Some of the most important aspects of our health are the ones we speak about the least. Prostate cancer is the second most common cancer in men, with more than 18,000 cases diagnosed in Australia every year.
Incontinence is a common problem following prostate surgery but many men don’t realise that Physiotherapists may be able to help.
We caught up with Physiotherapist Mitchell Shorten from Friendlies Physiotherapy & Allied Health to talk about men’s health Physiotherapy, the role of the pelvic floor in continence and prostate surgery recovery.
What are the key issues associated with men’s health that a Physiotherapist can help with?
The most important one would be continence. Urinary or bladder continence and bowel continence as well.
We work with many men who have had their prostate removed (prostatectomy or radical prostatectomy), who have had prostate surgery to reduce the size of benign prostate hyperplasia (enlarged prostate) or have had muscle damage to chemotherapy or radiation of the prostate. All of these treatments can dramatically impact the effectiveness of muscles that control continence.
Why does prostate removal or reduction cause incontinence?
Prostate removal has two main effects on urinary continence. The prostate surrounds a section of the urine tube and when it is removed, this 1-2cm length of the tube needs to be removed also. In doing this, it also removes the main automatic sphincter (the muscle that controls the closing of the urine tube), which makes it much harder to maintain continence after the operation.
The other aspect is that during surgery, chemotherapy or radiation, the tissue around the prostate including nerves and muscles can become damaged, again making it more difficult to maintain continence.
If you can’t hold or contract the muscle for more than a few seconds, you will likely have some level of incontinence. As with most muscles of the body, being strong and fit is one thing, but you also need to be coordinated and use the correct muscles at the right time. Being Physios, we like muscles, and that’s what we do.
How can Physiotherapy assist with urinary continence due to prostate issues?
Prostate surgery is quite delicate and involves a lot of small muscles. Ideally, it’s best to do a pre-op assessment and train patients on what to do before they have an invasive procedure that messes with their ability to use those muscles.
An essential aspect of prostate surgery recovery is retraining the muscles and getting them to work effectively again. We start with muscle contractions in a seated position and then move to standing and laying positions.
Our approach depends on the patient’s goals and what they enjoy doing, whether it’s running, lifting, playing golf or tennis. The aim is to make graduated progression using basic muscle activation exercises to build strength so the patient can confidently return to their normal activities, exercise and work.
What are the challenges associated with prostate surgery recovery?
Many men are not aware of the benefits of a consistent Physiotherapy treatment program in those early stages of recovery. Three fortnightly sessions with a Physiotherapist, followed by one every 3-4 weeks for a couple of months, results in improved strength and endurance.
A lot of blokes don’t understand the potential and will just accept the fact they are no longer continent. It’s common for men to feel embarrassed if they are not fully back to normal 3-6 months after surgery, which makes them even less likely to seek help and treatment.
Some men who come in for treatment for a musculoskeletal issue will mention they’ve had prostate cancer and start to open up about having continence trouble. That’s an excellent opportunity to chat about how we can help.
What role does technology play in supporting post prostate surgery incontinence?
At Friendlies Physiotherapy & Allied Health Services, we use a transperineal ultrasound, an incredibly safe, non-invasive and painless technology.
The ultrasound is placed against the skin on the perineum, and together with the client, we can visualise the muscle contractions in real-time on a computer screen.
Transperineal ultrasound lets the patient see how the muscles move and identify which ones to focus on. If you’ve never seen your pelvic floor in action with an ultrasound, you’re taking a stab in the dark trying to activate those muscles correctly. This technology turns the lights on so you can see what you are doing.
We can provide constant feedback about whether they are contracting the right spot to strengthen the targeted pelvic floor muscles. When they go home, they understand the movement better, what it should feel like and they can practice from there.
What are some of the signs that indicate Physiotherapy treatment may be worth exploring?
Any incontinence is a good enough reason to get checked. And if you have incontinence after prostate surgery that has persisted past three months and have not seen a Physiotherapist, it’s a good idea to come and see us.
It’s also important to be aware that if incontinence is related to ageing or if the person has reduced cognitive capacity that causes problems with coordination or memory, the muscle contractions may be challenging to learn or remember at home.
Can a Physiotherapist also assist with erectile dysfunction (ED) after prostate cancer treatment?
Nearly all men experience some level of erectile dysfunction after prostate cancer treatment. It can be a confronting and frustrating time.
If you’ve had surgery, it depends on the type of surgery you’ve had and whether the nerves are damaged or removed. More commonly, the nerves are spared, so it is just a matter of getting things working again, although this can take time and patience.
Pelvic floor exercises can be an effective strategy for addressing ED. Physiotherapists can help you understand the causes of ED and teach you strategies and tools for helping to get and sustain an erection.
Is a referral from a GP or urologist required?
No. You don’t need a referral, so you have nothing to lose by trying Physiotherapy. You may also get a rebate if you have extras cover on your Private Health Insurance. In some cases, men can access a treatment through a GP management plan.
Research shows that inactive men are 60% more likely to suffer from depression. How can Physiotherapy support men to be more active?
Physiotherapists have an understanding of injuries, pain and other barriers to exercise. Sometimes those barriers relate to a lack of motivation or poor mental health. We have medical knowledge and can tailor a program to suit individual wants and needs.
There are many exercises that Physiotherapists can prescribe to get people moving. Keeping active and maintaining a level of fitness ties in with the overall health aspect, including postoperatively. Incontinence can affect so many aspects of life and decrease motivation which can be detrimental to your overall health.
What other tools do Physiotherapists have in the toolbox to support men’s health?
We can help with pain management, injury prevention and management, and rehabilitation through hands-on treatment, joint mobilisation, joint manipulation, taping, massage and exercise prescription. It’s a large toolbox with many different tools and techniques tailored to individual needs.
Book an initial consultation now
Friendless Physiotherapy & Allied Health is committed to helping you regain your physical freedom. Call 07 4331 1888 to book an appointment with one of our male Physiotherapists.