It may be time to rethink advising all men to do Kegel exercises to ease stress urinary incontinence (SUI) following radical prostatectomy (RP), new study findings suggest.

The study, published in International Urology and Nephrology, suggests there may be a subset of patients for whom down-training instead of Kegel up-training may be required for maximal improvement of post-RP incontinence.

First author Kelly M. Scott, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center in Dallas, and colleagues conducted a retrospective study with 136 patients with post-RP SUI and treated with pelvic physical therapy. Of these, 25 had underactive pelvic floor muscles, 13 had overactive pelvic floor muscles, and 98 had evidence of both. The mean time between surgery and start of physical therapy was 6.8 months.

All men received therapy to either relax or strengthen their pelvic muscles. The total number of pelvic physical therapy sessions depended on a patient’s progress. Incontinence improved in 87% of them, with 58% achieving what is considered the optimal improvement of needing 2 or fewer protective pads per day. Further, pain was a problem for 27% of the men, but that proportion dropped to 14% by the end of therapy, which averaged slightly more than four sessions. In those men still experiencing pain at the end of therapy, the pain was significantly decreased (mean initial pain score 3.62 vs final mean pain rating of 1.08).

“This study is the first to demonstrate that pelvic physical therapy may be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be attributable to pelvic floor myofascial pain associated with the pelvic floor overactivity issue,” Dr Scott told Renal & Urology News.

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The traditional line of reasoning is that men who have SUI after RP need to do Kegel exercises because their pelvic floor muscles are too weak, Dr Scott said. However, now it appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence.

“We may want to move toward a more individualized approach aimed at normalizing the pelvic floor function for each man,” Dr Scott said.

This article originally appeared on Renal and Urology News