A large number of men we see in the clinic have had, or are preparing for, prostate surgery. Most of them arrive at their first appointment confused as to why they have been referred to physio, so we thought we'd take this opportunity to explain!
What is the prostate?
The prostate is a walnut-sized gland that sits underneath the bladder. It wraps around the upper part of the urethra (the wee tube). The role of the prostate is to make the fluid part of semen, that allows sperm to travel in during ejaculation.
Radical Prostatectomy
A Radical Prostatectomy is a surgery performed for prostate cancer. During the surgery, the prostate, seminal vesicles, and the part of the urethra that is inside the prostate are removed. The two ends of the urethra are then rejoined. A urinary catheter is inserted and left in place in the urethra for up to 10-14 days following surgery to allow the wound to heal. The catheter will be removed by your surgeon or continence nurse.
Most men will have urinary incontinence (bladder leakage) after their catheter is removed. This is rarely permanent and recovers within 6 months for most men, but some may take up to 12 months. A very small number may always have some degree of leakage, but if the leakage is persisting after 12 months then you should discuss this with your physio and your Urologist to get the best treatment for you. This leakage is usually not a full bladder, but a small amount of urine at a time. In the early days after the catheter is removed, leakage happens very frequently so continence pads will need to be worn and changed frequently.
Leakage happens because the part of the internal sphincter of the urethra is removed with the prostate, and the external sphincter has been weakened. When abdominal pressure rises with certain activities, the external sphincter and pelvic floor muscles are unable to keep the urethra closed. These activities can include:
Cough, sneeze, laugh, blowing nose, passing gas
Bending, standing up from a chair, getting out of bed
Lifting, “ab” exercises, running
Most men will find they do not have any erectile function immediately after surgery. This is because the nerves controlling erectile function are in a state of trauma, and this can take time to recover from. If your surgery is nerve-sparing, then erectile recovery can take 12-24 months, but some may see a return of some erectile activity after 6 months.
Physio after Radical Prostatectomy
Why see a Pelvic Health Physio? The pelvic floor muscles are an essential part of regaining bladder control and sexual function after prostatectomy. It is important to exercise these muscles correctly in order to get the results you want. Many men who learn the exercises from a pamphlet or a website contract muscles other than their pelvic floor and this will not help their leakage. In fact, in some cases using the incorrect muscles can make leakage worse!
We recommend that anyone booked for prostatectomy sees a Pelvic Health Physio before surgery where possible. In this session, you will be taught how to do pelvic floor exercises, and be provided with lots of information about how to care for your bladder, bowels, and pelvic floor after the surgery. We can also discuss your goals and give you an idea of how long it may take you to achieve those after surgery.
After surgery, we recommend seeing your physio again about 1 week after the catheter is removed. Your physio will check your pelvic floor muscles either with ultrasound or by placing 2 gloved fingers on your perineum (the area between the testicles and the anus). Your exercise program will be tailored to your level and be progressed in a way to get you to your goals as quickly as possible. You may do quick contractions, long holds, and do pelvic floor squeezes while you do another movement such as standing up from a chair.
Your physio can also help you with issues such as constipation, bowel urgency, or feeling like you're rushing to the toilet to urinate too often after your surgery. They will also guide you on when it is safe to return to different types of exercise, or when it's safe for you to return to work and other activities.
Another area that pelvic Health Physios can assist with is rehab for sexual function. Pelvic floor strengthening, cardio exercise and a healthy diet are all important parts of recovering erections after prostatectomy. A vacuum erectile device (also called a vacuum pump) can be used to maintain the length of the penis and maintain good blood flow into the penis
while the nerve recovers. Before using this device you must first discuss it with your surgeon and your physiotherapist to ensure that it is safe for you and that you are using it correctly.
General Advice after Prostatectomy:
Avoid heavy lifting for the first 6 weeks
Squeeze your pelvic floor before you cough, sneeze, bend or get up from a chair - this will help reduce leaking
Avoid straining to poo after surgery - you may need to increase the fibre in your diet, sit well on the toilet or take laxatives (as prescribed).
If you are still having trouble - discuss this with your doctor and your physiotherapist
Keep drinking 6-8 cups of fluid per day
While it's tempting to drink less so you'll leak less, dehydration can cause 2 main problems after prostatectomy: increased risk of a urinary tract infection, and constipation. Both of these are not good for your recovery!
Avoid alcohol for the first 6 weeks after surgery
Change your continence pads once they are wet, and consider using a barrier cream (such as Dermeze ointment, QV, or Sudocrem) over your penis and groins if your leakage is severe
We see a lot of men with nasty rashes in their groins and on their penis from keeping wet pads on for too long. It's easier to prevent this than to treat it!
Have some good positive support around you. This might be friends, family, a Men's Shed, or a counselor/psychologist.
Going through a diagnosis of prostate cancer, radical prostatectomy, and recovery afterward can all take a big toll on your mental health, and it is normal to feel shocked, angry, depressed, or overwhelmed by the whole process. We strongly believe it is a healthy and important step to reach out for support.
If you're not sure where to turn for help here are some helpful links to get started.
Your doctor or physio can also recommend local support services. We have seen many, many people go through this diagnosis and surgery, and we are all here to help support you in your recovery physically and mentally!