Post Prostatectomy or TURP

Following prostatectomy or TURP (transurethral resection of prostate) the pelvic floor musculature and nerve supply can be affected. Men may suffer from stress incontinence i.e. leaking urine on coughing, lifting, rising from a chair etc. Other symptoms after surgery may include urge incontinence, an urgent need to pass urine, with leaking on the way to the toilet and/or erectile dysfunction (difficulty achieving and maintaining an erection).
Symptoms
Urinary leakage during activities such as coughing, laughing, sneezing or during sporting activity
Urinary leakage from sitting to standing
A sudden feeling that you need to rush to the toilet, or leaking on the way to the toilet
Anal incontinence which is leakage of stool (faeces) or difficulty in controlling wind
Post-micturition dribble (leakage of a few drops of urine after you have finished passing urine)
Erectile dysfunction
Premature ejaculation

After your Prostate Surgery

How to do the exercises?
These exercises are not to address pelvic pain. Refer to the pelvic floor release section first for pelvic pain. Pelvic floor exercises may help symptoms after interventions for prostate cancer but ideally the exercises should be started before you have surgery and resumed after your operation, once the urinary catheter has been removed. You should not attempt to perform the exercises while your catheter is still in place.

These exercises are routine exercises to be done for muscle strengthening after prostate surgery. You may benefit from going through the sections on this website of first releasing the pelvic floor and then strengthening if you do not feel the pelvic floor muscles contract. These steps will help you to isolate the pelvic floor muscles better.

Pelvic floor muscle exercises can be done lying on your back with your knees bent and apart and your feet flat on the ground. They can also be done while you are sitting or standing.
To perform pelvic floor muscle exercises:
Squeeze the muscles around the anus as though you are trying to stop your self passing wind
Squeeze the muscles around your urethra as though you are trying to stop your self passing urine; and lift these muscles up inside
If you are doing the exercises correctly, you should be able to see

The anus contracting and lifting
The scrotum lifts
The area around the base of your penis dips in towards the abdomen

All of the above areas should be contracting at the same time, and there should be no movement or tilt of your pelvis when you are performing the exercises. Do not brace or harden your abdominal (tummy) muscles. Pelvic floor muscle exercises should not include active contraction of your buttock muscles or the muscles of your inner thighs.

You can assess whether you are doing the exercises correctly by looking at the movement of the pelvic floor muscles. This is best done with a hand mirror while reclining on the bed.

Pelvic Floor Contracting

Pelvic Floor Releasing

How many and how often?
A health professional working in the area of incontinence can provide you with an individualised bladder control programme based on your symptoms:

Build up to 10 long squeezes holding for 5 secs at first and then up to 10 secs each
Then do 10 short squeezes done rapidly to improve speed and strength
For some this will be too easy, for others this may be too difficult. Start with what you feel is a comfortable length of time for you to squeeze. Gradually increase it over the next few weeks

Do your exercises 3 times per day

PRACTICAL ADVICE

Tighten your pelvic floor muscles before and during any activity that makes you leak e.g. coughing, sneezing, lifting, rising from sitting, so that with practice this will become an automatic reaction

After urinating, tighten your pelvic floor muscles strongly to empty the last drops out. This may help to stop “after dribble.”

If you are sexually active, tighten your pelvic floor muscles during intercourse to maintain the quality of your erection

Urge control techniques: you learn to suppress the urge to urinate by doing the pelvic floor muscle contractions as well as using a number of distraction techniques

Postural awareness and control: pelvic muscles work more effectively when you are sitting upright as opposed to slumping or slouching

If you practise your pelvic floor muscle exercises as above, you should notice an improvement in 3-5 months. It is important that you continue with your exercises even if they do not seem to be helping. Further advice is available from a chartered physiotherapist.