There is a high incidence (between 69-98%) of urinary incontinence in men following a radical prostatectomy for prostate cancer. The severity of incontinence can vary greatly, from quite mild to severe. In most cases these symptoms will generally resolve over time. However, incontinence may persist for over 12 months in up to 50% of men following radical prostatectomy. This can have a huge impact on their sense of well being and can have negative effects their quality of life.
There is currently strong evidence to support pre and post-operative pelvic floor training for men having radical prostatectomy. In short, pelvic floor exercises help men get drier, quicker.
A new Australian research paper has been published to help identify which pelvic floor exercises may best help to achieve men regain continence following a radical prostatectomy.
In this research 101 men scheduled to have a radical prostatectomy for prostate cancer were randomly divided into two groups: routine care OR intensive pelvic floor exercises.
Men in both groups were seen for two (2) pre-operative physiotherapy sessions and provided information including fluid advice, bladder care and exercise advice. All men were given instruction on how to do pelvic floor exercises and a real-time ultrasound was used to check that they were able to do the exercises correctly. Both groups also attended physiotherapy appointments at 2, 6 and 12 weeks post-op.
One group of men (routine care) were instructed to practice pelvic floor exercises in LYING, SITTING AND STANDING, holding for 10 seconds, 10 times, THREE (3) times a day.
The second group of men (intensive exercise group) were instructed to practice pelvic floor exercises in STANDING ONLY, holding for 10 seconds, 10 times AND 10 quick (1 second squeeze, 10 times), SIX (6) times a day.
The results showed
· 2 weeks following surgery 14% of men in the intensive exercise group (versus 4% having routine care) were dry.
· 6 weeks following surgery 32% of men in the intensive exercise group (versus 11% having routine care) were dry.
· 12 weeks following surgery 74% of men in the intensive exercise group (versus 43% having routine care) of men were dry.
Key points
· Pre and post-op pelvic floor physiotherapy should be offered as standard care for men having a radical prostatectomy for prostate cancer.
· Real-time ultrasound is an important tool used by pelvic floor physiotherapists to help men identify the correct muscles and to check they are performing the exercises correctly.
· Intensive pelvic floor exercises can help men regain continence sooner.
I have extensive experience in treating men pre and post-operative prostatectomy. I use real-time ultrasound as an assessment and training tool to help men identify the correct muscles and improve their pelvic floor function.
If you have any question, please do not hesitate to contact me.
Reference: Milios et al (2019). Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urology, 19 (116).