The benefits of pelvic floor exercises for women, particularly after childbirth, are well established. However these simple exercises are also very valuable for men following prostatectomy (the removal of the prostate due to a diagnosis of cancer). During the first few weeks after a prostatectomy, almost all patients experience some urinary incontinence.

This is because removing the prostate disturbs the area between the bladder and urethra, which carries urine out of the body. During surgery, the bladder is pulled down to join the urethra and in so doing, restoring continuity. The bladder neck muscle (internal sphincter) is sometimes also weakened during surgery.

Consequently, before surgery men had three layers holding back urine - the internal sphincter muscle, the prostate lobes and an external sphincter muscle. After surgery, there is only one layer - the external sphincter.

This means that the single barrier needs to work very well. Therefore, pelvic floor exercises which strengthen these muscles can be very effective in the recovery of continence. A study following men through the first year after prostatectomy found pelvic floor exercises are effective in terms of reducing incontinence.*

The type of incontinence experienced by men in the first three months after a prostatectomy is typically mild leaking. But this can be very distressing for patients as they recover from surgery and want to return to normal life. Even when incontinence is mild, men are understandably uncomfortable about having to wear pads to work, for example.

At the Birmingham Prostate Clinic, we encourage our patients to do pelvic floor exercises and provide them with the support they need to ensure they are doing the exercises correctly.

Pelvic floor exercises are an unusual concept to most men, as they are far more closely associated with women. However we find that the majority of our patients are keen to do anything they can to improve their continence. Pelvic floor exercises are a valuable means of patients doing something themselves to aid their recovery.

We emphasise little and often. In many cases, patients expect results too quickly. We make the comparison with improving your muscle tone in the gym. You will not get results immediately, nor will you develop a 'six pack' if you pop down once a week. Improving bladder function through pelvic floor exercises, like muscle tone, requires effective practice, consistency and long term commitment.

By three months post surgery, 70 per cent of patients are continent. This is defined as no longer needing continence pads. Once patients have reached a year post surgery, only four per cent of patients are significantly incontinent. Among this group of patients who continue to experience incontinence after one year, many are older men and some will have had continence problems before surgery.

It is difficult to quantify exactly to what extent the recovery of continence is due to bulking up the muscles through pelvic floor exercises and how much is due to the natural healing process.

During surgery, the bladder is exposed and there will be some swelling after surgery and the bladder wall is left thickened. The bladder is unable to hold much urine and as soon as it begins to fill, the man feels the urge to urinate. This problem will improve with healing and time.

In conclusion, it is difficult to quantify exactly the role of pelvic floor exercises in the recovery of continence. Recovery varies from patient, influenced by individual factors. But we do believe that pelvic floors are beneficial in terms of improving muscle tone and therefore reducing incontinence. We also recognise the benefits for the patient of being able to do something himself in order to aid recovery.

Pelvic floor re-education reduced incontinence 1 year after radical prostatectomy Van Kampen M, De Weerdt W, Van Poppel H, et al.Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet 2000 Jan 8;355::98-102[Medline] http://ebn.bmj.com/cgi/content/extract/3/4/122

Alan Doherty is a Consultant Urologist and Medical Director of The Birmingham Prostate Clinic. A centre of excellence for Prostate Cancer Treatment