Prostatectomy Physical Therapy

Should I go to physical therapy after my prostatectomy?

Physical therapy is recommended for men post-prostatectomy to improve pelvic floor function in relieving urinary incontinence and erectile dysfunction. Pelvic floor muscle training and education before surgery benefits you as well as preparation can boost your confidence and improve your rate of recovery.

Often, men in the U.S. are not instructed to see a physical therapist until they try to Kegel (or contract their pelvic floor muscles) on their own for several months after prostate surgery.

Prostate cancer is the third leading cause of cancer death in men and the most common type of cancer in men older than 50. Survival rates for prostate cancer are increasing thanks to early detection through PSA testing and advancements in surgical techniques and treatment.

Methods of radical prostatectomies include surgery done by your urologist laparoscopically or with robotic assistance.

Radical prostatectomy is used when cancer is confined to the prostate. Removing the prostate is the standard treatment that involves surgical incisions through your abdomen or perineum. 

  • Retropubic or suprapubic incision is made through your lower abdomen. 
  • Perineal incision is made through the area between your scrotum and rectum.  

These surgical techniques affect your pelvic floor and can result in incontinence or erectile dysfunction. Your physical therapist can address issues related to your pelvic floor muscle impairments.

Is physical therapy worth going to after a prostatectomy?

Your prostate assists in sexual and urinary function. Unfortunately, it is common for your prostate to enlarge and place additional pressure on your bladder and urethra. As you age, you will likely run into sexual or continence issues as the prostate continues to grow. Some other less common reasons you may elect prostatectomy are:

  • Slow urination
  • Inability to empty your bladder
  • Bleeding from prostate
  • Bladder stones

When cancer is detected in the prostate, the benefits of prostatectomy are unquestionable. It is a life-saving procedure to remove cancer from your body, but it will also come with risks and complications, such as:

The 10-year survival rate after radical prostatectomy is 92% and the most significant complaints after surgery are urinary incontinence and erectile dysfunction. This negatively affects your quality of life and your social life.

It is important to note that symptoms improve on their own regardless of which procedure is used to remove your prostate, but at least 8% of men continue to live with complications up to two years following surgery.

If you are part of the population of men still experiencing pelvic floor dysfunction, you can still receive treatment to address prostate surgery complications at any point along your journey to recovery.

How do you rehab after prostate surgery?

The first line of defense for complications related to post-prostatectomy is pelvic floor muscle training. Physical therapy also offers the following treatments to help you quickly reach your goals:

  • Therapeutic exercise
  • Electrical stimulation
  • Biofeedback
  • Bladder training
  • Lifestyle education

Education and training of your pelvic floor muscles are essential to achieve a properly functioning pelvic floor. And you can elect to start your training before and after surgery. Training for a specific performance, such as continence or erection, must include training the muscles in movements that resemble the desired action.

Your physical therapist is trained to treat movement dysfunctions related to poor pelvic floor muscle performance.

Do pelvic floor exercises help after a prostatectomy?

Stress urinary incontinence is common following radical prostatectomy. You could also develop other types of incontinence due to a poor functioning pelvic floor:

  • Stress incontinence occurs when urine leaks due to increased abdominal pressure, such as during a sneeze, cough, or lifting something heavy.
  • Urge incontinence happens when you feel the need to pee even if you do not have to go and your bladder is not full.
  • Mixed incontinence is when you experience both stress and urge incontinence simultaneously, which is why doing strengthening exercises alone does not always improve your symptoms.

Strengthening your pelvic floor muscles will help you to control your urge to urinate and hold back urine until you are ready to relieve yourself. The pelvic floor muscles are also responsible for the following:

  • Bladder stability
  • Resting urethral pressure
  • Regulation of urethral pressure during exertion 
  • Erection and maintaining erection

Your pelvic floor is made up of several muscles that you can train to help improve your symptoms.

The ischiocavernosus muscle is involved in erection, while the bulbocavernosus muscle is involved in maintaining your erection. Your corpus cavernosum, or the erectile tissue in the shaft of your penis, blocks blood from exiting when your bulbocavernosus muscle is contracted. When this muscle contracts, it puts pressure against your deep dorsal vein to keep your penis erect. 

Training your pelvic floor muscles can prevent urine from dribbling or leaking on accident and increase the rigidity of your erections.

What can I expect from my physical therapist after prostate surgery?

A physical therapist can address your pelvic floor muscles and design an exercise program specific to the actions you want to complete, such as maintaining continence during physical activity and sexual performance.

Examining your pelvic floor muscles includes palpating or touching your anorectal tissues and perineal body to assess your pubococcygeus muscle. Also, your physical therapist will make observations of your anal contraction and penis lift. A complete examination will include an assessment of your pelvic floor muscle:

  • Strength
  • Symmetry
  • Tone
  • Reflex
  • Pain

You may also need to complete a voiding diary and questionnaires regarding your symptoms to give your physical therapist a complete picture of your situation. 

Once your physical therapist collects enough information, they can formally develop a functional diagnosis and create an individualized pelvic floor muscle training program to help you reach your goals.

How do you strengthen your muscles after prostate surgery?

Weak synergy, or unbalanced activation between your pelvic floor muscles and other muscles that encourage optimal core function, is believed to contribute to pelvic floor dysfunction. If your muscles do not work together correctly, or their timing is off, then all of your work will nullify the effects of exercise training.

Important muscles to address that result in synergy among your pelvic floor muscles include:

  • Transversus abdominis (stomach muscles)
  • Gluteus major (butt muscles)
  • Adductor femoris (inner thigh muscles)

Direct local trauma, such as from radical prostatectomy, can result in deficiencies in muscle recruitment whether you are experiencing pain or not.

Therapeutic exercises, stretching, and breathing exercises can help you achieve stronger and more coordinated pelvic floor muscles. These activities help improve pelvic floor strength and relaxation, which are both critical to achieving continence and proper function.

Your physical therapist will design a pelvic floor strengthening program at Smart Body Physical Therapy to promote optimal pelvic floor function. And we offer the best evidence-based treatments to help you improve the quality of your life by quickly recovering from incontinence and erectile dysfunction.

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