Pelvic floor exercises are often thought of as something for women, but they are just as important for men. After prostate cancer surgery, they are one of the most effective ways to regain bladder control. They can also help with dribbling after passing urine and with some erection problems.
What the pelvic floor is
The pelvic floor is a layer of muscles that stretches from the pubic bone at the front to the tailbone at the back. It supports the bladder and bowel and helps control the flow of urine.
After a robotic prostatectomy, the prostate is no longer there to help hold urine in. The pelvic floor muscles, together with the urethral sphincter, have to take over. Strengthening them helps this happen sooner.
Step 1: find the right muscles
It is important to exercise the right muscles. Try these methods:
- Stopping wind: imagine you are trying to stop yourself passing wind. Squeeze and lift the muscles around the back passage.
- Stopping the flow: imagine you are trying to stop the flow of urine midstream. You should feel a squeeze and lift at the base of the penis.
- The mirror test: standing in front of a mirror, tighten the muscles. You should see the base of the penis draw in and the scrotum lift slightly.
Do not regularly stop your flow while passing urine as an exercise, as this can affect bladder emptying. Use it only once or twice to find the muscles.
Step 2: check your technique
While squeezing:
- keep breathing normally
- do not tighten your buttocks, thighs or stomach
- do not hold your breath or push down
If you are unsure, a specialist physiotherapist can check your technique.
Step 3: slow squeezes
- Tighten your pelvic floor muscles and lift.
- Hold for up to 10 seconds, or as long as you can.
- Relax fully for 10 seconds.
- Repeat up to 10 times.
Start with a shorter hold if 10 seconds is too long, and build up.
Step 4: fast squeezes
- Tighten your pelvic floor muscles quickly and strongly.
- Let go straight away.
- Repeat up to 10 times.
Fast squeezes help the muscles react quickly to sudden pressure, such as a cough or sneeze.
Step 5: make it a routine
Aim to do a set of slow and fast squeezes three times a day:
- lying down at first
- then sitting
- then standing, which is harder
Linking the exercises to daily habits, such as brushing your teeth or waiting for the kettle, helps you remember.
Step 6: use them in daily life
Once you are confident, tighten your pelvic floor before activities that can cause leaks:
- coughing or sneezing
- standing up from a chair
- lifting
- bending
This is sometimes called "the knack".
Before and after surgery
Many surgeons recommend starting the exercises several weeks before prostate surgery, so you know how to do them. Our preparation checklist includes this. After surgery, do not do the exercises while the catheter is in. Restart once it has been removed, as advised by your team.
How long it takes
Improvement is gradual. Many men notice a difference within a few weeks, with continued progress over several months. Keep going even if progress feels slow. Our guide to recovery after robotic prostate surgery explains the typical timeline.
Other benefits
Pelvic floor exercises may also:
- reduce dribbling after passing urine
- help with urgency
- support erections, as the muscles help maintain blood flow in the penis. Our article on regaining erectile function explains more.
Getting extra help
If leakage is not improving after several months, ask your team about referral to a specialist pelvic floor physiotherapist. Prostate Cancer UK and Bladder and Bowel UK both publish clear guides.
Professor Prokar Dasgupta and his team support men with continence recovery at The London Clinic. Please contact the clinic with any questions.