The pelvic floor group of muscles work like every other muscle in your body, but are generally ignored until someone has an issue! Here’s how to make sure you’re engaging (and releasing!) properly.
One Minute Wellness: Kegels
Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good
Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good
Pelvic floor physiotherapy does not equal Kegels. It also involves teaching each patient how to manage the increased pressure in the system when they cough, sneeze or move, and also learning how to appropriately engage their pelvic floor muscles as they are moving in certain ways. Each patient is different: many men don’t properly engage their pelvic floor muscles, and other men might keep their pelvic floor muscles engaged too much of the time and need to learn to relax them.
A new study in International Urology and Nephrology, suggests there may be a subset of post-prostatectomy patients who need to learn to relax their pelvic floor in order to improve incontinence. Many men have significant incontinence initially following radical prostatectomy—not just stress urinary incontinence, but a consistent drip requiring the use of many pads through the day and night. Of course they improve as time goes on, and continence improves first when the man is not moving (sitting or lying down). Commonly, men continue to leak with movement for several months. Many men get in the habit of engaging their pelvic floor consistently in an effort to prevent any leaking, and over months can lead to them having difficulty getting those muscles to relax. Keeping the pelvic floor muscles tight too much of the time can lead to urinary urgency and frequency. As well, men often urinate more frequently because they don’t want to leak, so over time their brain teaches the bladder to become less of a reservoir.
The above retrospective study had136 patients with post-RP SUI who were treated with pelvic physiotherapy. Of these, 25 had underactive pelvic floor muscles, 13 had overactive pelvic floor muscles, and 98 had evidence of both. All men received therapy to either relax or strengthen their pelvic muscles. The total number of pelvic physical therapy sessions depended on a patient’s progress. Incontinence improved in 87% of them, with 58% achieving what is considered the optimal improvement of needing 2 or fewer protective pads per day. Further, pain was a problem for 27% of the men, but that proportion dropped to 14% by the end of therapy.
The authors concluded that this study was the first to demonstrate that pelvic health physiotherapy can be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be due to pelvic floor muscle overactivity.
It appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence. Kegel exercises can worsen pelvic floor overactivity, and are not the best treatment for every patient.
Nearly all men have urinary incontinence immediately after a prostatectomy, but that percentage drops to about 5% to 20% within 24 months following RP. Men who have not seen improvement within 2 to 6 months should seek physiotherapy.
It was also concluded that pelvic floor training engages the patient in their rehabilitation process, and is a good resource to utilize postoperatively. It also underscores that personalized treatment of post-RP incontinence may be warranted, as some patients will benefit from strengthening work, while others need to learn to relax their pelvic floor muscles.
Reference Scott, KM, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain
[published online December 5, 2019]
Pelvic floor physiotherapy does not equal Kegels. It also involves teaching each patient how to manage the increased pressure in the system when they cough, sneeze or move, and also learning how to appropriately engage their pelvic floor muscles as they are moving in certain ways. Each patient is different: many men don’t properly engage their pelvic floor muscles, and other men might keep their pelvic floor muscles engaged too much of the time and need to learn to relax them.
A new study in International Urology and Nephrology, suggests there may be a subset of post-prostatectomy patients who need to learn to relax their pelvic floor in order to improve incontinence. Many men have significant incontinence initially following radical prostatectomy—not just stress urinary incontinence, but a consistent drip requiring the use of many pads through the day and night. Of course they improve as time goes on, and continence improves first when the man is not moving (sitting or lying down). Commonly, men continue to leak with movement for several months. Many men get in the habit of engaging their pelvic floor consistently in an effort to prevent any leaking, and over months can lead to them having difficulty getting those muscles to relax. Keeping the pelvic floor muscles tight too much of the time can lead to urinary urgency and frequency. As well, men often urinate more frequently because they don’t want to leak, so over time their brain teaches the bladder to become less of a reservoir.
The above retrospective study had136 patients with post-RP SUI who were treated with pelvic physiotherapy. Of these, 25 had underactive pelvic floor muscles, 13 had overactive pelvic floor muscles, and 98 had evidence of both. All men received therapy to either relax or strengthen their pelvic muscles. The total number of pelvic physical therapy sessions depended on a patient’s progress. Incontinence improved in 87% of them, with 58% achieving what is considered the optimal improvement of needing 2 or fewer protective pads per day. Further, pain was a problem for 27% of the men, but that proportion dropped to 14% by the end of therapy.
The authors concluded that this study was the first to demonstrate that pelvic health physiotherapy can be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be due to pelvic floor muscle overactivity.
It appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence. Kegel exercises can worsen pelvic floor overactivity, and are not the best treatment for every patient.
Nearly all men have urinary incontinence immediately after a prostatectomy, but that percentage drops to about 5% to 20% within 24 months following RP. Men who have not seen improvement within 2 to 6 months should seek physiotherapy.
It was also concluded that pelvic floor training engages the patient in their rehabilitation process, and is a good resource to utilize postoperatively. It also underscores that personalized treatment of post-RP incontinence may be warranted, as some patients will benefit from strengthening work, while others need to learn to relax their pelvic floor muscles. Reference Scott, KM, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain [published online December 5, 2019]. Int Urol Nephrol
Weight Lifting For The Vagina
The pelvic floor group of muscles work like every other muscle in the body, but they are generally fairly ignored until someone has a problem. The muscles sling underneath from the pubic bone at the front of the pelvic to the tailbone at the back, and also wrap around the vagina, urethra and rectum.
Since these muscles are at the base of the core and attach onto the spine and pelvis, they can help support the pelvic structures, and are involved in control of botht the bladder and the bowel.
If these muscles are weak, and they are in most people due to the above-mentioned fact that people generally ignore them, some people can experience stress urinary incontinence (SUI), which is when urine leaks occur with exertion, like coughing, sneezing, and jumping. Pelvic organ prolapse (POP) can occur when the weakness of the pelvic floor muscles and other supporting structures causes the bladder or uterus to descend down into the vaginal canal.
So what can be done? Since the pelvic floor muscles are just like other muscles, there are strength-training exercises called “Kegels” that can be very effective in helping SUI and the symptoms of POP. Kegels can be done with short pulses (contraction and release of the pelvic floor muscles that takes 1-2 seconds, repeat 10x) or longer holds (squeezing the pelvic floor muscles and holding them engaged for 5-10 seconds, relaxing completely between repetitions).
Pelvic floor weights (vaginal cones) involve inserting a weight inside the vagina for the time that you would do the Kegel exercises—they are not meant to be worn through the day. The series of weights start out bigger and lighter so they are easier to hold inside, and get smaller and heavier as you improve.
A review of the data tells us that pelvic floor weights are no more effective that simply doing Kegel exercises for strengthening the pelvic floor muscles. If the idea of weight-training for the pelvic floor appeals to you (some women love tools and devices), then they are fine to try. Be sure to use a medical grade set that can be cleaned appropriately.
Making sure that you are doing a proper Kegel is most important. At Elevation Physiotherapy & Wellness, we assess each person to ensure they are performing Kegels properly and get you started on a program to help build strength, endurance and control through the pelvic floor. If you are experiencing urinary incontinence or a prolapse of the pelvic organs, we can help!
