That was definitely the weirdest sentence I've written this year, but also one of the most important.
The fastest path back to full bladder control after prostate surgery isn't a better surgeon. It's a muscle group most guys have never trained properly.
Even guys who think they have.
I called Dr. Victoria Mallow at Restore Pelvic Health & Rehab last week to ask her about Kegels.
She's been recommending Freewill to her post-prostatectomy patients.
“You’d be surprised how many men are doing Kegels all wrong,” she said.
I rubbed my forehead. “Wait, what? How are they doing Kegels wrong?”
“Well, no one teaches them the right way, so they end up just squeezing everything down there as hard as they can. Lots of guys end up mostly working their glutes, which fires the pelvic floor a little, but not enough to regain bladder control after prostate surgery.”
“So… eventually they give up?”
“Unfortunately, they do. I saw a patient last week — 67 years old, 16 months post-surgery. He’d been religious about his routine, but was still going through six pads a day. Poor guy thought he was broken.”
"Sixteen months." I sat with that.
“Yep. We got him firing the right muscles that day. He's already noticing changes.”
Of course, my next question was about exactly how she helps guys activate the right muscle group.
She told me. And gave me permission to share it with you.
Two things she said before we get to the technique itself:
One: Guys regain full bladder control after surgery all the time. Kegels work when the technique is right.
Two: Pre-surgery pelvic floor muscle training helps guys feel more confident coming out of surgery and start making progress sooner. (Dr. Mallow has patients start as early as possible.)
Then she walked me through the test she runs on visit one. Here’s what she explained.
The Lift Technique:
Imagine you're trying to lift your testicles without using your hands.
That subtle internal pull is the pelvic floor firing.
If your butt cheeks or inner thighs squeeze, you're cheating. Relax everything else, and try again.
Once you can fire the muscle group without dragging any other muscles into the mix, you're ready to start training.
As far as actual reps go, here's what Dr. Mallow recommends.
Once the catheter comes out (or today if surgery is still ahead), start here:
Work on gently activating your pelvic floor muscles with the lift technique. Note that it is often easier to begin lying down, but as you progress, you should be able to perform this in sitting and standing.
Alternate between these two types of contractions, three or four times a day:
Contraction Type 1: Long holds (5-10 seconds)
These build endurance and train the pelvic floor to stay engaged through sustained pressure. Be sure to give your muscles double the rest time to prevent early fatigue and frustration. (i.e., contract and hold for 5 seconds, and rest for 10 seconds between each rep).
Contraction Type 2: Quick flicks (one second on, one off).
These build reflex so the muscles can act fast in the event of a sneeze, a heavy lift, or a hard laugh.
Do both every day. Red lights, meetings, watching TV… nobody even knows.
Also worth noting (and this was news to me):
The pelvic floor is part of how you get and maintain an erection.
So the same training that helps restore bladder control also helps overcome the other casualty of prostate surgery.
In the meantime, you still have to live your life. Coughs, sneezes, standing up too fast, the long meeting after lunch.
Carolyn and I built Freewill to help you navigate this with style, comfort, and dignity.
If you haven't tried a pair yet, my First Pair Money-back Guarantee still stands. 30 days, worn or unworn, full refund if they’re not for you.
- Jack
Co-founder & CEO, Freewill
