Post-prostatectomy Urinary Incontinence
Condition Overview
A prostatectomy is when they remove the prostate due to cancer or preventative care. This procedure can leave 80% of men with urinary incontinence and 60-90% of men with erectile dysfunction (ED). Oftentimes, these symptoms can slightly improve within a year’s time, and pelvic health physical therapy can help get better results faster!
Urinary Symptoms Can Include:
Urinary incontinence (urge, stress)
Enuresis (nighttime leaking)
Nocturia (using restroom multiple times at night)
Dysuria (pain with urination)
Incomplete bladder emptying or weak stream
Post void dribbling (dribbling urine after urinating)
Sexual Symptoms Can Include:
Erectile dysfunction (unable to get or maintain a strong erection)
Climacturia (pain during orgasm)
Why Do These Symptoms Happen Post-Prostatectomy?
The prostate is an organ that has a role in passive continence and helps to support the bladder. With this organ removed there can be urethra hypermobility which can lead to loss of urine especially with increased intra-abdominal pressure or urgency.
In addition, the bladder neck loses its elasticity and is weakened causing decreased bladder capacity and difficulty storing urine for longer periods of time.
Lastly, the internal urethral sphincter can be affected. This is an involuntary muscle designed for tonic and sustained contraction to maintain continence. If this is affected, there is more emphasis placed on the external urethral sphincter and pelvic floor muscles to perform voluntary muscle contractions as necessary.
What Can Physical Therapy Do?
In physical therapy, we will discuss your symptoms and go over each of the systems of the pelvic floor including what were your typical habits prior to surgery and what has changed (bladder, bowel, sexual health). We will review your diet and fluid intake as well as your exercise routine and work duties that you want to continue participating in.
During our examination, we may recommend an internal pelvic floor muscle assessment with consent if you are 6 weeks post-surgery in order to assess muscle function. With this, we will determine the tone of your pelvic floor, and assess your abdominal, hip, and pelvic floor muscle strength, endurance, and coordination.
We will also view your body mechanics with lifting/carrying, getting in and out of bed, and performing daily activities that you have to accomplish throughout the day.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics! We will educate you about optimal bladder and bowel health and hygiene habits. Manual treatment can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization.
Exercises can include but are not limited to kegels, hip and abdominal strengthening, downtraining/pelvic floor stretches, and functional mobility exercises. With each session we will reassess and progress as appropriate!