Kegel Exercises-- not so easy

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Veteran Member

Date Joined Nov 2009
Total Posts : 7213
   Posted 12/28/2009 11:19 AM (GMT -6)   
OK, surgery next month so since they recommend doing Kegel stuff, I am. I know what muscles to tighten and relax. I know some folks don't think much of these, but I'm just following the suggestions I got from my surgeon!
On the handout I got, it says to build up to:  hold in (tighten) for 5 seconds and then loosen for 5 seconds. I am supposed to do this about 30 times and do it 3 times a day.
I find it is tough to do it intensely. That is, to tighten hard. I can tighten hard enough (by far) to say stop a stream, but not much harder. Also, I find it hard to take 5 seconds loosening. It seems to take 2 seconds.
Should I be trying to tighten hard?
Inout please?
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10


Veteran Member

Date Joined Aug 2007
Total Posts : 1015
   Posted 12/28/2009 11:46 AM (GMT -6)   
Doing Kegles properly is tough. After nearly one year post surgery, I went to a physical therapist that specializes in helping individuals strengthen their pelvic floor.

The trick to strengthening your pelvic floor is that you have to do it gradually... just like building up strength in any muscle in the body. 30 days before surgery is plenty of time to get a little stronger. However, you'll find that you'll weaken a little following surgery and need to rebuild again. You won't be using your pelvic floor much to hold back while the catheter is in place.

The physical therapist started me with three tighten and release exercises (10 sets each, 30 seconds between sets). I startred lying back in a chair for a week or so until I achieved a certain level of muscle stability. Then I did the same exercises with some additional exercises sitting up. After a week or so of that, I did a set of exercises standing up until the bio-feedback monitor showed the proper strength had been achieved.

Between visits to the clinic, I followed up with doing a set of these exercises three times per day at home. The whole strengthening process took about 4-6 weeks as I recall. The process helped a lot.

The clinical route to pelvic floor strengthening should only be necessary following surgery if you continue to have issues with urinary incontinence for several months. But I believe the gradual strengthening is the key whatever you do.

The hardest part about the pelvic floor strengthening is having patience. After all, this is a new way of retention for men!

My advice would be to take it easy on yourself.

I wish you all the best.

Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05

Worried Guy
Veteran Member

Date Joined Jul 2009
Total Posts : 3734
   Posted 12/28/2009 11:48 AM (GMT -6)   
You want to be able to tighten them without tightening your abdominals. They work against each other. I was always able to stop my stream - until the surgery. Now, no matter how hard I tighten, I still leak.
At one point about 2 wweks after the catherter came out I was so frustrated with leaking I tightened and tightened some more and tightened and yanked and... I felt a "pop" down there. Five months later I am still leaking 400 ml per day.
I hope they work for you.
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next?
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
. 9/27 2 months: Still 3 pads per day.
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day Experimenting with Nyquil for 10 days: Can sleep through the night but withdrawal is bad. Stopped 12/20.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 12/28/2009 1:36 PM (GMT -6)   
Start gradually, it takes a pretty long time to strengthen them. They ask to start pre-op so as to get a head start on strengthening muscles we never had to work on before

I recall doing the exercises as often as possible, pre-op even sitting in the car driving. Now 8 mo post op I cannot remember the last time I did them, stopped once I was leak free
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 12/28/2009 2:12 PM (GMT -6)   
With any exercise program the most important thing is that you DO IT. Thus it is worse if you set a program that is so hard that you can't keep it up than if you set one that is more modest but easy to do regularly.

You are not training for the Olympics, just to have a bit more strength where you will need it. The nurse who taught me pre-op said that most guys do fine even if they don't do any, so, whatever I did, it was going to give me an edge.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day

Regular Member

Date Joined Oct 2009
Total Posts : 103
   Posted 12/28/2009 6:25 PM (GMT -6)   
I have learned thru practice and asking that the best kegel workout is hold for 3 seconds then release for 3 seconds with 10 repetitions. Do that during a day as many times as you want. I still do it once or twice a day when I think about it and I am doing just fine.
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Surgery performed August 19th, 09.
One side nerves spared. Nerve graft on other side.
Six weeks incontinence almost over. ED a work in progress but seeing some response.
4 months no longer using pads. ED using trimix with positive response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.
Post op pathology 3+4 PT2A NOMO
6 wk PSA .004
4 month PSA .003 12-18-09

Veteran Member

Date Joined Apr 2008
Total Posts : 1131
   Posted 12/28/2009 6:59 PM (GMT -6)   
You are in better shape than I was. I went to some clinic and they stuck a rod up my rear-end (that would shock) to train me how to do kegels. However, they told me to do kegels for 5 minutes 2 times a day. They said to lay on my right side and hold for 5 minutes and then release for 10 seconds. It seemed to work. I did not do that many before surgery because I was so stressed about cancer I could not concentrate on anything. Also, as stated, I had a horrible experience with the rod up my rear.
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better

