Urinary incontinence, or loss of urine, is a common side effect which occurs in males after surgery for prostate cancer like a prostatectomy (removal of your prostate) or radiation therapy. Surgery can cause damage to the nerves and muscles around your bladder making bladder control difficult.   

Two common types of urinary incontinence that commonly occur after prostate surgery are:

• Stress incontinence: this leakage often occurs with coughing, sneezing, lifting, going from sit to stand or when turning in bed.  Leakage occurs because of increased pressure in your abdomen which pushes down on the weak pelvic floor muscles that are not yet strong enough to hold urine.
• Urge incontinence: this is when you feel a sudden need to urinate right away and lose urine before you can make it to the bathroom.  This is also often referred to as overactive bladder. 

Because the internal urine valve that helps control urine has to be removed as part of prostate surgery, only the external valve that remains is present to control urination.  In order to have good bladder control after surgery, both your pelvic floor and nerves have to work well.  

This is where pelvic floor physical therapy can be a wonderful addition to your rehab both before AND after prostate surgery to help get your bladder control back as well as your quality of life.  While the time it takes varies from person to person on how long it takes to get continence back, you can take a proactive approach with specific exercises for the pelvic floor and deep abdominal muscles to get back bladder control.

While Kegels (pelvic floor muscle contractions)  are one of the most common exercise prescribed usually with a handout from a physician,  men seen post surgery are doing them incorrectly 100% of the time.  Why?  It is because they are not thinking about or taught about how they are breathing when they performing the Kegels.

Breathing is a foundational exercise in all pelvic floor therapy.  It is so important because it helps move and relax the pelvic floor which is crucial for a successful, strong contraction of the pelvic floor muscles.  If you don’t have good movement in the pelvic muscles, you won’t regain full strength in the pelvic muscles for bladder control.

Breathing exercise:

Lie on your back with your knees bent.  Place hands on the sides of your ribs.  Inhale through your nose, filling your lungs with air and expanding your ribs into your hands.  Exhale through your mouth with lips and jaw relaxed.  Goal is a 4-5 second inhale and 4-5 second exhale.  Do 10 breaths morning and night while lying in bed.

Once you understand the breathing, then you add the pelvic contraction (Kegel) on your EXHALE.  This often sounds counterintuitive to most people, but exhaling takes pressure off your pelvic muscles which allows them to contract correctly ultimately increasing their strength for improved bladder control.  You may also feel the contraction of your pelvic muscles better when you breathe.   Try to spread  your Kegels out during the day, as too many at once can fatigue the muscles decreasing their effectiveness.  In 3-4 weeks you should start to see improvements in bladder control.  If not, talk to your physician to see if pelvic health physical therapy is right for you.