Hi friends! November is Prostate Cancer Awareness Month. Prostate cancer is second most common cancer with over 1.1 million new diagnoses each year (Baumann, 2022).
A radical prostatectomy (surgery to remove the prostate and cancerous tissue) is often the first line of treatment (Baumann, 2022). The most common side effect of a radical prostatectomy is stress urinary incontinence, with up to 90% of patients having urinary leakage of some kind (Rahnama, 2021; Milios, 2019). Symptoms typically begin immediately after surgery, even after the removal of the catheter (Chitre, 2023).
Stress incontinence typically happens after a prostatectomy because of damage that occurs to the muscles that control the opening/closing of the bladder (Chitre, 2023). When these muscles can no longer control the bladder closing, we often see urinary leakage with high-impact activities like coughing or jumping, but we may even see symptoms with simple day-to-day activities like getting in and out of bed or standing up from a chair. This can often be attributed to two causes: the damage to the muscles along with weak and/or uncoordinated pelvic floor muscles.
The pelvic floor muscles control the opening to the urethra to either keep pee in the body or let pee exit the body. In a well-functioning body, the pelvic floor muscles are the back up to prevent any urinary leakage while the muscle at the opening of the bladder is the main control. However, if muscle at the opening of the bladder is damaged during surgery, the pelvic floor muscles become the first-line of defense. You can think of it like the star quarterback getting hurt and the back up quarterback going in to play. It may take some time for the backup quarterback (muscles) to get strong and function well while also coordinating well with other teammates (muscles).
That’s where pelvic floor muscle training comes into play to help re-educate and strengthen the muscles (Chitre, 2023). While Kegel exercises are often a large part of the retraining process, good recovery often involves neighboring muscles as well. Studies have seen good success in eliminating urinary incontinence by 3 months after surgery in up to 94% of men who performed a regular pelvic floor muscle exercise program (Chitre, 2023). Research studies support the early initiation of these exercises in the first few days after surgery compared with waiting and beginning exercises after symptoms have not resolved. One study found that men who started on the 3rd day after surgery regained good pelvic floor muscle strength, had less dribbling and leakage, and had an improvement in quality of life (Chitre, 2023).
But not all pelvic floor exercises are created equal. Did you know that mnY people actually do not know how to do Kegel exercises or engage their pelvic floor muscles correctly? It’s common for people to feel like they are engaging the pelvic floor muscles, but in reality they are simply engaging neighboring muscles like the abdominals, gluteals, or inner thigh muscles. Research has shown that in early prostatectomy rehab, patients have better improvements in urinary leakage when the exercise is supervised by a trained professional (Baumann, 2022). Professionals like pelvic floor physical or occupational therapists are experts in training the pelvic floor muscles and surrounding musculature.
In the long haul, regardless of participation in a pelvic floor muscle training program, many individuals see an improvement in urinary incontinence over time. For this reason, some researchers and providers do not recommend pelvic floor training as a conservative treatment option. However, many studies do show that men who participate in guided pelvic floor muscle training before and/or after surgery regain continence sooner than those who do not receive treatment (Milios, 2019; Haga, 2017). If you could regain continence months earlier, wouldn’t it be worth it?
A medication called Duloxetin may be recommended as a conservative treatment option, however, it often has severe digestive and central nervous system side effects (Rahnama, 2021). Bulking agents have been used as a treatment option but they are not recommended due to complications such as embolization, migration, absorption, allergic or fibrotic reactions (Rahnama, 2021).
If conservative therapy fails, there are surgical treatment options like the placement of an artificial urinary sphincter; however, these are saved as a last resort since many times conservative treatment options are successful (Rahnama, 2021; Schifano, 2021).
As always, this does information is not medical advice and does not replace evaluation and treatment by a licensed healthcare provider.
To learn more about your pelvic floor muscles, check out these great resources:
Find a pelvic floor physical or occupational therapist near you at www.mypfm.com/find-a-pt
Watch our Male Bodies and the Pelvic Floor YouTube playlist
Subscribe to access our video courses on demand at Pelvic Flicks
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For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources. At myPFM Academy you’ll find courses like:
High Intensity PFMT Before & After Prostatectomy Improves Outcomes with Dr. Joanne Milios, PT, DPT
Intro to Male Pelvic Health with Gerard Greene, MSc (Manip Physio), MMACP, PG Cert HEd
Written by Emily Reul, PT, DPT
References
Baumann FT et al. Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following a radial prostatectomy—a systematic review and meta-analysis. Disabil Rehabil. 2022;44(19):5374-5385.
Chitre A, Kulkarni JN. Effect of early pelvic floor muscle exercises (Kegel’s) after robotic prostatectomy in prostate cancer patients. Journal of Robotic Surgery. 2023(17):1065-1070.
Haga N, et al. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy. Fukushima J Med Sci. 2017;63(2):46-56.
Milios JE, Ackland TR, Green DJ. Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urology. 2019;19:116.
Rahnama MS, Marcelissen T, Geavlete B, Tutolo M, Husch Tanja. Current management of post-radical prostatectomy urinary incontinence. Frontiers in Surgery. 2021;8:1-10. doi: 10.3389/fsurg.2021.647656
Schifano N, Capogrosso P, Tutolo M, Deho Fredrico, Montorsi F, Salonia A. How to prevent and manage post-prostatectomy incontinence: a review. World J Mens Health. 2021;39(4):581-597.
Smeenk RJ, Hoffman AL, Hopman WPM, Th van Lin ENJ, Kaanders JHAM. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(2):636-44.