Kegeling: First Line of Defense

In an effort to heal and strengthen my pelvic floor, and eliminate the incontinence that followed my radical laparoscopic prostatectomy in April 2018, I started seeing a physical therapist, Dr. Peter Muhn, at USC in September. I’d already been kegeling for several months and I was seeing a lot of improvement, but I felt I’d plateaued, and I wanted to pursue this new opportunity to help myself recover.

Reassurance from my doctor

During my first visit I shared my prostate cancer journey with Dr. Muhn, I let him know the progress I’d made with reducing incontinence, and that my goal was to eliminate it if possible, the sooner the better. He assured me that my progress was normal, that time and effort would produce the result I was hoping for, but that patience and persistence were important, that a year of healing and strengthening was not unusual. Dr. Muhn and his assistant observed my kegeling technique and then gave me a set of revised exercises to do between visits.

Dissatisfied with my progress

WebMD offers this short definition of kegeling and its benefits for men: “Kegels are exercises that help you zero in on and strengthen muscles below the bladder that help control urination. In men, urinary incontinence can be caused by a weak urinary sphincter that may result from surgery for prostate cancer, an overactive bladder, or a bladder that doesn't contract.” My new exercises consisted of short bursts of contractions, longer holds of up to 10 seconds, and a variety of positions: lying down, sitting, standing.

I followed Dr. Muhn’s instructions, experienced some improvement, and then returned for another visit in late October. I expressed that I wasn’t fully satisfied with my progress, explaining that while at rest or just doing light activities around the house my leakage was minimal, but long walks and vigorous exercise resulted in soaking a light shield. To play golf and walk the course I had to wear a maximum absorbency guard and change it after nine holes. I had to take the same precaution for rock climbing or back country hikes. In other words, I was constantly aware of my incontinence while doing the activities I enjoy most.

Measuring pelvic floor strength

To better test my pelvic floor strength and the power of my kegels, Dr. Muhn asked if I would agree to having them measured graphically through use of a rectal sensor. He explained the process, showed me the device, and I agreed. The sensor was inserted into my rectum, attached to a computer, and then I went through a series of kegel exercises that were visible as graphs on the computer screen: a bar graph, a pyramid graph, a peaks and valleys graph, etc. The graphs showed how strong my contractions were, how long I could hold them at a given level, and how much control I had. The computer recorded the information. I found that my hold during most ten second contractions began to weaken at five seconds.

Forging ahead with optimism

I now have a visible and numerical baseline to work with. We made a couple of changes in my exercise routine, and since my return home I’ve been working to gain pelvic floor strength with a renewed passion. I confess that there are days when I get frustrated when I don’t feel like I’m getting the results I want. I get fatigued by the effort, and I don’t want to do anything. After all, I’ve been kegeling for seven months! But I have to remain committed to give this approach every chance to be successful. My next appointment is in mid-December, a few days after my wife retires. What a nice gift it would be for both of us if my efforts pay off!

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