Rudy Maltez Alvarez, PT, DPT, is a physical therapist practicing in Washington, D.C., who specializes in pelvic health rehabilitation. He also obtained an advanced specialty from the Norton School of Lymphedema, becoming a Certified Lymphedema Therapist. In his career, he has treated patients of all age groups and sexes and has worked in the outpatient setting. He is also fluent in Spanish and volunteers his time collaborating with therapists in Honduras.
“Hi, this is my first time doing physical therapy ever,” said Gary* in an anxious tone. “I was very nervous about coming and almost canceled my appointment.” Gary was diagnosed with prostate cancer 3 months ago and had a radical prostatectomy to remove his prostate 1 month ago. Since his prostate-specific antigen (PSA) levels continued to be elevated, his next medical treatments were going to be radiation therapy and hormonal therapy. Gary came to me, a pelvic health physical therapist, to help strengthen his pelvic floor muscles ahead of further treatment.
Pelvic floor therapy can be an important way for people with prostate cancer to address issues related to their pelvic health. The pelvic floor muscles have a big role in helping the urinary and bowel organs perform their jobs effectively and at the appropriate times. I describe the pelvic floor as the bottom of a barrel that keeps its contents from spilling out. In the human body, the top of the “barrel” is the respiratory diaphragm, which is located below the lungs and is responsible for helping you breathe in and out. The sides of the barrel are composed of the abdominal muscles, obliques, and lower back muscles. This human “barrel” contains all of our vital internal organs.
For people with prostate cancer, common courses of treatment may include a radical prostatectomy or a transurethral resection of the prostate (TURP) to remove all or parts of the prostate that are cancerous. In this process, the sphincter that connects the bladder to the urethra can become significantly impaired, which can lead to stress urinary incontinence. Learning to do pelvic floor contractions, also called “Kegels,” allows the muscles to clamp off the urethra. This prevents urine from leaking out when doing things like laughing, sneezing, or standing up from a chair.
Learning to control your breath
When preparing to do pelvic floor contractions, you must first learn to breathe. Yes, breathing is important for life and for your pelvic floor. Breathing slow and controlled breaths helps to expand or elongate your body’s “barrel.” I often describe breath practice to my patients as a pre- workout stretch, with the workout being pelvic floor exercises.
Inhalation should be done through the nose, slowly and consistently. Think about taking roughly 4 to 5 seconds to inhale. When done correctly, the chest barely rises, and your lower ribs, abdomen, and pelvic floor expand. Think about filling your body’s barrel.
Then, you must exhale. Exhale through pursed lips for the same amount of time as it took to inhale. Exhale slowly and consistently as well, imagining that you are blowing out a row of 5 candles with one slow breath.
Doing this for several cycles will help you loosen up any increased resting tension in your pelvic floor muscles and will also help you relax. Getting a cancer diagnosis and starting with a treatment plan is life changing, and it can quickly become very stressful. This type of breathing practice can help lower your stress levels by tapping into your “rest and digest” nervous system.
How to do pelvic floor contractions
So, you’ve stretched and relaxed your pelvic floor muscles and have quieted your nervous system with some nice, effective breaths. Now, you get to contract those pelvic floor muscles.
Many people assume Kegels are just for pregnant people and older people having trouble with urine leaking when they laugh or sneeze. But Kegels are helpful for so many more people, including those with prostate cancer. For my patients with prostate cancer, I use 3 main imagery cues to help them tap into their pelvic floor muscles:
- “Imagine you are walking into a cold pool and you’re about to reach the water level to your testicles, and you are lifting your testicles away from the water.”
- “Imagine you are peeing, and you stop the flow of urine mid-stream.”
- “Imagine you are in a crowded elevator, and you need to hold in a fart.”
Try all 3 cues and find what works best for you. Some people even find it helpful to come up with their own imagery cue.
A good way to know you are doing pelvic contractions correctly is by standing sideways in front of a mirror and practicing a contraction while naked. If you see your penis and testicles draw upwards and have minimal abdominal activity, then you’ve got it! If you don’t have it down right away, don’t worry—it takes time and consistency to build strength and coordination.
Breathing practice and pelvic floor muscle training are the foundation of pelvic health rehabilitation. I encourage you to seek out a pelvic health rehabilitation specialist as soon as you get a prostate cancer diagnosis so you can have someone guide you through the process of recovery and help you manage any urinary symptoms that may occur during treatment.
* The patient’s name has been changed for anonymity.
The author has no relevant relationships to disclose.