Prostate surgery - what you need to know!

By Pelvic Health physio Danae Gardner

Most women learn about their pelvic floor muscles during the child-bearing years. But for many men, the first time they’re told they even have these same muscles is well into their 50’s or 60’s, sitting in the doctor’s office discussing their upcoming prostate surgery. And these blokes are the lucky ones.

There are approximately 19,000 new cases of prostate cancer in Australia each year. It is the most common cancer affecting Aussie men, second only to common skin cancers. There are different stages, which usually determine the course of treatment. In many cases, surgery to remove the whole prostate (‘prostatectomy’) or part of it (‘transurethral resection of the prostate’ (TURP) is performed. These can be done via the abdomen, laparoscopically or using robotic techniques.

The rate of urinary incontinence in these men post-operatively is as high as 87% - why? Well given its location, the prostate forms a crucial part of the male anatomy, both for reproduction and continence.

The prostate is a walnut-sized gland situated just below the bladder, around the urethra. Like all the pelvic organs, it is supported by the floor of muscles and connective tissue underneath. The pelvic floor – together with the internal urethral sphincter – work to maintain continence for men (ie avoid leakage). The prostate also plays an important role in sexual function, suppyling seminal fluid into the urethra for ejaculation.

Pelvic floor muscles?

Not sure how to find your pelvic floor muscles? Have a go!- Sitting, standing or laying down, take a big breath in and exhale, relaxing your tummy
- Now imagine you’re drawing up between your legs, lifting your “nuts to nose”
- OR you can imagine walking into a cold pool (“lift!”)
- OR you can use a mirror, watching your penis draw up/shorten as you lift from the inside
Be careful to isolate just the pelvic floor muscles – you shouldn’t need to hold your breath or squeeze your buttocks/legs at any point.

What happens with prostate surgery?

Removing the prostate drastically changes the way a man has controlled his bladder all his life. Suddenly there is less resistance AND distance between the bladder and the outside world. Surgery often irritates the adjacent structures. It is extremely common for men to need continence aids (pads) in the immediate post-operative period after catheterisation, while healing occurs and sensation improves.

Physio's role regaining control ASAP

But it’s not all doom and gloom. Remember the lucky men, who were told about their pelvic floor muscles by their doctor or physio, beforehand? Well these are the blokes who learned how to use their pelvic floor muscles to regain their bladder control, and optimise their recovery. To get back to their usual work, social and physical activities without losing their quality of life.

Research tells us that 87% of men return to continence by 12 months post op, with 93% dry by 2 years. But why wait? The gold standard in rehabilitation after prostate surgery, is specialised pelvic floor muscle retraining!

group A (blue)= physio intervention

group B (red) = no physio intervention

Your pelvic physiotherapist can teach you how to correctly find and activate your pelvic floor muscles. Once you know how to do this you will need a specific program to strengthen for urinary control and build support for all the functional tasks you need and want to get back to.

All the evidence shows that men who sought supervised, guided treatment not only regained their continence but did so sooner (3-6 months vs 6-12). Better yet, if patients began their education and exercises before surgery, they showed even better outcomes and continence measures afterwards. We refer to this as prehab and it’s the very best way for men to take charge of their post-prostatectomy future!

So here’s the deal: prostate cancer is very common and surgery is often the answer. But this does not have to mean the end of life as you know it. Early education, tailored exercises and advice around return to activity are the keys to getting men back to their business!

If you have had a prostate diagnosis, or an upcoming/past surgery – do not hesitate to call your pelvic floor physio at Vital Core for a consult. We specialise in getting people back to their best – individualising treatments and helping you reach your goals.