The Manual: Step-by-step exercises to help you get to grips with urinary problems

If you’ve had treatment for prostate cancer or an enlarged prostate, particularly if you’ve had surgery, you may have experienced the side effect of leaking urine (incontinence).

It’s something many men with prostate cancer have to deal with at some point – whether that’s leaking just a few drops or a steady flow throughout the day. For some men it clears up after time but for others it can be something that they have to manage long term. And it can really affect things like self-esteem and independence as well as work life, sex life and social life.

There are a number of different treatments and methods for helping to control leaking but one thing that many men find useful is practicing pelvic floor muscle exercises.  

Pelvic floor exercises are relatively easy once you get the hang of them, but finding the right muscles to exercise in the first place can be tricky. Here we answer your questions on getting to grips with your pelvic floor.

What and where are my pelvic floor muscles?

Your pelvic floor muscles stretch from your pubic bone at the front of your body to the bottom of your spine, below your bladder and bowel (see diagram below). They act as a sort of sling, supporting your bladder and bowel and helping you control when you urinate or empty your bowels.

How do pelvic floor muscle exercises help?

Exercising your pelvic floor muscles helps strengthen them and having strong pelvic floor muscles may help with some urinary problems. This could be anything from leaking urine, having a sudden urge to go and needing to urinate all the time, to dribbling urine after you think you’ve finished or when you’re sexually aroused.

Some men have also found pelvic floor muscle exercises helpful in managing other side effects of prostate cancer treatment. For example, problems getting or keeping an erection and bowel problems, such as needing to rush to the toilet, leaking or passing lots of wind. So there are lots of reasons to give them a try – depending on what you’re experiencing.

When should I start the exercises?

If you’re going to have surgery for prostate cancer or an enlarged prostate, it’s a good idea to start doing the exercises before the surgery. It will get you used to doing them correctly and possibly to help you to stop leaking sooner.

After surgery, you can start doing pelvic floor muscle exercises again as soon as your catheter has been removed (usually one to three weeks after surgery for prostate cancer and two to three days after surgery for an enlarged prostate). They’re safe to do, and won’t hurt or cause any damage.

If you had your surgery a while ago but are still having urinary problems, starting the exercises now could still help. Have a word with your doctor or nurse – they can talk to you about pelvic floor exercises and other treatments that might help.

How can I find my own pelvic floor muscles?

Because of where they are, they’re not muscles you can easily feel through your skin, like arm or leg muscles, so they can take a while to find.

• Firstly sit, stand or lie down, whichever you find most comfortable, and relax your thighs and buttocks.
• Then tighten the ring of muscle around the opening to your back passage (anus) as if you’re trying to control wind. Then relax. Try not to squeeze your buttocks together, or tighten your thigh muscles or stomach (abdominal) muscles. And try not to hold your breath – just keep breathing normally.
• At the same time, imagine you’re urinating and tighten your muscles as if you’re trying to stop mid-flow, then relax. You can try this once or twice while you’re actually urinating, if this helps you to find the right muscles – but don’t do this all the time as it could cause problems emptying your bladder.
• If you’re tightening the right muscles, you should feel a dip at the base of your penis and feel your scrotum (the skin around the testicles) move up a little. You might find it helpful to do the exercises in front of a mirror to begin with, so you can see the base of your penis and your scrotum move.
• You can also check if you’re using the right muscles by touching the skin just behind the scrotum. You should feel the muscles lift up and away from your fingers when you tighten them. If you feel the muscles pushing down, you aren’t tightening the right muscles.

How do I do the exercises?

After you’ve found the right muscles you’re ready to start the exercises. There are two sets of exercises – slow and fast. You can do them while sitting, standing or lying down, whichever you prefer. People sometimes think that pelvic floor muscle exercises have to be done while lying on the floor – but we’re not talking about that kind of floor!

Slow pelvic floor muscle exercises

1. Slowly tighten the muscles as hard as you can so you feel a lifting sensation.
2. Try to hold this lift for ten seconds. Keep breathing normally.
3. Slowly relax the muscles and rest for ten seconds.
4. Repeat the lift and rest up to ten times.

You might find that you can’t hold the lift for ten seconds to start with. Just hold it for as long as you can and try to build up to ten seconds.

 Fast pelvic floor muscle exercises

1. Repeat the same action, but this time try tightening the muscles as quickly as possible.
2. Hold the lift for one second and then let go.
3. Try to do up to ten of these short, fast lifts.

How often should I do the exercises?

There’s no fixed advice on how often you should do pelvic floor muscle exercises. You may want to try doing a set of slow and fast exercises three to six times a day. And try to make them part of your daily routine.

But don’t overdo it. Pelvic floor muscles are like any other muscles – they can get tired if you do too many exercises.

The exercises don’t seem to be working for me. Am I doing something wrong?

Don’t give up straight away - improvements won’t happen overnight. You might see a small improvement each week, but it can take up to three months before you notice a real difference.

Try to concentrate while you’re doing the exercises. If you don’t do them properly, they might not help. If you’re finding them difficult and need some advice, ask your doctor, nurse or GP to refer you to a continence advisor or specialist continence physiotherapist, who can help you with the exercises.

Here are some more tips:

• Tighten the muscles strongly before and during activities that cause you to leak urine, like getting up from a chair, lifting, bending, coughing or sneezing.
• Tighten the muscles for as long as you can – over time, this might help to prevent urine leaking.
• Tighten your pelvic floor muscles strongly after you urinate – this should get rid of any urine that’s left and avoid any dribbling afterwards.

If the exercises do start working for you, you’ll need to keep on doing them throughout your life - but once your pelvic floor muscles are strong, you should be able to do fewer exercises each day. Read more in our fact sheet, Pelvic floor muscle exercises.

If the exercises aren’t working for you, there are other things that might help including treatments and lifestyle changes. Read more about dealing with urinary problems after prostate cancer treatment.