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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

Jul 17, 2016

 In today’s episode I’ve chosen to talk about post prostatectomy incontinence and how to do a Kegel or pelvic floor exercise to strengthen the pelvic floor in order to correct post prostatectomy incontinence.

I’ve chosen this topic because I recently gave a talk to patients who are about to have a prostate removal for prostate cancer.

At Metro Urology, we do a class for men who are about to get treatment for prostate cancer, most commonly removal of the prostate with a daVinci robotic prostatectomy.

Today we are talking about just one portion of that class—the portion where we talk about the male “pelvic floor”, incontinence and Kegel exercises. I’ve recorded voiceover videos of all the slides so if you want to view some videos of other portions of the talk you can go to www.vidscrip.com/drtoddbrandt. Also www.TBUrology.com should provide that link. 

Prostate anatomy relative to the bladder and the pelvic floor.

The prostate is a gland that is located under the bladder and on top of the pelvic floor muscles/sphincter. We say that it surrounds the urethra but it actually is the urethra. The urine passes right through the prostate.

During cancer treatment with a prostatectomy, the prostate is removed. The bladder is then brought down to meet the urethra and sewn together.

When the prostate is removed a man will be more conscious of the pelvic floor and sphincter. There’s less distance between the bladder and the urinary sphincter to stop the flow of urine. Furthermore when the bladder is brought down into the pelvis this changes the angle of the bladder and urethra enough in some men to increase the risk of urinary incontinence.

What is the pelvic floor? What is the purpose?

The pelvic floor is a group of muscles and connective tissue that support the bowel, rectum, bladder and sexual organs. The muscles connect to the pelvis almost like a hammock. In addition, the pelvic floor muscles help to stabilize the pelvis, acting as an aid to the abdominal muscles and back muscles.   The urethral opening and the anus go through the pelvic floor; the pelvic floor assists in urinary and fecal continence. 

How does the pelvic floor relate to urinary function?

The pelvic floor muscles coalesce around the urethra as a sphincter, controlling the flow of urine. When the pelvic floor muscles contract, the internal organs are lifted and the sphincters tighten around the openings to the anus and urethra, preventing output or leakage. When the pelvic floor muscles are relaxed, they allow the passage of urine or bowel movements. Incontinence happens when someone leaks urine, unable to control urine output.

Men don’t typically spend a lot of time thinking about their pelvic floor muscles because the prostate provides a fair amount obstruction, even for normal size prostates, preventing small amounts of leakage.

Therefore men will have a variable amount of strength and control within the pelvic floor prior to an operation.

Men who have had their prostate removed will have to rely on the pelvic floor and sphincter for their continence. Most all men after prostatectomy will benefit from strengthening the pelvic floor muscles.

To strengthen pelvic floor in gain urinary control we recommend routinely doing Kegel exercises.

What is a Kegel exercise?

A Kegel exercise, named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form the pelvic floor.

How to do a Kegel exercise.

To find your pelvic floor muscles, imagine trying trying to stop the flow of urine midstream or hold back a fart. The muscles you’re activating are your pelvic floor muscles. Most men describe a lifting sensation at the base of the penis if they are doing the exercise correctly.

It may be easier to isolate your pelvic floor muscles if you lie on your back with your feet flat and knees bent. Allow yourself to relax. Then, try to contract the muscles.

The contraction should feel like you are lifting up, not bearing down. You should try to lift the perineum, which is the area between your scrotum and anus. Do not contract the abdominals, thighs or buttocks. Never hold your breath.

To do a “Kegel”, to exercise your pelvic floor muscles, you contract hold your muscles for a count of five then relax fully.

Squeeze. Count to five. Relax. That’s one Kegel.

To “Kegel” you repeat this contraction/relaxation sequence for about 5-10 repetitions. You should aim to do these repetitions 2 to 4 times per day.

Does it help right away?

It takes 4 to 6 weeks to make changes in the muscles to see noticeable improvement in strength.

What is Biofeedback?

Biofeedback is a way to monitor the pelvic floor contraction and gauge its strength.

A session with a specially trained nurse can apply the EMG monitor to you so you can actually see if you are contracting the right muscles and if the muscles themselves are gaining strength.