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  • Karen Crudden

Prostatectomies and what you need to know pre and post op

Men are unfortunately an under served population when it comes to pelvic health, so this week I want to talk about prostate removal surgery (prostatectomy) and the importance of seeing a pelvic health physiotherapist.


Prostatectomies are most often performed when a person has prostate cancer and involves removal of the prostate gland and the portion of the urethra that runs through the prostate. All surgeries can have side effects and prostate removal surgeries are no different, with urinary incontinence and sexual dysfunction being two major side effects. This can have a huge impact on a man’s quality of life, were many describe feeling unprepared for these complications post-surgery.


So, if you’re reading this and feeling frustrated about your bladder problems or heading for prostate surgery, read on. I hope this information will be helpful to some.


Why does incontinence happen after prostatectomy?


The prostate sits under the bladder, and thus, plays an important role in continence. When the prostate gland is removed, the support and control at the bladder neck is impacted and sometimes the muscles, nerves and connective can be damaged. This then leads to bladder leakage: most often termed as ‘stress incontinence’ which is leakage occurring with an increase in intra-abdominal pressure e.g. sit to stand, cough, sneeze, laugh or walking.

Most men will have some degree of bladder leakage immediately post-surgery which gradually improves, but it’s been reported up to 69% of men can experience leakage lasting more than a year.


What can pelvic health physio offer?


Men are notoriously bad at voicing concerns, on top of that feel guilty for being bothered by incontinence or erectile issues post-surgery..… ‘survivors’ guilt’, thinking “At least I don’t have cancer anymore…”. Yes, not having cancer is HUGE, but your quality of life does still matter after cancer.


One way to improve urinary incontinence and sexual function is by exercising the pelvic floor muscles. The pelvic floor is a hammock like layer of muscles at the bottom of the pelvis. The pelvic floor muscles give support to the pelvic organs (bladder, rectum, intestines) and control continence as well as erections.


In the perfect world every man should have a pelvic health physiotherapy session before prostate surgery, to learn how to correctly activate their pelvic floor muscles and receive a pelvic floor exercise program specifically for prostate surgery to enhance pelvic floor function, reduce post prostate surgery incontinence and improve quality of life overall.

Again, in the ideal world this would occur as soon as possible, or at least 4 weeks prior surgery, to reap the benefits. Understandably pelvic floor exercises might be the last thing some men want to think about, for others it can be a good distraction, we are all different and there is no right or wrong way to cope. Help will always be available when ready.


When seeking help, the most successful physiotherapy program is individualized with a comprehensive examination to identify individual needs, goals and expectations. Male anatomy is different! and this requires a different approach to rehabilitation, so if your wife is trying to teach you her exercises…. smile and nod! Some men require pelvic floor muscle relaxation exercises first, others need strengthening exercises. It is then important to integrate these muscles into daily activities to help men regain bladder control and return to activities they enjoy once more!


If you’re reading this and feeling frustrated about your bladder problems or heading for prostate surgery, know that there is help available. I hope this information will be helpful to some.


A must buy: Prostate Recovery MAP Men’s Action Plan 2, by Craig Allingham


Men are unfortunately an underserved population when it comes to pelvic health, so this week I want to talk about prostate removal surgery (prostatectomy) and the importance of seeing a pelvic health physiotherapist. Prostatectomies are most often performed when a person has prostate cancer and involves removal of the prostate gland and the portion of the urethra that runs through the prostate. All surgeries can have side effects and prostate removal surgeries are no different, with urinary incontinence and sexual dysfunction being two major side effects. This can have a huge impact on a man’s quality of life, were many describe feeling unprepared for these complications post-surgery. So, if you’re reading this and feeling frustrated about your bladder problems or heading for prostate surgery, read on. I hope this information will be helpful to some.

Why does incontinence happen after prostatectomy?

The prostate sits under the bladder, and thus, plays an important role in continence. When the prostate gland is removed, the support and control at the bladder neck is impacted and sometimes the muscles, nerves and connective can be damaged. This then leads to bladder leakage: most often termed as ‘stress incontinence’ which is leakage occurring with an increase in intra-abdominal pressure e.g. sit to stand, cough, sneeze, laugh or walking.

Most men will have some degree of bladder leakage immediately post-surgery which gradually improves, but it’s been reported up to 69% of men can experience leakage lasting more than a year.

What can pelvic health physio offer?

Men are notoriously bad at voicing concerns, on top of that feel guilty for being bothered by incontinence or erectile issues post-surgery..… ‘survivors’ guilt’, thinking “At least I don’t have cancer anymore…”. Yes, not having cancer is HUGE, but your quality of life does still matter after cancer.

One way to improve urinary incontinence and sexual function is by exercising the pelvic floor muscles. The pelvic floor is a hammock like layer of muscles at the bottom of the pelvis. The pelvic floor muscles give support to the pelvic organs (bladder, rectum, intestines) and control continence as well as erections.

In the perfect world every man should have a pelvic health physiotherapy session before prostate surgery, to learn how to correctly activate their pelvic floor muscles and receive a pelvic floor exercise program specifically for prostate surgery to enhance pelvic floor function, reduce post prostate surgery incontinence and improve quality of life overall. Again, in the ideal world this would occur as soon as possible, or at least 4 weeks prior surgery, to reap the benefits. Understandably pelvic floor exercises might be the last thing some men want to think about, for others it can be a good distraction, we are all different and there is no right or wrong way to cope. Help will always be available when ready.

When seeking help, the most successful physiotherapy program is individualized with a comprehensive examination to identify individual needs, goals and expectations. Male anatomy is different! and this requires a different approach to rehabilitation, so if your wife is trying to teach you her exercises…. smile and nod! Some men require pelvic floor muscle relaxation exercises first, others need strengthening exercises. It is then important to integrate these muscles into daily activities to help men regain bladder control and return to activities they enjoy once more!

If you’re reading this and feeling frustrated about your bladder problems or heading for prostate surgery, know that there is help available. I hope this information will be helpful to some.

A must buy: Prostate Recovery MAP Men’s Action Plan 2, by Craig Allingham



#menshealthweek#prostatectomies#pelvichealthphysio#preopmanagement#postopmanagement#bladderissues#menshealth#malepelvichealthphysio

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