Exercises to give your love life a lift

Exercise may not be at the forefront of a man’s mind after prostate surgery, but there is one area of their body that really does require a workout at this time: their pelvic floor.

This band of muscles runs from the pubic bone at the front to the coccyx or tailbone at the back, and as with women, it helps support the bladder and the bowel. it also helps maintain an erection.

‘ Most men amble through life without even knowing they have a pelvic floor,’ says Gerard Greene, a specialist pelvic health physiotherapist for men who lectures on the subject at coventry University.

‘it’s of no concern to them until they have their prostate taken out and then it becomes crucial.’

This is because it is key to preventing the incontinence that most men experience — usually temporarily — after the surgery.

That’s because during surgery a valve that helps close the bladder is always removed with the prostate — and so the main way to control the flow of urine is for the pelvic floor to tighten, to close the neck of the bladder. But if the pelvic floor lacks tone, this won’t happen effectively.

Pelvic floor exercises for men differ slightly from those for women.

‘We tell men to imagine that they’re lifting “nuts to guts”, says Gerard Greene, who is in private practice in Birmingham.

‘This has been found to work much better than the previously-used way of just tightening all the way through from the back passage.’

Don’t wait until after surgery to do the exercises — it’s worth doing them six weeks before and then continuing with this routine after the operation, says Gerard Greene.

A review of studies by sydney University in Australia in 2015 found prostate cancer patients who did the exercises prior to surgery were 36 per cent less likely to still be incontinent three months after surgery than men who did exercises only after surgery.

When it comes to doing the exercises afterwards, you can start after the catheter (the tube that’s put in place immediately after surgery) is removed.

even if you’ve already been doing the exercises before, start back at the minimum number of repetitions a day (see below) — though you should feel able to progress up again quicker than you would otherwise.

‘Post op, you should expect to see a significant improvement in eight to 12 weeks,’ adds Gerard Greene.

There are two main types of muscle fibres in men and women’s pelvic floor and each needs to be worked slightly differently.

SLOW contractions work the endurance muscle fibres, the ones that work all the time to prevent leaks. You need to contract at 50 per cent of the maximum, advises Gerard Greene. ‘To get used to what that feels like, contract as hard as you can and then let half of that tension go — that’s what you need to achieve.’ repeat ten times, holding for ten seconds each time.

FAST contractions help with the fast twitch muscle fibres that react quickly when you cough or move quickly. repeat these ten times quickly (doing roughly one a second).

start by doing one set of each exercises each day — as you get stronger, increase to doing them three of four times a day.

And change positions: when you start doing the exercises it can be easiest to do them lying down, but as you get more confident progress to doing them standing or do the fast contractions while going from sitting to standing.

Most men may struggle to do the exercises properly at first, and so can find it helpful to see a specialist men’s physiotherapist.

‘We can check the technique using ultrasound imaging to see if the muscles are contracting or not,’ says Gerard Greene. ‘Men are very visual and they like that.’

However, access on the NHs to specialist physios, ‘ though improving’, is limited, he says. To find a private specialist, search ‘ male pelvic health physio’ on the internet — expect to pay around £ 80 an hour outside London, but double that in the capital.

‘As the exercises start to take effect, men will find they are drier at night and in the morning,’ says Gerard Greene.

‘Problems may persist at first in the afternoon and evening — just because like other muscles in the body those in the pelvic floor tire throughout the day.

‘Men may also find that as they get more active, everyday activities, even gardening, may make their leaks worse, but this will gradually improve.’