Kegels Exercises

Pelvic Floor Rehabilitation following Robotic Radical Prostatectomy (RRP)

Male urinary continence is maintained at two levels in genitourinary passage. First is the internal sphincter at the level of the bladder neck which is involuntary & requires no thought process from the patient. The other is the active resistance by the pelvic floor muscles at the level of the external sphincter. These muscles are under voluntary control & are in a state of perpetual contraction to provide urinary control.

Following RRP the only remaining control to urinary flow is the external sphincter. Therefore, we encourage our patients to start training this muscle prior to surgery to prepare for better postoperative urinary controls.

Dr. Arnold Kegel devised this regimen to strengthen the pubococcygeus muscles. It involves regular contraction & relaxation of the muscles of the pelvic floor. Increased muscle tone develops the necessary resistance to stop urinary leakage following RRP.

 

The correct way to do Kegels exercises!

While passing urine stop the flow. This identifies the right muscles.
Caution – only do Kegel exercises when you are not urinating. Doing the exercise while urinating retains urine & may increase your risk of a urinary tract infection.

Another technique to learn the correct way includes the placement of one finger in patients rectum. While the patient tightens the pelvic floor muscles, the rectal muscle should tightens around the finger.

If all fails the patient is asked to hold a pillow between his legs with knees folded. His partner helps by pulling away the pillow while the patient strains to retain it between his thighs. This ensures contraction of his pelvic floor & sphincteric muscles.

Caution: Don’t make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can be very uncomfortable.

If you’re having trouble finding the right muscles, don’t hesitate to ask your doctor for help.

 

The Exercise Regimen

Empty your bladder and get into a sitting or standing position. Firmly tense your pelvic floor muscles. Keep the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions eight to ten times in a row. Prior to RRP, we recommend doing at least 200-300 contractions, spread over the entire day.

Do not to tighten the muscles in your abdomen, thighs or buttocks. Focus on tightening only your pelvic floor muscles. Do not to hold your breath. Just relax, breathe freely and focus on tightening the correct muscles.Repeat throughout the day (start with 3 times a day).

Do your exercises at the same times every day to develop a regular habit. You may want to keep a Kegel exercise diary & write down how many times each day you doKegel exercises and how many repetitions you do each time.

 

Developing the Kegel reflex

Establish automatic reflex of contracting the pelvic floor muscles with any body movement which increases the abdominal pressure like standing, squatting, coughing, laughing, etc. These events increase the pressure inside the bladder and cause urinary leakage. If the pelvic floor muscles are not tightened at the right time, urine will leak! Hence the timing of the pelvic floor contraction is essential to become pad-free and leak-free (continent) following RRP. Practice before your surgery of coughing and doing the Kegel contraction at the same time. This helps immensely the early return of continence.