Surgery to treat men with prostate cancer is often followed by months of difficulty controlling urine flow, a condition known as urinary incontinence. But new research suggests that this problem may go away more quickly if the men perform certain exercises to strengthen their pelvic floor muscles.

Researchers from the Kaiser Permanente Medical Center in Los Angeles, California, found that men who were taught how to perform pelvic floor exercises (commonly known as Kegel exercises) before and after surgery were more likely to have regained continence three months later. The results of the study were published in the Journal of Urology (Vol. 170, No. 1: 130-133).

The exercises, which typically involve contracting and releasing the muscles at the bottom of the pelvis, were originally developed in the 1940s by Dr. Arnold Kegel as a noninvasive way to help women experiencing incontinence after childbirth. Their value for prostate cancer patients, however, has been controversial, as previous studies have produced mixed results.

Radical prostatectomy – surgical removal of the prostate – is an effective way to treat prostate cancer that has not spread beyond the prostate gland, and may offer the best chance for a cure. But the operation is not without its side effects. Impotence and incontinence are the two that can have the largest effect on a man’s quality of life.

With the surgical techniques in use today, only a small percentage of men have long-term or permanent problems with these side effects, but most men will have some period of time when they will be affected.

Bladder problems in particular can affect many aspects of a man’s life. The anxiety it causes can make him less likely to be active or to engage in social situations that may be awkward or embarrassing.

Incontinence after radical prostatectomy can have different causes. Problems with the bladder sphincter (the muscular valve that keeps urine in the bladder) causes stress incontinence, where urine may leak out during coughing, sneezing or other activities. Hypersensitivity of the bladder itself can cause urge incontinence, in which a person feels a sudden and uncontrollable need to urinate.

Medications are available to treat both problems, but they can have unpleasant side effects of their own. Surgery can also treat incontinence, but it is usually a last resort.

Exercising the seldom used pelvic muscles would seem to be a simpler way to help regain continence, but doctors are divided about its usefulness after prostate surgery because of the results of previous studies.

In the current study, the researchers randomly assigned 38 men scheduled for radical prostatectomy to either a treatment group or a control group. The men in the treatment group were referred to a physical therapist. They were instructed how to do Kegel exercises both before and after surgery, using biofeedback to ensure they were using the proper muscles. The control group did not receive any formal instruction. All of the men completed questionnaires regarding bladder function at regular intervals over the next year.

Overall, 82% of the patients had regained continence (defined as not needing to use any absorbent pads) by the end of the year, including about equal numbers in both groups. But on average the men who had been educated about Kegel exercises regained continence about one month earlier than those in the control group (at 12 weeks vs. 16 weeks).

Most of the men who did not regain continence within a year were still using at least three absorbent pads a day, indicating continued severe incontinence. The study authors explained that these men probably had extensive damage to the bladder sphincter or severe dysfunction of the bladder after surgery, and the exercises alone were unable to compensate for this.

The authors did not do a cost comparison between the two groups, which might have helped determine if the added costs of physical therapy were offset by the decreased use of pads or other treatments for incontinence.

But the exercises seemed to be effective. “Pelvic floor exercise and education initiated prior to surgery is an effective noninvasive intervention useful for improving early return of urinary continence,” the authors concluded. “It would certainly have a positive impact on our patients undergoing radical prostatectomy in an effort to improve quality of life after major urological surgery.”