Benefits of Pelvic Floor Physical Therapy After Prostatectomy

June was Men’s Health Month!! Although I’m a little slow to get this out, I feel this information is better late than never. When talking about men’s health, you can’t ignore the topic of prostate cancer. Next to skin cancer, prostate cancer is the most common cancer among men and the third leading cause of cancer death in the U.S. The American Cancer Society (ACS)1 estimates that one in seven men will be diagnosed with prostate cancer in their lifetime. Fortunately, the disease is very treatable if found early. The ACS recommends men begin discussing cancer screening with their physicians around the age of 50, depending on the patient’s family history. The U.S. Preventative Services Task Force recently changed their recommendations2and now suggest men ages 55-69 discuss prostate specific antigen (PSA) screening. African American men and men with a family history of prostate cancer are at higher risk and may need closer monitoring. The good news is that the 5-year survival rate is near 100%.   With it being so prevalent and one of the three standard treatment options being a prostatectomy, it is important to discuss some of the side effects of prostatectomy. These side effects are not limited to just prostatectomy but may be prevalent to some degree in any of the treatment approaches for prostate cancer.  

LIFE POST-PROSTATECTOMY

So, you’ve had a positive cancer screen and your physician decides that the prostate has to be removed. Now what?? Here are some common hurdles you may encounter after a prostatectomy. Immediately after surgery, you will have a catheter in place to drain the bladder and allow the tissues to heal. This will commonly remain in place for 1-2 weeks. After removal of the catheter, you will be able to urinate on your own although controlling your bladder may be difficult for several weeks. The major and most common side effects after radical prostatectomy are urinary incontinence and erectile dysfunction. This is where pelvic floor physical therapy comes into play!   URINARY INCONTINENCE The prostate surrounds the urethra and assists in controlling urination. After prostatectomy, the pelvic floor muscles have to work harder to maintain continence. Bladder control will slowly improve after the catheter is removed and can take 6-18 months for complete return of continence.4 At one-year post-robot assisted laparoscopic prostatectomy, an overwhelming majority of men (approximately 90%) are using 0-1 pads to manage urinary incontinence.5 Being incontinent can affect more than just physical control, but it can be emotionally and socially stressful. There are different types of incontinence.
  1. Stress urinary incontinence – This is the most common type of incontinence following radical prostatectomy. With this, a person experiences leakage with coughing, laughing, sneezing, straining or even just moving around.
  2. Overflow incontinence – This presents with the person having difficulty emptying the bladder. It is commonly caused by narrowing of the urethra or the outlet which you urinate from causing a dribbling stream.
  3. Urge incontinence – This is the sudden and strong urge to urinate. With this, the bladder has become sensitive to the stretch reflex of the bladder as it fills with urine.
Pelvic health physical therapy after prostatectomy can help train the muscles and reduce incontinence. The muscles need some good old-fashioned strength training to improve the strength, endurance and coordination of the muscles. Weakness may also be present in the abdominal wall following laparoscopic procedure causing what is known as diastatis recti, or a separation of the rectus abdominis muscle – “the six-pack muscle” – which can affect urinary incontinence. All of this can be addressed and improved with pelvic health physical therapy all in order to reach the goal of improved/full continence.   EJACULATION The prostate assists the testicles and seminal vesicles in creating the secretions for ejaculation. Following prostatectomy, the seminal vesicles along with prostate are removed therefore these men will have dry orgasms.5   ERECTIONS The nerves responsible for an erection are often damaged with a prostatectomy, even if the surgeon performs a nerve sparing procedure. Depending on the severity of the cancer identified, radiation therapy may also be necessary. Radiation will often effect the nerves and cause further difficulties with an erection. If the nerve is spared, it will still take some time (often time 2+ years) for erections to improve.1 Nerves heal very slowly therefore erectile dysfunction can last for a couple years after surgery. Nerves recover better when oxygenated blood readily available. This is done by having an erection (obviously difficult if the man has erectile dysfunction), being aroused, use of medications (Viagra, Cialis, Levitra, etc), vibratory stimulation to the pudendal nerves and vacuum erection devices. In short, the more frequently you can increase blood flow to the area, the better the nerves will heal.5 It still may not be quite as easy to achieve or maintain an erection, but it will be significantly more likely to occur than if nothing had been done to address the issue.   If you or a loved one have more questions regarding pelvic health therapy to manage urinary incontinence or side effects of prostatectomy, please contact Chelsea Beyers, PT, DPT, OCS at our Meridian location (208-887-3498).   References:
  1. ACS: https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html
  2. US Preventative Task Force: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/prostate-cancer-screening1
  3. Cancer.Net: http://www.cancer.net/cancer-types/prostate-cancer/statistics
  4. Ahlering UC-Irvine: http://www.urology.uci.edu/prostate/Continence.html
  5. PHRC.com: http://www.pelvicpainrehab.com/prosatectomy/4630/what-does-physical-therapy-do-for-men-following-prostatectomy/

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