Kegel Exercise Guidelines for Men

Introduction to Kegel Exercises

• Men should perform Kegel exercises by contracting the pelvic floor muscles for 6-8 seconds, followed by 6 seconds of rest, doing 15 contractions per session, two times a day for at least 3 months to obtain optimal benefits 1
• It is fundamental to receive instruction from trained healthcare personnel to ensure the correct technique and avoid incorrect muscle activation 1

Specific Exercise Protocol

• The duration of each contraction should be 6-8 seconds 1
• The rest period between each contraction should be 6 seconds 1
• The maximum number of contractions per session should be 15 1
• The frequency of the sessions should be two daily sessions of 15 minutes each 1
• The minimum duration of the treatment should be 3 months to obtain optimal benefits 1

Precautions During Exercise

• Men should maintain normal breathing during the entire exercise, never holding their breath or making excessive effort to avoid the Valsalva maneuver 1
• Men should isolate only the pelvic floor muscles without contracting the abdomen, glutes, or thighs 1

Clinical Indications

• The American Cancer Society recommends referring survivors with post-prostatectomy incontinence to a physical therapist for pelvic floor rehabilitation; at a minimum, instructing them on Kegel exercises 2
• Kegel exercises are specifically recommended for patients post-prostatectomy with incontinence and erectile dysfunction, addressing both conditions simultaneously 3
• The American Urological Association supports a shared decision-making model where Kegel exercises should be discussed with patients as a treatment option for erectile dysfunction 3

Optimization of Treatment

• Biofeedback therapy can be implemented using programs that teach muscle isolation using surface EMG perineal electrode feedback 1
• Adherence to long-term pelvic floor muscle training maintains the benefits 1
• It is crucial to instruct on the adequate technique by trained healthcare personnel to maximize effectiveness 1

Expectations and Referrals

• The American Cancer Society recommends referring men with persistent leakage or other urinary symptoms to a urologist for further evaluation and discussion of treatment options, including surgical placement of a male urethral sling or artificial urinary sphincter for incontinence 2
• Men with persistent sexual dysfunction should be referred to a urologist, sexual health specialist, or psychotherapist to review treatment options and counseling 2

Pelvic Floor Muscle Training (PFMT) After Radical Prostatectomy

Guideline Recommendations

• The American Urological Association (AUA) together with the Society of Urologic Female Urology (SUFU) recommends that pelvic floor muscle exercises be offered to men in the immediate postoperative period following radical prostatectomy. 4
• The AUA Overactive Bladder guideline advises that men with urgency‑predominant or mixed urinary incontinence after prostate treatment receive targeted overactive‑bladder therapy in addition to PFMT. 4

Efficacy of PFMT

Early Continence Recovery

• Initiating PFMT after catheter removal shortens the time to achieve continence, with many patients regaining control within 3–6 months compared with usual care. 4

Long‑Term Continence Rates

• At 12 months post‑prostatectomy, overall continence rates are comparable between men who performed PFMT and those who did not, indicating that the main benefit of PFMT is accelerated recovery rather than higher final continence prevalence. 4

Contraindications

• Acute pelvic infection is an absolute contraindication to PFMT; therapy should be deferred until the infection resolves. 5
• Active urinary tract infection is a relative contraindication; infection must be treated before initiating PFMT. 5

Referral and Escalation Criteria

Lack of Improvement After Conservative Management

• Men who show no significant improvement in urinary leakage after ≥ 6 months of supervised PFMT should be referred for urologic evaluation and discussion of surgical options such as a male urethral sling or artificial urinary sphincter. 4

Early Surgical Consideration

• If continence does not improve despite ≥ 6 months of PFMT, early surgical intervention may be considered. 4

Patient Counseling and Expectations

• Patients should be informed that urinary incontinence is common in the early postoperative period, typically improving to near‑baseline levels by 12 months, but may persist in some individuals. 4
• The primary advantage of PFMT is a faster return to continence (approximately 3–6 months) rather than an increased overall continence rate at one year. 4

Assessment of Mixed Incontinence

• A comprehensive history, physical examination, and appropriate diagnostics are required to differentiate stress, urgency, and mixed urinary incontinence patterns. 4
• Overactive bladder symptoms occur in up to 48 % of men after prostate treatment and warrant specific management per AUA guidelines. 4

Pelvic Floor Muscle Therapy in Men – Evidence‑Based Recommendations

Urinary Incontinence

• The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) recommend initiating pelvic‑floor muscle exercises immediately after radical prostatectomy to accelerate continence recovery, with most men regaining continence within 3–6 months compared with delayed recovery without therapy. 6

• The American College of Physicians (ACP) advises that pelvic‑floor physiotherapy be offered as first‑line treatment for stress, urgency, and mixed urinary incontinence patterns in men. 7

• If urinary leakage persists after ≥ 6 months of supervised pelvic‑floor muscle training, referral for urologic evaluation for surgical options (e.g., male urethral sling or artificial urinary sphincter) is recommended. 7

Sexual Function Restoration

• The American Society of Clinical Oncology (ASCO) acknowledges that pelvic‑floor exercises reduce anxiety, lower urinary‑tract symptoms, and discomfort, thereby supporting sexual recovery after prostate treatment. 8

• In men with erectile dysfunction, incorporating pelvic‑floor therapy into a comprehensive regimen that may include phosphodiesterase‑5 inhibitors can enhance medication response and improve erectile outcomes. 8