March 11, 2007

One of the possible and unpleasant side effects of prostate cancer treatment (or sometimes of the disease itself) is incontinence, the involuntary leakage of urine from the bladder. Most often, this problem is temporary, the result of surgery or radiation. In fact, according to Dr. S. Larry Goldenberg, approximately 95 percent of all radical prostatectomy patients will regain almost total bladder control or be left with only a minor degree of stress incontinence — small amounts of urine escaping with exertion, for example, when laughing, sneezing, or coughing.

Since 2003, researchers have suggested that men treated for prostate cancer recover bladder control more quickly if they perform pelvic floor exercises (called Kegel exercises) before and after surgery. The results of a study published that year in the Journal of Urology determined that, of the 82 percent of radical prostatectomy patients who had regained continence one year after surgery, the men educated about Kegel exercises regained continence on average one month earlier.

Kegel Exercises
So what are Kegel exercises, and how do men do them properly? The exercises simply involve contracting and releasing the muscles at the bottom of the pelvis — muscles that support the bladder. Originally, these exercises were developed by Dr. Arnold Kegel as a non-invasive way to help women experiencing incontinence after childbirth. Unfortunately, says Beverly Cleland (the Nurse Continence Advisor at the McGill University Health Centre), “The problem with Kegel exercises is most people don’t do them right. If I see 100 patients, only about 25 percent will do the exercise properly.”

How do I do Kegel exercises properly?

1. Find your pelvic muscles. To do this, tighten the muscles you would use to stop your urine flow mid-stream or to hold back bowel movements or gas. You should feel this tightening action in the area of your anus, and you should see your penis twitch and contract slightly. You can check that you are tightening the right muscles by touching the opening of your rectum to see whether it contracts when you tighten the muscles.
    
2. Stand, sit, or lie down in a relaxed position with knees slightly apart.
    
3. Tighten the pelvic muscles and hold for 5 to 10 seconds. (Remember to breath while holding the muscles tight and to keep your buttocks relaxed.)
    
4. Relax the muscles for ten seconds.
    
5. Repeat the contraction-relaxation cycle 12 to 20 times, and do each set of 12 to 20 repetitions at least three times daily. (Recommendations vary, but usually men are advised to do a set of between 10 and 20 Kegel exercises from three to five times daily.)
    
6. Do a Kegel when you feel a sneeze or cough coming on — or anytime you expect that stress incontinence might occur.
    
7. If in doubt, consult a health care professional about the correct procedure for doing Kegel exercises.

When do I start?
If you have a radical prostatectomy scheduled (or any treatment that might affect your bladder control), you can start Kegel exercises immediately to strengthen the pelvic muscles that surgery or other treatments might weaken. After surgery, you may begin Kegel exercises when your catheter is removed. Remember to start slowly and to listen to your body.

A wealth of information on Kegel exercises and on other ways of regaining continence or coping with incontinence is available from the Canadian Continence Foundation. Registration is free but necessary if you want to download this organization’s excellent publications