Pelvic PT Post Prostatectomy
The prostate is a gland that sits at the base of the bladder and surrounds the urethra (tube that transmits urine from the bladder to the exterior of the body). The primary role of the prostate is to produce prostatic fluid, which contributes to semen. It also acts as a valve that allows ejaculate or urine to flow in the right direction.
Unless inflamed, the prostate does not typically produce pain. With age, the prostate gland naturally enlarges and with enough enlargement, can constrict the urethra and cause symptoms such as weakened urine stream or difficulty starting the flow of urine. Although a man can have both benign prostatic hypertrophy (BPH) and prostate cancer, BPH does not cause cancer.
About 1 man in every 8 will be diagnosed with prostate cancer in his lifetime. Risk factors include older men, having one first degree relative with prostate cancer, lifestyle factors such as high fat intake and/or excess body weight and/or non-hispanic black men. Prostate cancer is the second leading cause of cancer death, behind lung cancer. However, more than 3.1 million men in the United States who have been diagnosed with prostate cancer are still alive today.
Prostate cancer is diagnosed by a physician and typically includes a rectal exam, prostate-specific antigen testing (PSA), biopsy, Gleason score and/or transrectal ultrasound. Protein-specific antigens are proteins produced by the cells of the prostate that form liquid secreted by the prostate during ejaculation. Normal PSA values are between 0-4 ng/ml, 4-10.0 ng/ml is borderline, and >10 ng/ml calls for a biopsy. Common treatment options for prostate cancer include active surveillance, radical prostatectomy, nerve-sparing radical prostatectomy, brachytherapy, hormone treatment, cryotherapy, external beam radiation therapy and more. For a video animation of the Da Vinci robotic prostatectomy, please click the link below.
https://www.youtube.com/watch?v=u2A_aXsD9CQ
So what can one expect when recovering or rehabilitating after prostatectomy? The most common complaints post prostatectomy include urinary incontinence and sexual dysfunction. Due to the nature of the procedure, in which the bladder neck is stretched to reattach to the urethra, men typically wear a catheter for 5-6 days. Due to the healing of the new anastomosis between the bladder neck and the urethra, urinary incontinence may continue. If a nerve sparing technique is able to be performed, men may also experience less sexual dysfunction due to the sparing of the nerve bundles around the prostate. Following catheter removal, pelvic floor rehabilitation can begin. Pelvic floor muscle examination can include perineal observation (external observation of the male pelvic floor), palpation, examination of the trunk and scar management, discussion of bladder irritants, and review of proper lifting techniques.
A retrospective review was performed in 2019 that looked at how well patients responded to pelvic floor muscle training after robot assisted prostatectomy (performed by the same surgeon). All patients reported developing urinary incontinence between 2009-2014. Patients were referred to physical therapy for pelvic floor dysfunction; 25 had weak pelvic floor, 13 had overactive pelvic floor, and 98 were of the mixed type pelvic floor dysfunction. All patients received individualized pelvic floor physical therapy and 87% reported significant improvement in incontinence. Additionally, the 27% of the mixed type patients also experienced pelvic pain and physical therapy reduced that to only 14% of the patients.1
As a prostate cancer survivor, you owe it to yourself to take the best care of yourself and your new opportunity at living life. Allow a pelvic floor physical therapist to work with you after surgery to maximize your potential and minimize pain and dysfunction.
Scott KM, Goasai E, Bradley MH, et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain [published online December 5, 2019]. Int Urol Nephrol. Doi: 10.1007/s11255-019-02343-7.
