After Prostatectomy: Kegels and Clamps

By Bryn Zolty, PT

Kegels
Yes, men do Kegels too! In fact, you can start Kegels as soon as your doctor clears you to begin contracting your pelvic floor. After a prostatectomy, physical therapy can help educate men on how to reduce pelvic dysfunction and urine leakage. ​Some of this education can include: reducing excessive pressure on pelvic muscles, improving tissue mobility, re-educating deep core muscles, and strengthening pelvic floor muscles. A pelvic health physical therapist can tailor a program for you, as there isn’t a one-size-fits-all treatment. ​

How do men Kegel? In the literature, the phrase that was found to be most associated with stopping urine leakage was, “Shorten the penis.” This simple cueing creates the greatest displacement of the muscles that close the urethra. Other cues like “lift the bladder” were not as effective and increased pressure in the abdomen and pushed down on the pelvic floor. (1)  It is important to be aware that you are not contracting other muscles in the legs, buttocks, and abdomen when isolating the pelvic muscles.

Every Kegel or pelvic floor strengthening program should be customized to each person. In the clinic, we work on endurance and quick contractions. For example, a home exercise program may include:

1. Endurance contractions: Shorten the penis and hold that contraction for 10 seconds. Release the contraction and rest for 10 seconds. Perform 10 times in a row. Do this set 3 times a day.
2. Quick contractions: Shorten the penis and hold that contraction for 2 seconds. Release the contraction and rest for 5 seconds. Perform 10 times in a row. Do this set 3 times a day.
3. For everyday activities that cause urine leakage, perform a Kegel simultaneously. For example, if standing up from a chair causes leakage, take a deep breath first and allow your abdomen to expand. Next, exhale and perform a Kegel prior to standing. Hold the Kegel while getting up to stand. Did you leak less?  

Clamps
Some men lose large amounts of urine after prostate surgery, which can have a huge impact on normal daily activities. It may take time for kegels to make a difference in symptoms. A penis clamp may be an appropriate option to stop large leaks. The clamp places gentle pressure on the urethra to block urine loss.  It may not stop all leakage but can significantly reduce it. When the clamp is removed, the release of pressure allows for normal urination. The amount of time recommended for wearing the clamp is variable between different devices. If you have any interest in a using a clamp, contact your physician or pelvic physical therapist to see if you are a good candidate.

According to the Journal of Neurourology and Urodynamics, men " found the device easy to use, felt more confident wearing the device, and had increased levels of physical activity with device in situ." They had significantly improved urinary incontinence symptoms per the Incontinence Impact Questionnaire. (2)

If you are going to have a prostatectomy or already have, ask your physician for a referral to a pelvic physical therapist. They can guide you through your pre- and post-surgical rehabilitation and reduce urinary incontinence.
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(1) Stafford, R. E., Ashton‐Miller, J. A., Constantinou, C. , Coughlin, G. , Lutton, N. J. and Hodges, P. W. (2016), Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourol. Urodynam., 35: 457-463.
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(2) Barnard, J. and Westenberg, A. M. (2015), The penile clamp: Medieval pain or makeshift gain? Neurourol. Urodynam., 34: 115-116.