Author: Aileen Curtis MCSP, POGP Pelvic physiotherapist
In the UK, 1 in every 8 men will be diagnosed with prostate cancer in their lifetime. This risk does increase for men of black ethnicity, or if it already runs in the family.
Common symptoms of both prostate cancer and Benign prostatic hyperplasia (BPH) are:
Urgently going for a pee more frequently during the day and more than once at night
Dribbling of urine
Image source: NHS website
What is the treatment?
It is possible you'll be offered surgery such as a prostatectomy or transurethral resection of the prostrate (TURP), radiotherapy and hormone therapy.
You may be surprised to know, that if you have radiotherapy, then you will be asked to have a full bladder during treatment, which some find challenging. Pelvic physiotherapy can help with bladder training and control. You also may develop bowel urgency and incontinence following radiotherapy so; pelvic physiotherapy can help with supervised anal sphincter muscle strengthening.
If you have surgery, it is possible that the internal sphincter below the bladder neck and the nerves may be damaged. This can cause incontinence and erectile dysfunction.
Scar management to improve healing may also be advised, to prevent painful or tight scars.
How soon can I start pelvic health physiotherapy?
If you're able to, start these pelvic floor exercises 4-6 weeks prior to surgery. This can help you strengthen your muscles to lessen the impact of these complications. It will also help you to know if your muscles are overworking and tight, and how to relax them.
With some practice, you will be confident in doing a correct technique for pelvic floor muscle squeezes and continue to breathe.
You can restart pelvic floor muscle exercises once the catheter is removed, and we can guide you in how many long and short (slow and fast) squeezes to do as this may feel different after surgery.
Then we can suggest a variety of functional and dynamic positions which will help prevent leaking when standing up, bending over, coughing and sneezing or going back to a particular job, hobby or sport such as cycling or golf.
This should improve the power, speed, endurance and muscle bulk in your pelvic floor. We can also give advice to help with dribbling after peeing or leaking during sexual intercourse at arousal or climax.
Everybody is an individual and muscles get tired at different rates. We might give advice on how to use a penile clamp to train the bladder to hold more or using pads and more importantly how to build confidence to come off the pads.
What about medication?
We do not prescribe, but we might suggest using medication such as ‘Solifenacin’ or ‘Mirabegron’ to reduce urgency from your bladder. Laxatives are recommended prior to your prostatectomy and helping you to open your bowels following surgery until they are back to normal. We can write to your doctor to request a prescription. We also give advice on foods that can help constipation and breathing techniques to help you have your bowels open more easily and discuss different positions on the toilet that may be helpful.
Prostate cancer UK recommends that drug management for erectile dysfunction be started from about 3 weeks post operatively to help with penile recovery to improve blood flow, and reduce shrinkage even if you are not intending to have sexual intercourse. Also, a vacuum pump that artificially creates an erection is also recommended to prevent scar tissue and retraction. Pelvic floor muscle exercises may help to maintain an erection to keep the blood in the penis once and erection is possible. Some doctors recommend ‘Caverject’ injections which can be more effective than medications initially and then low dose medications once the tissues and nerves start to recover spontaneous erections.
Pelvic health physiotherapy can help you with:
1) Advice on pacing yourself to get back to work
2) Regain your fitness
3) Losing weight
Image source: Wix EditorX
The above should improve your quality of life to enjoy the things that matter to you.
Following radiotherapy, you may have developed bowel issues, pelvic pain and chronic fatigue. Pelvic health physiotherapy and improve each of these symptoms as well. Some people benefit from using anal irrigation to help them empty their bowels and then go on with the rest of the day.
Feelings of embarrassment, shame, frustration about a body that is not working can lead to low mood so, working with a pelvic physiotherapist you trust may help you achieve goals step-by-step but some people benefit from talking therapy or antidepressants and also peer support from others who are going through the same things. These difficulties should improve but do you ask for help if they seem overwhelming particularly if you are having difficulty with your relationships or feeling suicidal.
What can I expect from pelvic health physiotherapy?
A specialist men's health physiotherapist will listen to you and answer your questions. We will take a full history, offer an assessment of your pelvic floor muscles, and may ask you to do a bladder or bowel diary. You can start with pelvic floor physiotherapy around 2 weeks after surgery.
We will analyse the diaries together and offer advice on food and drinks and timing of pees to train the bladder.
If your pelvic floor muscles are tight, we may teach pelvic floor relaxation using breathing techniques and mindfulness or stretches. This can happen due to urgency with your bladder or bowel, stress, anxiety, or due to pain.
Then we can give you an individualised programme of pelvic floor muscle strengthening checking that you we are confident that you have a good technique and are able to relax the muscle between each squeeze. We give you verbal cues such as imagine walking into cold water, stopping wind and slowing down peeing, ‘nuts to guts’ and looking at your penis to see if you are testicles drawn upwards and making sure you are not pushing down. Then we can suggest that you do these in a variety of positions to gradually increase the challenge on your muscles.
We will give you a strengthening program to help you regain your fitness and balance reactions. Recent evidence suggests better recovery from stress urinary incontinence if a strengthening program is added to pelvic floor muscle training.
We can discuss returning to sexual intimacy and penile rehabilitation and liaise with your medical team if necessary.
We can help you with motivation by regularly supervising your progress. This is like pre-season training prior to you getting back to normal.
The NICE guidelines recommend that you have regular supervision for pelvic floor rehabilitation which should show improvements in symptoms by 3 months and can continue to improve. 80% of men are dry following prostatectomy at around 6 months and 95% are continent by 1 year. Evidence shows that having pelvic health physiotherapy reduces the time taken to get dry.
Further information and resources:
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