Gentleman, are you tired of constantly wondering where the bathrooms are located when traveling? Or experiencing urinary leakage with little to no movement, especially when playing outside with your children or grandchildren? Perhaps, you feel uncomfortable, hiding your undergarments under baggy clothing and always needing a change of clothes available. Have you noticed a decline in your sexual function because of erectile dysfunction?  

The Center of Disease Control reported prostate cancer was the most common male cancer in the United Stated and estimated 1 in 7 men will be diagnosed in their lifetime. The surgical procedure to undergo for this specific cancer is a prostatectomy. Unfortunately, the most common side effects are urinary incontinence, erectile dysfunction, and pain. Many don’t know that pelvic floor physical therapy should be the first line of treatment to prevent or improve these symptoms.

A radical prostatectomy, removes the entire prostate gland and surrounding lymph nodes. There are different techniques for this procedure which include:

1. Robot-assisted radical prostatectomy- a computer-assisted mechanical device is used for the precise excision of the prostate, where several small incisions are made in the lower abdomen.
2. Open radical prostatectomy- the surgeon makes a longer incision in the lower abdomen to remove the prostate.
3. Laparoscopic radical prostatectomy- small incisions of the abdomen are made to remove the prostate.
4. Simple prostatectomy- may be recommended for patients suffering from severe urinary symptoms due to an enlarged prostate. This can be non cancerous such as, BPH, benign prostate hyperplasia.

Patients should use pelvic floor physical therapy in order to prevent or improve their symptoms. These treatments, prior to surgery and post surgically, have tremendous results on improving urinary incontinence, pain, and overall quality of life

Regardless of the chosen surgical technique listed above, there is disturbance of the pelvic floor muscles, urinary sphincter, and nerves during each procedure. Teaching and implementing  techniques to strengthen the pelvic floor muscles is essential to minimize or abolish episodes of urinary incontinence. Stronger pelvic floor muscles prevent leakage with movement such as bending, lifting, and exercise. Physical therapy also involves strengthening of the hips and core muscles that surround the pelvis and help decrease the load on the pelvic muscles.

Erectile dysfunction may also be a result of a prostatatectomy and treatment is essential in the recovery process. Blood flow has a direct impact on the ability to initiate and maintain an erection. Pelvic floor therapy has been found to be effective to restore adequate blood flow through strengthening the pelvic muscles and performing soft tissue massage to the abdomen.

Pelvic floor physical therapy entails a variety of techniques to facilitate healing.

1. Biofeedback- a tool to assist in retraining the pelvic muscles to work with functional activity. Ideally, this approach should be utilized prior to surgery, to work on building the muscles, and then post surgically, to restore pelvic muscle health and nerve regeneration.  
2. Postural examination- observing for any tightness of muscles in the trunk and hips; this muscle restriction and poor posture interferes with activation of the pelvic floor muscles. Re-establishing better posture, muscle length, and body mechanics will decrease pressure through the abdomen and the bladder.
3. Diastasis recti examination- ruling out a separation of the abdominal muscles, which is quite common in men. A customized home program will be developed according to findings.
4. Abdominal muscle strength- it is important to activate abdominal muscles when standing or lifting in order to decrease the load placed on pelvic muscles.

Pelvic floor physical therapy is a crucial component to the patient diagnosed with prostate cancer, recovering from surgical intervention. After an initial evaluation, a customized program is created for each patient; by focusing on strength, activating pelvic and lower abdominal muscles, and restoring blood flow, our patients are able to stop episodes of incontinence.

Let IDPT help you start living life, leak free. Call us today at our Ocean office 732-508-9926 or our Toms River office at 732-506-3471 to see how we can help you get stronger and healthier.

How Physical Therapy Can Help Post-Prostatectomy