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The development of urinary incontinence after undergoing prostatectomy is a common occurrence, affecting an estimated 70 percent of men to some degree at 12 and 24 months post-surgery. Men who plan to undergo this surgical procedure should discuss the potential side effects with their doctor before the operation and be offered ways to manage it. One of those ways is physical therapy for incontinence following prostatectomy. The key component of this physical therapy is strengthening the pelvic floor muscles, which in turn help control urinary flow, with a possible added bonus of improving sexual function.
What causes urinary incontinence after prostatectomy?
When surgeons remove the prostate, they attempt to salvage as much of the area adjacent to the bladder and sphincter muscles that surround the urethra as they can. However, it is possible for surgeons to damage the nerves that help control bladder function. Even under the most talented surgical hands, urinary incontinence can occur following prostatectomy.
Urinary incontinence can take several forms. The most common type seen after prostatectomy is stress incontinence, in which there is urine leakage when men cough, laugh, sneeze, or exercise. Some men experience dribbling throughout the day, which may increase when they are engaged in physical exercise.
Physical therapy for incontinence following prostatectomy
The first step in physical therapy for incontinence following prostatectomy is to undergo an evaluation of the function of the pelvic floor muscles, which can be done by a specially trained physical therapist. The evaluation involves an intrarectal exam to determine flexibility, strength, and mobility. A biofeedback assessment also is done to evaluate resting tone, endurance, and strength of the pelvic floor muscles.
A key part of physical therapy for incontinence following prostatectomy is pelvic floor exercises, which can be done with or without biofeedback. Pelvic floor exercises basically consist of Kegel exercises, which involve contracting and releasing the PC muscles. These are the muscles you tighten to stop urination midstream or to stop the release of gas, and they also help support the bladder, small intestine, and rectum.
- To do Kegel exercises, identify your pelvic floor muscles. A fast way to do this is to stop your urine stream the next time you need to urinate.
- Once you identify your PC muscles, practice contracting them for three to four seconds and then relaxing for an equal amount of time. Repeat 10 to 15 times per session and practice at least three times a day.
- Focus on your PC muscles only. Do not contract your thighs, buttocks, or abdomen. Breathe freely throughout the exercises.
Evidence of the effectiveness of this approach has been demonstrated in numerous studies, including a recent one that involved biofeedback. Thirteen men who underwent radical prostatectomy were randomly assigned to participate in pelvic floor exercises plus biofeedback or biofeedback alone following their surgery. The men participated in a total of up to eight individual sessions. A comparison of urinary incontinence before, during, and after two months of treatment showed a significant improvement in incontinence within two months in both groups.
Biofeedback for pelvic muscle therapy teaches men how to reduce muscle tension and strengthen weakened muscles. A physical therapist can help men become more aware of their pelvic floor muscles and develop a specific exercise program that suits their individual needs. Other therapeutic methods involved in physical therapy for incontinence include use of a cold laser to help heal stressed tissues, and various stretching and yoga poses to support relaxation and healing. For best results, physical therapy for incontinence following prostatectomy should be started as soon as possible post-surgery.
Santos NA et al. Assessment of physical therapy strategies for recovery of urinary continence after prostatectomy. Asian Pacific Journal of Cancer Prevention 2017 Jan 1; 18(1): 81-86
Stanford JL et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 2000 Jan 19; 283(3):354-60