Pelvic floor exercises — commonly called Kegels — strengthen the muscles that control urination. They are the single most important thing you can do to improve urinary control after prostate cancer treatment, especially after surgery. Ideally, start these exercises before treatment.
What Is the Pelvic Floor?
The pelvic floor is a group of muscles that stretch like a hammock from your pubic bone in front to your tailbone in back. These muscles:
- Support your bladder and bowel
- Help control urination (starting and stopping the stream)
- Play a role in erectile function
- Help control bowel movements
After prostate surgery, the internal sphincter (which was part of the prostate) is removed. Your pelvic floor muscles and external sphincter must take over the job of keeping you dry.
Finding the Right Muscles
Method 1 — Stop the stream:
- While urinating, try to stop the flow mid-stream
- The muscles you squeeze to do this are your pelvic floor muscles
- Do this only once to identify the muscles — do not practice Kegels while urinating regularly, as this can cause problems
Method 2 — The "elevator" technique:
- Imagine you are trying to stop yourself from passing gas
- Squeeze and lift those muscles — you should feel a tightening and lifting sensation around your anus and urethra
- Your abdomen, buttocks, and thighs should stay relaxed
Method 3 — Mirror check:
- Stand in front of a mirror
- Try to lift your penis and scrotum without using your hands
- If you see movement, you are using the right muscles
Common mistakes:
- Holding your breath — breathe normally throughout
- Squeezing your abdomen, buttocks, or thighs instead of the pelvic floor
- Bearing down (pushing) instead of lifting up
- Doing too many too fast before building strength
The Exercise Program
Phase 1 — Learning (Weeks 1–2):
- Squeeze and hold for 3 seconds, then relax for 3 seconds
- Repeat 10 times
- Do this 3 times per day (morning, afternoon, evening)
- You can do these lying down, which is easiest
Phase 2 — Building (Weeks 3–4):
- Squeeze and hold for 5 seconds, then relax for 5 seconds
- Repeat 10–15 times
- Do this 3 times per day
- Try doing some while sitting
Phase 3 — Strengthening (Weeks 5 and beyond):
- Squeeze and hold for 10 seconds, then relax for 10 seconds
- Repeat 10–15 times
- Do this 3 times per day
- Practice in all positions: lying, sitting, and standing
Phase 4 — Functional training:
- Practice "the knack" — squeeze your pelvic floor just before and during activities that cause leakage:
- Before standing up from a chair
- Before coughing or sneezing
- Before lifting something
- Before laughing
- This pre-contraction protects against stress leakage
Quick Flick Exercises
In addition to the long holds above, practice quick contractions:
- Squeeze and release as quickly as you can
- Repeat 10 times
- Do this after each set of long holds
- These train the muscles to react quickly when you cough or sneeze
Daily Schedule Template
| Time | Position | Long Holds (seconds × reps) | Quick Flicks (reps) | Done? |
|---|---|---|---|---|
| Morning | Lying in bed | sec × reps | ___ reps | □ |
| Midday | Sitting at desk/chair | sec × reps | ___ reps | □ |
| Evening | Standing | sec × reps | ___ reps | □ |
Weekly Progress Tracker
| Week | Hold Duration (sec) | Reps per Set | Sets per Day | Pads per Day | Notes |
|---|---|---|---|---|---|
| 1 | |||||
| 2 | |||||
| 3 | |||||
| 4 | |||||
| 6 | |||||
| 8 | |||||
| 10 | |||||
| 12 | |||||
| 16 | |||||
| 20 | |||||
| 24 |
Tips for Success
- Start before surgery or radiation if possible — stronger muscles recover faster
- Be patient — improvement is gradual; most men see significant progress by 3–6 months
- Make it a habit — link exercises to daily activities (after brushing teeth, at red lights, during TV commercials)
- Do not overdo it — more is not always better; muscles need rest between sets
- Stay consistent — daily practice is more important than doing many at once
- Track your pads — decreasing pad use is the best measure of progress
- Consider pelvic floor physical therapy — a specialist can use biofeedback to ensure you are doing the exercises correctly; this is especially helpful if you are not improving after 6–8 weeks
When to Seek Professional Help
- No improvement after 2–3 months of consistent exercises
- Unsure if you are doing the exercises correctly
- Leakage is severe and not improving
- Pain during exercises
Your doctor can refer you to a pelvic floor physical therapist who specializes in men's health. These specialists use biofeedback (sensors that show you on a screen when you are squeezing the right muscles) to optimize your technique.