What are pelvic floor muscles?

Pelvic floor muscles sit below the bladder and bowel, and stretch from the pubic bone at the front of your body to the bottom of your spine. They act as a sling, supporting the bladder and bowel and helping to control when you urinate (pee) or empty your bowels. Pelvic floor muscle exercises (also called Kegel exercises) help to strengthen these muscles.

How do pelvic floor muscle exercises help with urinary problems?

If you’ve had certain treatments for prostate cancer, such as surgery to remove the prostate (radical prostatectomy), you might have some urinary problems. You might also have urinary problems if you’ve had surgery for an enlarged prostate, such as an operation called a transurethral resection of the prostate (TURP).

Strong pelvic floor muscles may help with some urinary problems, including:

• leaking urine – this could be just a few drops, or a steady flow throughout the day (urinary incontinence)
• leaking urine when you go to sit down or stand up, cough, sneeze or bend forwards (stress incontinence)
• a sudden urge to urinate (urgency), and sometimes leaking before you get to the toilet (urge incontinence)
• needing to urinate more often than usual (frequency), including several times at night (nocturia)
• dribbling urine after you finish urinating (after-dribble)
• leaking a little urine when you get sexually aroused.

Some men find pelvic floor muscle exercises help with problems getting or keeping an erection after treatment for prostate cancer. Some men also find they help to improve the quality of their erections.

The exercises may also help with bowel problems such as needing to rush to the toilet, leakage (faecal incontinence), or passing a lot of wind.

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. This will help you to do them properly after your treatment. It might also help you to stop leaking urine sooner.

After surgery, you’ll have a tube called a catheter to drain urine from your bladder. If you’re having surgery for prostate cancer, the catheter is usually removed after one to three weeks.

After surgery for an enlarged prostate, the catheter is usually removed after two to three days, once your urine is clear of blood and you can urinate properly.

You can start doing pelvic floor muscle exercises as soon as your catheter has been removed. They’re safe to do, and won’t hurt or cause any damage. But like all muscles, pelvic floor muscles can become tired so try not to overdo it.

If you had your surgery a while ago but still have urinary problems, starting the exercises could still help. You should also speak to your doctor or nurse, as there may be other treatments that could help.

How do I find my pelvic floor muscles?

It’s important to find the right muscles before you start doing pelvic floor muscle exercises. You can do this when you’re sitting, standing or lying down – whatever you find most comfortable, as long as you relax your thighs and buttocks.

If you want to do this when you are sitting, sit forward on a chair with your feet on the floor, shoulder width apart.

If you are standing up, stand with your feet shoulder width apart.

If you prefer to find your pelvic floor muscles when you are lying down, lie on your back with your knees bent and slightly apart, and your feet apart on the floor.

• Tighten the ring of muscle around the opening to your back passage (anus) as if you’re trying to control wind. Then relax. Make sure you don’t squeeze your buttocks together, and try not to tighten your thigh muscles or abdominal (stomach) 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 doing the exercises properly.

How do I do the exercises?

Make sure you’ve found the right muscles and you know what it feels like to tighten them before trying these exercises. There are two sets of exercises – slow and fast. You can do them while sitting, standing or lying down – whichever you prefer.

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 10 seconds. Keep breathing normally.
3. Slowly relax the muscles and rest for 10 seconds.
4. Aim to repeat the lift and rest up to 10 times.

You might find that you can’t hold the lift for 10 seconds to start with. Just hold it for as long as you can and try to build up to 10 seconds. It’s more important to do the exercises properly than to do them for the full 10 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 10 of these short, fast lifts.

Try to concentrate while you’re doing the exercises. If you don’t do them properly, they might not help.

Biofeedback

This is a way of monitoring your pelvic floor muscles while you do the exercises. Your continence advisor or specialist continence physiotherapist might suggest biofeedback if you’re struggling to find the right muscles or to do the exercises. But many clinics don’t offer biofeedback.

If you’re offered biofeedback, your continence advisor or specialist continence physiotherapist will insert a small probe into your back passage. Tightening your pelvic floor muscles puts pressure on the probe. This pressure is displayed on a screen and shows if you’re doing the exercises correctly.

Your continence advisor or physiotherapist will show you how to use biofeedback and help you do the exercises. They may lend you a biofeedback unit to take home.

How often should I do the exercises?

There’s no fixed advice on how often you should do pelvic floor muscle exercises. Speak to your doctor or nurse to see what they suggest.

You may want to try doing a set of slow and fast exercises three times a day. And try to make them part of your daily routine.

Don’t overdo it. Pelvic floor muscles are like any other muscles – they can get tired if you do too many exercises. You might notice that you leak more urine towards the end of the day, as your muscles get tired. This should get better with time as the muscles get stronger.

It might help to tighten your pelvic floor muscles at certain times.

• When you leak urine. Tighten the muscles strongly before and during activities that cause you to leak urine – for example, when 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.
• After urinating. Tighten your pelvic floor muscles strongly after you urinate. This should get rid of any urine that’s left in the urethra (the tube you urinate through) and avoid any dribbling afterwards.

It’s important to be patient and keep doing the exercises. It takes time to see an improvement – it 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. The exercises might not work for some men, but there are other things that might help if they don’t work for you.

You’ll need to keep doing the exercises for the rest of your life, but once your pelvic floor muscles are strong, you should be able to do fewer exercises. Keep doing some exercises each day – otherwise the muscles will get weaker again.

What else can help?

If pelvic floor muscle exercises don’t help to improve your urinary problems, there are treatments available and things you can do to help yourself. Read about more about urinary problems and ways to manage them.

The following things can help reduce the pressure on your pelvic floor muscles.

• Try to maintain a healthy weight and level of fitness. Being overweight can put pressure on your pelvic floor muscles. This could make you leak more urine.
• Physical activity can help you to stay fit and keep to a healthy weight. Some types – particularly pilates and yoga – also strengthen the pelvic floor muscles.
• Eat plenty of fibre and drink plenty of fluids to avoid constipation (difficulty emptying your bowels), as this can put pressure on your pelvic floor muscles.
• If you smoke, try to stop as this can cause coughing, which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking.
• Speak to your doctor for help with hay fever, asthma or bronchitis to reduce sneezing and coughing.
• Avoid heavy lifting. If you have to lift something heavy, tighten your pelvic floor muscles at the same time. This can help to prevent leaking urine.

Urinary problems can be hard to deal with. If you have any worries or questions about urinary problems or pelvic floor exercises, speak to your GP, specialist nurse or continence nurse.

You can also speak to our Specialist Nurses. It can sometimes help to talk to other men living with prostate cancer. We have a range of services that can help put you in touch with someone who’s been there and understands what you’re going through. Visit our Who can help page to find out more.

References

Updated: December 2016 | To be reviewed: December 2019