Pre-and Post-Prostatectomy

Many men require the removal of their prostate or a portion of it to treat a condition such as prostate cancer. In addition to the emotional effects of losing a part of your body, there can be challenging physical symptoms, such as incontinence and erectile dysfunction. Our bodies are incredibly adaptive – and by learning how to harness the power of your pelvic floor, it is possible to get where you want to be.

What is Pre- and Post-Prostatectomy?

A prostatectomy is a surgical procedure to remove a part of or the entire prostate to treat prostate cancer. Pelvic health physiotherapy before (pre) and after (post) prostatectomy can be very beneficial in managing pelvic health issues that can occur following surgery.

Prostate cancer represents 37% all new cancer cases in men.1

What Is The Role of The Pelvic Floor in Pre- and Post-Prostatectomy?

The pelvic floor is a group of dome-shaped muscles and tissues located at the bottom of the pelvic bones. The pelvic floor functions to:

• Provide support to the pelvic organs (bladder, urethra, intestines, and rectum) so that they can function correctly

• Stabilize the low back and hip joints

• Support sexual function

• Maintain bowel and bladder continence

When the prostate has been removed or partially removed, the internal urethral sphincter is also removed. The internal urethral sphincter (involuntary control) and the external urethral sphincter (voluntary control) act to provide a “double stop” system to close the urethra (the channel through which urine leaves the body) so that urine doesn’t leak. With the internal urethral sphincter is removed, the pelvic floor muscles “kick in” to compensate. When properly coordinated, a person can use these muscles to control their bladder.

However, after a prostatectomy, many men experience weakened pelvic floor muscles, leaving them unable to properly coordinate them. Scar tissue can also develop, which can further weaken the pelvic floor muscles. If the pelvic floor muscles are weak, urine can leak out of the bladder when you don’t want this to happen (e.g., when coughing, laughing or sneezing). This is called stress incontinence. A weakened pelvic floor can also lead to pelvic pain and erectile dysfunction.

If you’ve had prostate surgery and are experiencing challenges, know that you’re not alone. Studies show that up to 90% of men report urinary incontinence after surgery, and up to 60% report erectile dysfunction. The good news is that effective treatments are available, including pelvic health physiotherapy.

How Can Pelvic Health Physiotherapy Help Me?

Pelvic Health Physiotherapy focuses on building up the strength, endurance, and coordination of the pelvic floor muscles so that they can meet the new demands that have been put on them after prostate surgery. The goals of pre and post-surgical pelvic floor physiotherapy include:

• Restore and/or increase the strength, endurance, and flexibility of the pelvic floor muscles

• Ensure the pelvic floor muscles are properly coordinated with other core muscles during dynamic movements (e.g., getting out of bed, getting up from a chair, coughing)

• Assess and address pelvic alignment and postural symmetry

• Address bladder and/or bowel issues by providing education on optimal toileting positions to decrease pressure on the pelvic floor

• Improve erectile function and reduce climacturia (urine leakage during orgasm) through specific exercises to increase the strength and endurance of the muscles near the penis (called the bulbospongiosus and ischiocavernosus muscles)

If it is feasible, learning how to contract your pelvic floor muscles before surgery, and then continuing this work after surgery, may be an even more beneficial approach. If you will be undergoing prostate surgery, book an appointment with us to find out how we can help you on your journey to health and recovery.

How Do We Approach Treatment For Pre- and Post-Prostatectomy?

Pelvic health is often thought of as a woman’s issue – but it is a vital part of a man’s overall health and wellness too. At Proactive Pelvic Health Centre, we’re dedicated to helping destigmatize issues related to pelvic health, and empowering people to take control of their bodies. Opening up about intimate issues, such as incontinence or sex, can feel difficult. Know that Pelvic Health Physiotherapists are trained specifically in these issues. They will listen, encourage, and support you in achieving your goals.

The first step: your Pelvic Health Physiotherapist will take your full medical history and discuss your symptoms.With informed consent, they will perform a complete physical assessment of the affected muscles and tissues. Based on your examination, your Pelvic Health Physiotherapist will work with you to put together a treatment plan specific to your symptoms.

At Proactive Pelvic Health Centre, we use a variety of proven techniques, from manual therapy to biofeedback, to help improve the strength of your pelvic floor to better support your bowel/bladder muscles and sexual function. Our approach is structured and evidence-based, using techniques clinically proven to strengthen and retrain the pelvic floor muscles.

Book an appointment to learn more about how we can help.

What Other Treatments Are Available?

As you will be under the care of a physician before and after your prostatectomy, we encourage you to work with them to discuss other treatments and strategies that can help you with any symptoms you are experiencing. It may also be a good idea to inform them of your work with a Pelvic Health Physiotherapist so that they are informed about your complete treatment plan.