It’s Movember! At East Sacramento Physical Therapy, we are focusing this month on raising awareness about pelvic health for people at risk for prostate cancer. One question I am frequently asked as a physical therapist (PT) is whether people born with prostates can “Kegel”. Let’s break that down!
First, what is a Kegel? To Kegel is to squeeze or contract the pelvic floor muscles, and the term is named for gynecologist, Arnold Kegel. Everyone has pelvic floor muscles, so everyone can Kegel! For people with a penis, a “Kegel” feels like shortening or pulling in the penis. It can also feel like tightening or lifting the anus. So, how does the ability to do a strong, coordinated contraction of the pelvic floor muscles, or a “Kegel”, help people who have undergone treatment for prostate cancer?
Getting the pelvic floor muscles in shape can help reduce or eliminate urine leakage. Urine travels out of the bladder through the urethra. There are two sphincters, or circles of muscle, around the urethra that can tighten and hold urine in. If you imagine kinking off a hose, that’s what your sphincter muscles are doing. One is the internal urethral sphincter, which is between the bladder and prostate in people with prostates, and the other is the external urethral sphincter, which is between the prostate and end of the urethra. When people undergo treatment for prostate cancer, the internal sphincter can be removed or damaged, so that external sphincter becomes even more important for holding in urine!
Another function of the pelvic floor muscles is to move blood into erectile tissue and keep it there. This allows erectile tissue to become and remain erect. Treatments for prostate cancer can damage arteries, nerves and/or tissues that can reduce the ability to have and maintain an erection. Strong and coordinated pelvic floor muscles that are able to both contract and relax may help with sexual function.
Additionally, the muscles of the pelvic floor work like a pump to help with lymph and blood drainage. This is especially important after any pelvic surgery to increase blood flow to healing tissues as well as to reduce inflammation in post surgical tissue.
A few common mistakes tend to arise when people try to do Kegels. One is that people may hold their breath and overuse their abdominal muscles when they Kegel. The problem with this technique is that breath holding and overuse of the abdominal muscles actually puts abdominal pressure downward on the bladder. Basically, the abdomen is potentially pushing out urine at the same time the pelvic floor muscles are trying to hold it in. The other common issue is that people may overuse other “accessory” muscles, like the gluts or thighs, when they Kegel. This makes it really difficult for a Kegel to be functional. If you have to squeeze your gluts and hold your knees together every time you Kegel, will you be able to do a Kegel to prevent urine leakage while you bend over and pick something up off the ground? Probably not! A third mistake is keeping the pelvic floor muscles contracted all the time. If the muscles are always contracted, they can’t move and react to your body’s movements effectively to hold in urine when you change position. Overly contracted muscles will also not allow good blood flow in and out of the pelvic area.
A trained pelvic floor PT can make sure people who have undergone treatment for prostate cancer are exercising their pelvic floor muscles effectively. This is why a pelvic PT is an important part of the healthcare team both before and after treatment for prostate cancer. People who are experiencing any prostate or prostate cancer related pelvic symptoms may benefit from asking their physician if PT with a pelvic specialist might be a beneficial part of their treatment.
The above is for informational purposes only and is not meant to be a substitute for advice or directives from you own physician or PT.