Although early detection and treatment of prostate cancer has significantly improved the outcomes of this disease over the years, the side effects of prostatectomy surgery can significantly hinder ones quality of life. The following list describes the most common symptoms associated with post prostatectomy recovery:
- Stress urinary incontinence (SUI) – this is when there is involuntary loss of urine in varying amounts during activities such as coughing, laughing, sneezing, getting up from bed or a chair, and even walking
- Urge urinary incontinence (UUI) – this occurs when there is a loss of urine following a very strong and uncontrollable urge to urinate
- Erectile dysfunction (ED) – this is generally described as an inability to have or sustain an erection sufficient for penetration and/or climacturia (urinary leakage during orgasm)
Normally, there are two mechanisms that help keep men continent. The internal urethral sphincter (IUS) lies just below the bladder neck and is made of smooth muscle (involuntary control). The IUS is kept tonically contracted and is the primary muscle for preventing unwanted urinary leakage. The external urethral sphincter (EAS) is made up of skeletal muscle (voluntary control) and is the second component of the continence mechanism. Both the IUS and the EUS act as a “double stop” closed door system to keep the urine stored nicely in the bladder. When it is time to urinate, both the IUS and the EUS relax their muscle tone and this cues the bladder to contract and commence bladder emptying.
During removal of the prostate, the IUS is removed. With removal of this sphincter, there is a much greater reliance on the EUS mechanism for continence. The EUS is made up of the pelvic floor muscles. If the pelvic floor muscles are weakened or lack flexibility, this can contribute to the symptoms of SUI and UUI. A pelvic assessment followed by pelvic floor muscle training by a specialized physiotherapist helps those who have undergone a prostatectomy to know how to properly activate and strengthen the pelvic floor muscles and meet the demands of their new role. It has been shown that pelvic floor muscle training prior to prostatectomy surgery helps men regain continence sooner.
Why Should I Be Seen Before my Surgery?
Preoperative pelvic floor physiotherapy addresses and identifies any pelvic floor issues prior to surgery. This optimizes post-surgical recovery by ensuring clients can effectively identify and isolate the pelvic floor muscles. Clients are guided on initiating a safe pelvic floor strengthening program immediately upon catheter removal as well as other exercises that may help with pain management in the early post-surgical period. Preoperative physiotherapy ensures clients are aware of strategies to prevent post-surgical constipation by optimizing toileting postures, hydration and fibre intake. Straining when toileting is very strenuous to the pelvic floor muscles and can contribute to pelvic floor weakness as well as delay the recovery of the sensitive tissue around the surgical site.
Erectile dysfunction (ED) has been hypothesized to be due to the mechanical stretching of the nerves that supply the penis, thermal damage to nerve tissue, and local inflammatory effects following surgery. Pre-existing factors may compound post-operative ED such as older age, cardiovascular disease, diabetes, cigarette smoking, physical inactivity, and some medications such as hypertensives. It has been reported that 60% of men report some level of ED up to 18 months post-surgery. Postoperative erectile function has been found to improve over time, at least up to 24 months and in some series up to 48 months. Penile rehabilitation has suggested that early induced sexual stimulation and blood flow (within the first 3 months post-surgery) to the penis may help facilitate the return of natural erectile function. A comprehensive pelvic floor muscle training program aims to optimize the blood flow and nutrient exchange within the muscles that promote erectile function as well as enhance oxygenation to the injured nerves that supply the penis. Pelvic floor muscle training has been found to improve erectile function and reduce climacturia (urine leakage during orgasm) post-surgery.
If you or a loved one will be undergoing a prostatectomy in the near future, or you are still suffering from the effects of prostate surgery, start on your road to recovery by contacting ALPHA Health Services today for a pelvic health assessment.
Pelvic Health Physiotherapist
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