intensity exercise without proper conditioning, coordination training, and permission from your provider. Going back to exercise too soon can lead to potential complications. If you have specific goals for returning to exercise, working with a pelvic health physical therapist can help you meet these goals safely!

Questions? Connect with a pelvic floor physical therapist!