Pre and Post Prostatectomy Rehabilitation

Prostate cancer is the most commonly diagnosed cancer in men. Radical prostatectomy surgery is highly effective, however, the post-operative side effects can be severe and quite troublesome. Urinary incontinence, or “leakage”, is the most common side effect and is to be expected after prostate surgery. It may be a mild problem, requiring temporary use of protective pads, or more severe and require long term use of continence aids. The pelvic floor muscles control the bladder and flow of urine, and exercising these muscles can help to regain bladder function earlier.

Pelvic Floor Muscles – What Are They?

The male pelvic floor is a complex structure made up of muscles, ligaments, nerves and fascia. The pelvic floor muscles stretch like a hammock from the tail bone at the back to the pubic bone at the front. They are responsible for the maintenance of bladder and bowel continence, sexual function and pelvic organ support.

Some pelvic floor muscles are made of skeletal muscle, which means they can be voluntarily activated. These muscles comprise of two types of muscle fibres, with each responsible for different functions:

• Slow twitch (type 1) fibres make up 80% of the PFM.
  • Capable of long-lasting but relatively weak contractions
  • Activated to maintain bladder and bowel continence, assist in an upright posture, and help maintain PFM tone during rest or activity.
• Fast twitch (type 2) fibres make up the other 20% of the PFM
  • Capable of strong, rapid contractions but fatigue faster than type 1 fibres.
  • Responsible for preventing leakage during sudden actions such as coughing and sneezing

Pelvic Floor Muscles – Why Do We Train Them?

Studies show 69-98% of men experience urinary leakage for some duration following radical prostatectomy.

Recent research has investigated the impact of pelvic floor muscle training on the recovery of urinary continence following prostatectomy surgery. These studies show that intensive pelvic floor muscle training prescribed and instructed by a physiotherapist is effective at:

• Improving your pelvic floor muscle function
• Reducing severity and duration of urinary incontinence
• Improving your quality of life-related to incontinence.

Pelvic floor muscle training is even MORE effective if commenced 4-6 weeks PRE-SURGERY.

Physiotherapist’s Role in Pre/Post Prostatectomy Rehabilitation:

The pelvic floor muscles are hard to identify inside the body, so help from an expert will ensure the best possible technique and training protocol is used. It can boost confidence in knowing how to do the exercises correctly.

Real-time ultrasound is used to allow you to see your muscles contracting and relaxing during the training process, which can improve the timing and quality of your contractions. Ideally, you should see your physiotherapist for an initial appointment 4-6 weeks prior to surgery.

During an appointment, your physiotherapist will:

• Discuss your current symptoms and concerns.
• Discuss what to expect after your prostate surgery and how your post-operative rehabilitation will be structured.
• Assess your current pelvic floor function using real-time ultrasound.
• Provide you with home exercises and ongoing guidance regarding specific training details for your pelvic floor exercises.
• Advice regarding other lifestyle factors which may impact and promote faster recovery.

Your physiotherapist will also provide recommendations for when to re-commence exercises following surgery and when you will need to follow up for another appointment to check your progress.

During the post-operative rehabilitation period, your physiotherapist will keep in close contact with your GP, Urologist and other medical practitioners to ensure that all members of your rehabilitation team are on the same page.

Exercise and Prostate Cancer

There is a significant amount of evidence that shows appropriate exercise is safe and well-tolerated by men with prostate cancer, and can achieve improvements in aerobic fitness, muscle strength and fatigue resistance.

Recommended physical activity guidelines are:

• 150 minutes per week of mild-moderate aerobic exercise, for example, 30 minutes of exercise 5 days per week.
• 2 or more sessions per week of resistance training, involve 3 or more sets of 6-8 exercises with appropriate load to achieve fatigue by 6-10 repetitions. ‘

Following prostate surgery there will be a period where relative rest is recommended to allow things to settle, however your doctor and physiotherapist will recommend when you should get started again.

The benefits of regular exercise can also be complemented by a healthy diet, reducing alcohol consumption and reducing stomach girth.