What is ‘Prehab’ for Prostate Surgery Patients?
A prostatectomy is a surgical procedure that removes all or part of the prostate gland. The most common cause for this surgery is prostate cancer but other causes include BPH (benign prostatic hyperplasia, also known as an enlarged prostate). The prostate gland sits between the bladder and the penile shaft. Pelvic floor muscles create a sling which the prostate rests on. The prostate is circumferential while the urethra runs through it and the prostate itself also supports the urethra. Based on the anatomical position of the prostate, it can also act a bit like a stopper when men have benign prostatic hypertrophy. One of the most common side effects after a prostatectomy, the surgical procedure where the prostate is removed, is urinary incontinence. After its removal, the pelvic floor muscles need to be stronger than before to support the bladder/urethra.
If there is pelvic floor muscle weakness, urinary leakage, also known as stress urinary incontinence (SUI) is likely to occur. SUI occurs when you leak urine with activities such as getting up from a chair, going up and down stairs, laughing, coughing, sneezing and picking up objects such as boxes or shopping bags. Some other symptoms that can occur post-op include urinary frequency, urinary urgency, nocturia (urinating 2 or more times per night), abdominal discomfort and erectile dysfunction. Muscles need to undergo some type of rehabilitation in order for them to function appropriately again.
If radiation treatment is medically warranted with aggressive prostate cancer, then working on muscle strengthening prior to radiation treatment is quite important. The muscles need to be as strong as possible in order to prevent leakage after radiation. Some side effects of radiation are similar to surgery such as urinary frequency and urinary leakage, but can include rectal burning, penile burning, and pelvic pain symptoms, but these symptoms are less frequent.
Pelvic floor physical therapy can help to strengthen these muscles and reduce your symptoms. Physical therapy can also help to decrease pain and can address any limitations due to scar tissue or core/abdominal weakness. In a study performed by Santos et al., it was shown that physical therapy intervention with biofeedback contributed to improvement in symptoms of urinary incontinence and nocturia. It also showed decreased use of pads in the men who had received intervention. Even if you have had a prostatectomy years ago and are still struggling with symptoms such as urinary incontinence, pelvic floor physical therapy can still help. Men may also benefit from pelvic health physical therapy prior to having this type of surgery. If someone is going into this surgery with an already weak pelvic floor or already has symptoms of urinary leakage, they may experience worsened side effects. An article written by Goonewardene et al. discusses the importance of exercising pelvic floor muscles prior to surgery. At New Dimensions Physical Therapy, we offer treatment post prostatectomy and we also offer a wellness visit prior to surgery to assess the strength of your pelvic floor muscles and to teach you how to exercise your pelvic floor correctly.
External beam radiation for prostate cancer. (2018, March 22). Retrieved April 1, 2019, from https://www.mayoclinic.org/tests-procedures/external-beam-radiation-for-prostate-cancer/about/pac-20384743
Fontaine, M. (2017, August 17). Pelvic floor physical therapy helps men after prostatectomy. Retrieved from https://pelvicpainrehab.com/male-pelvic-pain/4630/what-does-physical-therapy-do-for-men-following-prostatectomy/
Goonewardene, S. S., Gillatt, D., & Persad, R. (2018). A systematic review of PFE pre-prostatectomy. Journal of Robotic Surgery, 12(3), 397-400. doi:10.1007/s11701-018-0803-8
Santos, N. A., Saintrain, M. V., Regadas, R. P., Da Silveira, R. A., & De Menezes, F. J. (2017). Assessment of Physical Therapy Strategies for Recovery of Urinary Continence after Prostatectomy. Asian Pacific Journal of Cancer Prevention, 81-86. doi:10.22034/APJCP.2017.18.1.81
Prostatectomy. (2018, March 28). Retrieved April 1, 2019, from https://www.mayoclinic.org/tests-procedures/prostatectomy/about/pac-20385198