Regular Member

Date Joined Jun 2009
Total Posts : 77
   Posted 12/29/2009 7:52 AM (GMT -6)   
The best approach per my doctor is to stop and start when urinating. If you do this for every bathroom visit, I that should be enough to suppliment the other sets.
>Age 41 (At Dx-July 05) -Psa during annual physical went from previous 2.8 to 3
>Biopsy by 'primary' Urol Aug 05 - Gleason 6 low grade. 2nd opinion at  Hopkins confirmed Dx
>Chose Active Surv (AS)- modified diet etc.
>Around Oct 07 Psa moved up to 5.5. I decide to treat at Hopkins. Not sure what kind yet. My doctor decided on re-biopsy first.
>2nd Biopsy Dec 07 at Hopkins was NEGATIVE for Pca! Nothing found in 14 cores!
>'Primary' Urologist baffled. Planned a saturated biopsy (22 cores) to settle issue once and for all. I wasn't going to do 22 cores wide awake!
>July 07 - Did MRI just for comfort. Nothing significant found. No spread. I'd live! Still in AS mode.
>July 08 - Saturated Biopsy performed. Cancer confirmed again (of course, you took 22 cores)! Same Gleason score, same grade, similar numbers but Urol says treat very soon! I am thinking not so fast - numbers are same and you told me it means not aggressive! In any case I agreed with Urol that I will go the way of the Seeds. I research seeds more and I don't like it.
>July 08 - Dec 08 I re-lapse back into AS mode but seriously researching/considering treatment options beside surgery - went on to Mass Gen and Georgetown to explore proton therapy and Cyberknife respectively. Anything but Surgery! Both experts who are about my age were unanimous in strongly declaring they will chose surgery 'if they were me'. In addition, I learn that if either if these radiation methods (and seeds too!)  failed, no backup plan (or will be complicated)! I got the message!
>Jan 09. Went back to see my doc at Hopkins. I decide to put my fate in the hands  of the 'Da Vinci Robot' then!
> May 09. Had surgery. some Pain and discomfort but normal. Pathology all clear. Gleason 6 as before. Feeling very lucky. I gambled (based on my numbers and got 4 more years!) on the slow nature of the cancer and took my time. Very happy I finally did it. Hoping for a great recovery of all 'key' functions. Great wife and family helping out.
> Sept 09 - 3month PSA - Undetectable!

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 12/29/2009 3:32 PM (GMT -6)   
Greetings, everyone.  I agree with Ike.  My surgeon advised from the first visit until surgery to stop my flow of urine 4 or 5 times each time I went.  He also advised me to do the same after my catheter came out.  This is what I did both prior to surgery and for about 6 weeks post surgery and was basically dry from the day my cath came out.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

Veteran Member

Date Joined Nov 2006
Total Posts : 883
   Posted 1/3/2010 4:51 PM (GMT -6)   
I would suggest a visit to a physical therapist that works in this area. They have equipment that will let you know if you are actually working the pelvic floor muscles. It was my experience the it is very easy to work the abdominal muscles.
Good Luck
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
     Dec. 2006 – Oct. 2008 Cystoscope, Two Collagen injections,Second Opinion   
    Consultation for Incontinance at OU Medical Center, Bio-Feedback       
    training, Chiropractic, Accupuncture , AdVance Male Sling, Two More Collagen 
    injections, AUS Installed and Activated (Dr. Morey at UT Southwestern Dallas TX)
    All to try to resolve incontinence (using 6-8 Depends Guards a day)

    To Date All PSA's 0.00.

Veteran Member

Date Joined Jan 2010
Total Posts : 2845
   Posted 1/4/2010 4:25 AM (GMT -6)   
Kegels seem to be one of those exercises that is the same but different for each man
- my urologist/surgeon has me doing 20 kegels 5 times a day - basically set up as standing pelvic thrusts - with no basic -do it and hold it guideline - I equated it to the" time warp dance" from the Rocky Horror Picture Show.
Things are improving slowly. If I hold before standing I don't leak , but if I stand up I leak - and if I got up to go to the bathroom to pee - well, the flow starts and I can't stop it (yet).. I have not been able to stop / restart flow once it has started -
One of the best descriptions I found in order to isolate the right muscle ( do not clench the buttocks or abdomen) is to imagine and focus on stopping a fart.
Imagine being in a crowded elevator with the CEO of your company ( or the in-laws) and having to stop breaking wind.
That helped me isolate the right muscle. It is still weak, but I am working on it daily.
Age: 54 - openly gay - with common-law spouse of 13 years, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Biospies: October 8, 2009 - 12 specimens taken rectally
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous, Gleason 7 (4+3)
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Catheter: in November 18 - out December 8, 2009
Incontinence: Life brand - Male Guards - extra absorbant - one for day - one for night - leaking on standing, quick movement, walking up stairs -
Incontinence Exercises: standing Kegel excercises - pelvic thrust (ala Rocky Horror Show Time Warp Dance) 20 reps x 5 times daily
Post Surgery Biopsy: - n/a - get results January 7, 2010 -
Post Surgery PSA: - n/a
ED:- some difficulty before surgery - after surgery - loss of length - 1-2" - some arousal 4 weeks after surgery - girth increase but not length
ED Therapy: use of water-based Bathmate pump - increase in girth and a little in length -
ED Prescription: n/a
location: Peteborough, Ontario, Canada

Worried Guy
Veteran Member

Date Joined Jul 2009
Total Posts : 3734
   Posted 1/4/2010 4:48 AM (GMT -6)   
I was able to stop and restart my stream easily before the surgery- I practiced in the shower. Kegels were no problem. After the surgery, things are different.

I do kegels in bed before I get up and before I go to sleep. I will do them while reclining on the couch too. It is the only way I do not squirt into my pad.
I have been to the PT who used ultra sound twice to show me how, and electrical biofeedback another time. In all cases I was doing it correctly. However I still leak.
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