From UCLA Urology

The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.

What Will I Learn By Reading This?

When you have prostate cancer surgery or radiation therapy the muscles that help you control your urine flow may be weakened. When this happens you may have incontinence. Incontinence is when you leak or pass urine when you do not want to. This is a very common side effect or unwanted change of prostate cancer treatment. The good news is that there is a simple exercise, called a Kegel (Keygul) exercise, you can do to help strengthen your muscles. This exercise will help you have more control over your urine flow after your prostate cancer treatment. You will learn:

What a Kegel exercise is

Why you should do Kegel exercises

How to find your pelvic floor muscles

How often you should do your Kegel exercises

It is important for you to think about and plan how you will take care of yourself before and after your prostate cancer treatment so that you can keep doing as many of your normal activities as possible.

What Are Pelvic Floor Muscles?

Your pelvic floor muscles are a network of muscles that support your bladder and help you control your urine flow. There are three pelvic muscles:

The bladder. Your bladder is a muscle shaped like a balloon and holds your urine.

The sphincter muscles. These muscles help you open and close your urethra, the tube that drains urine from your bladder. And,

The pelvic floor muscle [also known as the pubococcygeus (pu-bo-kak-sije- us) or PC muscle] supports your bladder and rectum and helps control your urine flow.

Pelvic Floor Muscles

What are Kegel Exercises?

Kegel exercises are easy exercises you can do before and after your prostate cancer treatment to help strengthen your pelvic floor muscles. These muscles help control your urine flow. Kegel exercises are one of the most effective ways of controlling incontinence without medication or surgery.

Why Should I Do Kegel Exercises?

The prostate is a gland, about the size of a walnut, located under the bladder surrounding the upper part of the urethra. The urethra is a tube that carries urine through the penis to the outside of the body. There are many muscles that surround the prostate gland. These muscles may be weakened during your prostate cancer treatment. This may cause you to have urine leakage also known as incontinence. Building up the strength in your pelvic floor muscles can help you gain better control of your bladder and urine flow. Remember, that just as it takes time to build your biceps and strengthen any other muscle in your body, it takes time to strengthen muscles in your pelvic floor.

How Do I Find My Pelvic Floor Muscles?

In order to help strengthen you pelvic floor muscles, it is important that you take time to make sure you are exercising the right muscles. It may take you several tries to find your pelvic muscles. So, take your time.

There are several ways that you can find your pelvic floor muscles. One way is to:

Try to stop and start your urine stream while you stand at your toilet to urinate (pee). Try to do this two or three times.

Another way to find your pelvic floor muscles is to:

Imagine that someone walks in to your bathroom while you are urinating (peeing) and you need to stop your urine flow.

Try to stop your urine flow.

The muscles you use to stop your urine flow are your pelvic floor muscles. These are the muscles you want to strengthen before and after your prostate cancer treatment.

How Do I Do A Kegel Exercise?

Now that you have located your pelvic floor muscles, you can exercise them even when you do not have to urinate (pee) by following these simple steps:

Tighten and hold your pelvic floor muscles for five seconds (count 1 one thousand, 2 one thousand, 3 one thousand, 4 one thousand, 5 one thousand).

Relax your pelvic muscles. You have just done one Kegel exercise. You should plan to do 10 to 20 Kegel exercises three to four times each day.

Another way to tighten your pelvic floor muscles is to:

Squeeze the muscles in your anus (like you are holding a bowel movement).

Relax your pelvic floor muscles after each attempt.

Repeat this exercise 10 to 20 times.

When you do your Kegel exercises, remember

Do not hold your breath.

Do not push down. Squeeze your muscles together tightly and imagine that you are trying to lift this muscle up.

Do not tighten the muscles in your stomach, buttocks, or thighs.

Relax your pelvic floor muscles between each squeeze.

How Often Should I Do My Kegel Exercises?

When you first start doing your Kegel exercises, you may not be able to repeat the exercise 10 to 20 times. This is ok. It is much better for you to do fewer Kegel exercises that make your pelvic floor muscles stronger, than to do more exercises that do not work the muscle in the right way. As you get better at doing your Kegel exercises, slowly increase the number of times you repeat the exercise until you reach 20. Your goal should be to do 20 Kegel exercise three to four times each day.

