Most men are told to "do kegels" and nothing else. Then they squeeze everything and wonder why nothing changes. Here is what a kegel actually is, when to start, and how to tell you are doing it right.
Not while the catheter is in. Your tissues need to heal first. Start once the catheter is out and your surgeon clears you.
If your surgery is still ahead of you, the weeks before it are a good time to learn the muscle. It is easier to learn while you are rested and not sore.
A kegel is small. It is a gentle squeeze and lift deep inside the pelvis. Nothing on the outside of your body should move.
Squeezing your abs, clenching your glutes, and holding your breath is not a kegel. It is straining, and it can push down on the very muscles you are trying to train.
The urine cue. Imagine you are urinating and need to stop mid-stream. The muscles that would shut off the flow are your pelvic floor. Use it as a picture. Do not practice it on the toilet.
The gas cue. Imagine holding back gas in an elevator. That squeeze is the back part of your pelvic floor.
The lift cue. Picture the pelvic floor as an elevator. Draw it up one floor. Not ten. A gentle lift.
Try all three. One of them usually clicks.
Lie on your back with your knees bent and your feet flat. Gently squeeze and lift. Hold for two to three seconds. Let go completely and rest for ten seconds.
Do five of those, three times a day. That is the whole starting dose. It looks like too little. It is not. You are teaching your brain to find the muscle again, and that comes before strength.
Dr. Meg Cochran, DPT shows the first pelvic floor exercise, lying down, with the cues that make it click.
Bearing down instead of lifting. If it feels like pushing out, it is backwards.
Holding your breath. If you cannot breathe and hold the squeeze together, you are squeezing too hard. Dial it back.
Squeezing your abs. Put a hand on your belly. If it tenses, the wrong muscles are helping.
Doing too many too soon. More is not better. This muscle tires like any other, and a tired pelvic floor leaks more.
Only doing slow holds. You also need quick squeezes. Those are what catch a cough or a sneeze.
Once you can find the muscle every time, the work gets harder in a set order. Longer holds. Then sitting. Then standing. Then walking. Lying down is where you learn it. Standing and moving is where you need it.
Letting go matters as much as squeezing. End each session with a few slow belly breaths and let the pelvic floor soften.
Pad count is the number most men watch, and it is slow to move. Two things usually change first. The list of things that make you leak gets shorter. And the amount you leak each time gets smaller.
If several weeks of steady work have changed nothing, or you cannot tell whether you are squeezing the right muscle at all, that is the time to see a pelvic floor physical therapist. A written instruction cannot watch you do it.
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Recovery After Prostate Surgery: A Week-by-Week Guide
Pads for Men After Prostate Surgery: What to Buy and How to Leave the House
Pelvic Floor Physical Therapy After Prostate Surgery: Do You Need It?
Kegel Exercises for Men: How to Do Them Right
Dr. Meg Cochran is a licensed Doctor of Physical Therapy specializing in pelvic floor rehabilitation, and treats men after prostate surgery through Where You Are Physical Therapy in Oxford, Mississippi.
This article is educational and is not medical advice, a diagnosis, or a substitute for in-person care. Follow your surgical team's instructions. If you have urgent symptoms including severe pain, fever, unexpected bleeding, or a sudden change in function, contact your healthcare provider.
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Educational content. Not medical advice.
The Prostate Recovery Quick Start is Dr. Meg showing you the first exercises on video, from before surgery through week 4, with the two sheets to print. Open it on any phone, tablet, or computer, from anywhere. It is educational, not physical therapy.
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