When I started to go down the road of becoming a pelvic floor physiotherapist I really only thought about my role working with women. Earlier this year I was lucky enough to begin working alongside a group of urologists in treating men who are being treated for prostate cancer often by robotic prostatectomy. Thus commenced my journey of learning about all things prostate cancer and prostate cancer recovery.
I thought it might be worthwhile jotting down a couple of the things I’ve learnt so far for any budding physiotherapists or patients out there wanting to understand a bit more about this area and some of my personal experiences with the process.
First things first you need to get the bladder and the bowels sorted. Make sure there is enough water in the system to keep things moving through the urinary system and to keep the bowels soft. If you’re not someone who goes to the toilet regularly to do number 2’s or spends a long time pushing and straining to get it out it’s time to sort it out. Eat some more fibre- fruits, veggies, wholegrains or some kind of fibre supplement. Move more. Bowels love a good long walk. Eat regularly and give yourself a chance to go when you need to ie don’t shy away from the toilets at work or rush out the door so quickly in the morning that you don’t have time to get things sorted. Also if you’re not drinking much water and you’re only drinking coffee or tea- it’s quite simple- drink some more water. Grab a glass and fill it up first thing in the morning and then do that a few more times throughout the day. If you don’t like water consider herbal tea or something non-caffeinated as caffeine can irritate the bladder and cause bladder urgency.
Second thing you need to look at is your weight. When I meet men I will often weigh them and measure their abdomen. Then I’ll head to the heart foundation BMI calculator and bring up their BMI on the screen for them. You can do that here: https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator
I find a lot of my patients (but not all) are overweight and are carrying significant abdominal obesity. This makes surgery more difficult. We don’t have any really good statistics about whether being overweight or obese makes urinary incontinence worse in men we know this to be the case in women so we can make a rough guess that added weight sitting on top of the bladder and the pelvic floor might make it harder to keep all the wee securely inside the bladder until we are ready to let it out.
Next question is always- do you exercise. Again, the majority aren’t meeting the recommendations of 150 minutes of moderate intensity exercise per week. In fact, most aren’t even coming close. I don’t mind what you do for exercise. Walking probably isn’t going to get you over the line in terms of meeting the recommendations but it’s wayyyy better than nothing and a bit of added walking or activity in your day alongside a healthy, calorie restricted diet will probably help shed a few extra pounds. There is plenty of research being released currently about exercise as medicine for cancer and can both prevent and reduce the incidence of cancer. It is a developing area but doing a quick google will yield plenty of results about the benefits of exercise in cancer.
Next is learning about your pelvic floor muscles. The group of muscles that sit at the base of the pelvis. The cues I tend to use are ‘lift up your testes’ and ‘try and shorten your penis’. Using these two cues together will generally get you a reasonable squeeze and it’s also good to emphasis letting the rectal portion of the pelvic floor relax and avoid letting it take over as it’s often stronger and has a tendency to do that. Another thing to keep in mind is that men will tend to think that harder is better so I usually spend a lot of time getting technique right before I focus too much on strength or endurance. Often I will assess the movement using transperineal ultrasound which gives the men a fairly good visualisation of their urethra and the effect of a pelvic floor muscle squeeze on urethral closure.
Once they’ve got the hang of things (usually by the second session) I’ll progress them to some endurance holds and some functional exercises like a squeeze prior to sit to stand, cough (the knack), lift, etc.
After surgery the catheter stays in for a week. Once this comes out usually the flood gates open for a few days and men experience a fair amount of leakage. I try and demonstrate some male specific continence pads to the men prior to this as often they have never bought pads before.
The men can commence pelvic floor muscle training (gently) once the catheter comes out and their effort should be able to increase within the first few weeks.
Basic post op recommendations usually apply ie the old no lifting >5kg thing for 6 weeks. I just suggest to men that if they do start lifting anything again prior to the recommended period that they consider starting slow and building up. Robotic surgery has the advantage of being relatively painless so alot of men will just want to jump back into things so I usually throw them a line about not deciding to change over the engine in their car or paint their house during their sick leave period.
That’s where I start and then depending on their post op continence I will address issues of leakage, urgency, hesitancy or pain as they arise. Hope that helps and give me a yell if you want some further advice.