Why see a pelvic floor physiotherapist if you are having a radical prostatectomy?
A radical prostatectomy is the full removal of the prostate as a treatment for prostate cancer. One of the most common post-operative complications is post-prostatectomy incontinence (PPI) (leakage of urine after the surgery). This may occur with activities (e.g. walking, sit to stand or bending), may be due to an urge to get to the toilet quickly, or may occur randomly and you are not quite sure what has caused the leakage.
Research has shown that pelvic floor muscle training exercises can help with this.
Improved outcomes are seen with:
- Those that perform pelvic floor exercises to those that do not.
- Those that perform pelvic floor exercises with a physiotherapist to those that perform them based off verbal instructions.
- Those that commence pelvic floor training 4 weeks prior to surgery.
- (Patel, et al., 2013, Centremeroa, et al., 2010, Dubbelman, et al., 2012, Nilssen et al., 2012, Overgard, et al., 2008).
Other benefits of seeing a pelvic floor physiotherapist include:
- A thorough assessment of the pelvic floor muscle function. This is good to set you an individualised strengthening program.
- Education on the continence mechanism to better understand why the PPI may be occurring. It is thought that PPI occurs due to an insufficiency of the internal urethral sphincter post-operatively. It is helpful to understand the way the muscles function, and this is discussed in detail during a pelvic floor appointment.
- Provide further education and resources.
- Perform real time ultrasound to allow for biofeedback on the most optimal activation for you.
What to expect:
- An assessment of your pelvic floor to provide you with an individualised program.
- Education on the pelvic floor muscles and the other muscles involved in maintaining continence.
- A treatment plan to address your goals.
- The introduction of a pelvic floor training program, in addition to functional training for most people.
I hope that helps you understand the role of the pelvic floor physio as part of the team managing your outcomes post-operatively.
Please be in contact if you have any questions about pelvic floor physiotherapy pre / post radical prostatectomy. I am always happy answering any questions.
Jess ?
References:
Demidko YL, Glybochko PV, Vinarov AZ, et al. Treatment of urinary incontinence after radical prostatectomy using training of pelvic muscles under the control of biofeedback [in Russian]. Urologiia. 2015:41–43.
Nam RK, Cheung P, Herschorn S, et al. Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapyforprostatecancer: a population-based cohort study. Lancet Oncol. 2014;15:223–231. doi:10.1016/S1470-2045(13)70606-5
MacDonald R, Fink HA, Huckabay C, Monga M, Wilt TJ. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int. 2007;100:76–81.
Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48:734–738. doi:10.1016/j.eururo.2005.06.004
Manassero F, Traversi C, Ales V, et al. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder neck-sparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn. 2007;26(7):985–989. doi:10.1002/(ISSN)1520-6777
Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol. 2010;57:1039–1043. doi:10.1016/j.eururo.2010.02.028
Dubbelman Y, Groen J, Wildhagen M, Rikken B, Bosch R. Urodynamic quantification of changes in detrusor function and pressure-flow parameters after radical prostatectomy: relation to postoperative continence status and the impact of intensity of pelvic floor muscle exercises. Neurourol Urodyn. 2012;31(5):637–641. doi:10.1002/nau.v31.5
Nilssen SR, Mørkved S, Overgård M, Lydersen S, Angelsen A. Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study. Scand J Urol Nephrol. 2012;46(6):397–404. doi:10.3109/00365599.2012.694117
Overgard M, Angelsen A, Lydersen S, Morkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised controlled trial. Eur Urol. 2008;54:438–448. doi:10.1016/j.eururo.2008.04.021
Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy. Inter J Urol. 2013;20(10):986–992.