In Australia 1 in 9 men will be diagnosed with prostate cancer in their lifetime. Following prostate surgery many men will experience urinary incontinence or erectile dysfunction which can be extremely challenging for the man and their partner.
Urine leakage can occur after surgery due to damage to the bladder neck sphincter which is situated at the base of the bladder and top of the prostate. This is usually damaged when the surgeon removes your prostate and reattaches your urethra to the base of the bladder. This can occur despite nerve sparing surgery. Physiotherapy can assist with pelvic floor exercises to improve bladder control.
Studies have shown that men who are assessed and given a pelvic floor exercise programme before surgery are drier at 12 months. In fact 92% of men dry in the pre-operative group compared to 72% of men who start their exercises after surgery.
80% of men with incontinence can be cured or improved by seeing a continence physiotherapist.
Side effects of prostate surgery that can be managed with your continence physiotherapist include:
- Urinary incontinence
- Bowel incontinence
- Erectile Dysfunction
- Post micturition dribble
- Weight gain
Management of prostate cancer can also include:
- Radiation therapy
- Hormone therapy
Men undergoing these types of treatment can also experience the same side effects as those men who undergo surgery. Therefore Physiotherapy can be helpful in improving these conditions.
Management of pelvic floor function before and after prostate surgery or treatment includes:
- A thorough assessment of the condition, medical history and current health pre and/or post operatively, including diet and fluid intake, exercise levels and mobility, all the medicines you are currently taking, and any other factors that could affect bladder, bowel and erectile function
- Physical assessment of the pelvic floor function, strength and endurance
- Rehabilitation which may include pelvic floor muscle exercises, otherwise known as Kegel exercises, bladder retraining, erectile dysfunction information, changes to lifestyle and bladder habits, void retraining and pain management.
- Education on anatomy, catheter care, continence aids, fluid and fibre input before your surgery
- Further assistance with continence aids such as pads and pants.
- Use of biofeedback such as Real Time Ultrasound to observe bladder lift against gravity
- Exercise program prescription after prostate surgery or during hormone replacement therapy.
Outcomes from treatment may include:
- Correct pelvic floor muscles exercises can increase the size, strength and length of the pelvic floor muscles.
- Decreased urinary leakage, reduced usage of pads, improved control and reduced urgency.
- Decreased bowel incontinence, flatus or urgency, improved bowel function and reduced usage of pads
- Improved understanding of anatomy involved of the male pelvis and pelvic floor.
- Improved understanding of strategies to improve erectile dysfunction and void dysfunction
- Patient specific post-operative exercise programs for men undertaking hormone deprivation therapy.
- Improved confidence and reduced financial burden