Post-Prostatectomy Care and Pelvic Physical Therapy
How Pelvic PT Reduces Incontinence, Impotence, and Other Complications
WHAT IS POST-PROSTATECTOMY CARE?
Nearly every surgery - from ankle to neck - is followed by multiple visits to physical therapy to help restore normal motion and function. Unfortunately, many times men aren't told about this option after a prostatectomy, even though it significantly improves outcomes.
Without treatment, scar tissue can adhere, or stick, to the tissue underneath, causing restrictions that can result in dysfunction and pain. Scar tissue should move and feel just like the skin around it. But for more than half of surgeries, scar tissue does adhere and can cause symptoms ranging from pain to constipation to incontinence.
Common side effects following prostate surgery include:
Incontinence - Up to 60% of men remain incontinent six weeks after surgery. Even a year after the procedure, nearly one in four men still struggle with bladder control. Fecal incontinence is also common.
Impotence - A full year after surgery, 60% of men still struggle with impotence, and are unable to manage or sustain an erection.
Pelvic Pain - Almost half of men have lingering pelvic pain at three months after surgery. Any pelvic or abdominal surgery creates scar tissue, inflammation, and trauma to the region. Often the body doesn't completely recover, resulting in lingering pain or symptoms.
HOW DOES PELVIC PT HELP?
Physical therapy works to restore normal function to an area following surgery. After surgery, many men are told 'just Kegel' and sent home. However, restoring the pelvic floor is much more complex than that - most men can't do a Kegel correctly in the best of times, much less after a major surgery to the area. Kegels also only work the voluntary muscles, but not the involuntary system that naturally keeps us continent throughout the day.
In studies of prostatectomy patients, 95% regained continence when given physical therapy after their surgery.
The pelvic floor is responsible for keeping us continent throughout the day. The involuntary muscles in the pelvic floor act as a gatekeeper, holding back urine until we decide to go, and then consciously relaxing in order to allow urine to escape. Pelvic floor physical therapy works to find and address the underlying issues within the pelvic floor following a pelvic surgery to restore normal function.
The muscles of the pelvic floor are also responsible for sexual function, including arousal, maintaining an erection, and orgasm. In fact, this is one of the most complicated jobs the pelvic floor has. It must relax to allow blood to flow into the penis to create an erection, and then squeeze tight to trap the blood inside to maintain it. Finally, orgasm requires a complex series of muscle contractions. Sexual dysfunction is often one of the earliest indicators of pelvic floor dysfunction, and physical therapy can help improve sexual function and eliminate any pain that occurs with or following ejaculation.
Physical therapy is routine after every other type of surgery to promote full recovery. Why would a prostatectomy - in such a sensitive area of the body - be the exception?
THE PELVICSANITY DIFFERENCE
At PelvicSanity, your physical therapist will be a specialist in the field and an expert in male pelvic issues and post-surgical care. Almost 30% of our patients at PelvicSanity are men, and most have been to multiple doctors for their symptoms before finding success here at PelvicSanity.
We believe full-length sessions are crucial to success with pelvic PT, so all appointments at PelvicSanity are an hour in length and spent entirely with a pelvic floor specialist. You’ll never be hooked up to electrodes, see an aide instead of a physical therapist, or be told to ‘just do your Kegels.’ We create a positive, calm environment for healing in private treatment rooms.
We also believe the pelvic floor can’t be treated in isolation, so your treatment will address both the pelvic floor and the external muscles that connect and influence the entire pelvis for optimal results.
YOUR INITIAL EVALUATION
Your initial evaluation will be an hour in length, and have three major components:
Consultation: Most of our patients have been to multiple doctors, but have never really felt listened to in their appointments. In your initial evaluation you’ll have a chance to go through your medical history with your physical therapist. We’ll listen to you and ask about your personal goals for physical therapy.
Assessment: Next your physical therapist will do a complete assessment. They will look at your posture, hip and pelvic alignment, fascia, scar tissue, and anything else influencing your pelvis. Then they will do an internal evaluation, looking for trigger points and dysfunction within the pelvic floor muscles.
Treatment: We also want to know how your body responds to treatment, so your initial evaluation also includes targeted treatment. You’ll also leave with ‘homework’ that you can be doing in between your visits to build on the improvements with physical therapy.
With physical therapy, 95% of men achieve full continence after prostate surgery.
With either approach, a prostatectomy causes scar issue and inflammation in the pelvic floor, and often results in (treatable!) incontinence, erectile dysfunction, or other pelvic symptoms.
"The excellent and precise treatment I have received has shifted me from a plateau where I was still very disabled, despite nearly three years of varied treatments, to feeling nearly pain-free for a full two weeks. I had given up hope that I would ever experience anything more than a temporary respite from intractable pain. I am extremely grateful."
Our team at PelvicSanity has served on the Board of Directors of Prostate.net, founded the PelvicSanity Research Portal, taught continuing education courses, and established groups for both practitioners and patients.
"I would highly recommend this place for any nerve, pelvic floor, or soft tissue pain...I am a Golf Pro, and came to PelvicSanity because I had nerve pain from a groin injury and other injuries over the years. Nicole has been able to help me eliminate all my nerve pain with consistent weekly sessions. I'm very thankful I have found PelvicSanity - you will be too!"