Male Incontinence and Prostate Health
General information on male pelvic health is harder to find than for females, and men rarely discuss urinary incontinence openly. However, information should be available since prostate cancer happens in one out of seven males, and 80% affected will be incontinent after a radical prostatectomy, many times remaining incontinent after a year. It is worth noting that some men may not recognize minor urine leakage as incontinence, though it is a common symptom following surgery.
It has been a few years since my father was diagnosed with prostate cancer and had a prostatectomy for treatment of the metastasis. I was able to experience firsthand the journey he went through, from the delayed access to care — a three-month wait to get to urology — diagnosis, treatment and the struggle to regain continence. The impact it had on his quality of life and mental health made this hardworking, 83-year-old farmer slow down more than the heart surgery or subdural hematoma he had years earlier.
What Is Involved in an Incontinence Treatment Plan?
I am a pelvic floor physical therapist and treat men, women and children with incontinence. The American Physical Therapy Association’s Pelvic Health Academy has been advocating for “prehab” — a single session with patients before having a prostatectomy. This is similar to how an orthopedic patient has a physical therapy session before hip or knee surgery to understand the rehabilitation of the pelvic floor post-surgery.
It’s typical for a surgeon to inform a patient about what to expect medically and may provide a handout on Kegels or pelvic floor exercises … and that’s it before they go to surgery to remove the cancer and get back to everyday life. In my experience with my father and the patients I have seen, they do not understand how to contract the pelvic floor muscles to have fewer symptoms of incontinence after surgery.
Patient handouts are often geared toward females, but the anatomy and continence mechanism are significantly different in males. Research shows that to remain continent after radical prostatectomy specific muscles must be activated. These are the striated urethral sphincter, bulbocavernosus and puborectalis muscles. These muscles differ from those that are the focus of most patient handouts. Activation requires specific instruction and feedback for success. Generalized instructions to “hold back gas” or contract around the anus will not activate these muscles.
What Can I Expect During My First Pre-Surgical Evaluation?
During an evaluation with a pelvic floor physical therapist, a review of your overall health and a detailed history of continence status are reviewed through a questionnaire. We’ll also talk about activities that cause leakage and review your bladder habits. An assessment of the ability of the trunk and pelvic muscles to maintain continence during daily functions is also performed. The exam may include palpation of the pelvic floor muscles, particularly the bulbocavernosus, externally or rectally to determine the tone, strength and functional capacity of each muscle. These muscles have an impact on the striated urethral sphincter and subsequent continence in men.
Seeing a patient before radical prostatectomy allows the physical therapist to teach them how to optimize the contraction of the pelvic floor muscles with bias toward the striated urethral sphincter. This allows for the cognitive learning process of muscle awareness during conscious practice to visualize stopping the flow of urine or retracting the penis. It is more difficult to teach this learning post-surgically when patients are sore, muscles are deconditioned and incontinence is evident. Once pelvic floor activation is achieved, integrating the pelvic floor contraction into function — such as pre-contracting the pelvic floor as you move from sit to stand — is important. Post-surgically, these exercises can be resumed after the urinary catheter is removed. After surgery, pelvic physical therapy includes working on endurance of the pelvic floor and maintaining continence with movement and leisure activities.
What Can I Expect After Surgery?
Bladder training also will occur post-surgery. Some patients mistakenly reduce fluid intake in response to incontinence, but this can negatively affect bladder function. While it seems to make sense, drinking less should cause you to have less urine and going to the bathroom more frequently should reduce the incontinence. Unfortunately, it’s not so simple. In fact, increasing voiding frequency often reduces the bladder’s ability to hold urine adequately without becoming incontinent. Maintaining bladder compliance with adequate filling and time between voids is a goal to return to normal bladder function. Many people do not get adequate hydration, so never try to restrict fluids to prevent leakage. Adequate hydration is essential for overall health and bladder function.
Post-Surgical Recovery and Rehabilitation
Optimal recovery from prostate cancer and incontinence requires adherence to a pelvic muscle exercise program along with other health and wellness strategies. Managing bowel consistency will impact continence, and maintaining positive mental health practices helps avoid frustration or depression as the client goes through this scary and life-changing diagnosis. Participating in a general exercise routine improves strength and function throughout the body, and weight maintenance allows the pelvis to heal without the stress of increasing body mass. Sexual dysfunction and erectile dysfunction are common with radical prostatectomy. Pelvic physical therapy offers targeted strategies to address sexual dysfunction and other post-surgical concerns. Speak with your health care provider for guidance.
If you are preparing to have surgery or are experiencing incontinence, you don’t have to suffer in silence. The Des Moines University Clinic has exceptional physical therapists who specialize in pelvic health for both men and women. Schedule an appointment at 515-271-1717.
Disclaimer: This content is created for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health care provider with any questions you may have regarding a medical condition.