The great thing about Kegel exercises is that you can do them anytime you want to do them. No one can tell that you are doing these exercises. You do not need any special equipment to do Kegel exercises. You can do your Kegel exercises before you get up in the morning, at lunchtime, at suppertime, and at bedtime. You can do them while you are watching TV or reading. Some men put notes on their refrigerator or on their bathroom mirror to remind them to do their Kegel exercises. Kegel exercises can help both men and women. Some men’s partners do the exercises with them. The more you do them, the stronger your pelvic floor muscles will become.

When Should I Do The Kegel Exercises?

It can take six weeks or longer to strengthen your pelvic floor muscles so it is best to start doing your Kegel exercises before you have prostate cancer treatment. This will help you become better at doing the Kegel exercises and strengthen your pelvic floor muscles before your treatment starts. Remember, your pelvic floor muscles are like any other muscle in your body. It takes regular exercise and time to strengthen them.

Plan For Doing Your Kegel Exercises

When will you practice your Kegel exercises?

How will you get in touch with your doctor or health care team if you have questions about Kegel exercises?

Can I do Kegel Exercises If I Have A Catheter?

A catheter is a thin rubber tube placed in your body to drain urine from your bladder out through your penis. Do not do any Kegel exercises if you have a catheter in your penis.

Start doing your Kegel exercises according to the instructions above as soon as the catheter is taken out of your penis. After your catheter is removed you may experience some urine leakage (incontinence) when you stand up, cough, sneeze, laugh, or lift something. You will probably need to use incontinence pads for a while. However, doing Kegel exercises may help you control your urine flow sooner. If you have urine leakage when you stand up, cough, sneeze, laugh, or lift something, try doing a Kegel exercise. This may keep you from leaking urine.

Will My Urine Leakage Stop if I Do The Kegel Exercises?

Most men gain control of their urine leakage (incontinence) within nine to 12 months after their surgery. Studies with men show that Kegel exercises help lessen urine leakage. However, each man’s healing time is different.

Do not become discouraged if you have urine leakage. If you do your Kegel exercises on a daily basis, you can expect to see some results. You may have a great improvement or you may help keep your urine leakage from getting worse. You will need to continue doing your Kegel exercises each day so that your pelvic floor muscles stay strong.

If you have any questions or concerns about urine leakage (incontinence), how to do a Kegel exercise, or if you would like to know about other things that may help with urine leakage, please talk to your doctor or your healthcare team.

What Have I Learned By Reading This?

You learned about:

What a Kegel exercise is

Why you should do Kegel exercise

How to find your pelvic floor muscles

How often you should do your Kegel exercises.

If you have any questions, please talk to your doctor or health care team. It is important for you to think about and plan how you will take care of yourself before and after your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment.

Key Words

Anus: the opening through which stool passes out of your body. The act of passing stools is called a ‘bowel movement.’

Bladder : a muscle shaped like a balloon and holds your urine.

Bowel movement: The act of passing stool.

Catheter : a thin rubber tube placed in your body to drain urine from your bladder out through your penis.

Incontinence : when you leak or pass urine when you do not want to.

Kegel (Key-gul) exercise : exercises strengthen the pelvic floor muscles, which support the bladder and bowel.

PC muscles (also known as Pelvic floor or pubococcygeus muscles): muscles that support your bladder and rectum and helps control your urine flow.

Pelvic floor muscles (also known as the pubococcygeus (pu-bo-kak-sij-e-us) or

PC muscles): muscles that support your bladder and rectum and helps control your urine flow.

Prostate : a gland, about the size of a walnut, located under the bladder surrounding the upper part of the urethra

pubococcygeus (pu-bo-kak-sij-e-us) muscles (also known as pelvic floor or PC muscles) : support your bladder and rectum and helps control your urine flow.

Rectum: The outermost portion of the large intestine. Stools are stored in the rectum until they are passed out of the body through the anus.

Semen: The fluid that comes out of your penis at the climax of sex.

Side effect : unwanted changes in your body caused by your prostate cancer treatment.

Sphincter muscles : muscles which help open and close your urethra, the tube that carries urine and semen through the penis to the outside of the body.

Stool: the fecal matter that comes out at each movement of your bowels.

Urethra : a tube that carries urine through the penis to the outside of the body.

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