The prostate is part of the male reproductive system-a gland that produces most of the semen that carries sperm. Anatomically, it is located beneath the bladder and surrounds the upper part of the urethra, the tube responsible for carrying urine from the bladder. Prostate cancer is a disease where the prostate cells have lost normal control of growth and division. Currently, it is the most common cancer affecting Canadian men, as one in seven men will be diagnosed with this disease in their lifetime.
If you have recently undergone treatment for prostate cancer, then you will have discussed the treatment options at length with your urologist, oncologist and possibly your surgeon. For most men, the prognosis following one of the life-saving treatments such as radiotherapy, brachytherapy, hormone therapy and surgery is very good. You will have made your decision about which treatment option is best for you based on the advice of your doctors.
Side effects of cancer treatment
The side effects of the various treatments are very significant and debilitating and can have a profound effect on quality of life. The good news is that huge amounts can be done to help alleviate these side effects.
This is the most common side effect following radical prostatectomy and also following radiotherapy. In fact all men will be incontinent for at least a few weeks following surgery to remove the prostate.
Luckily, there are other muscles (at the base of the bladder) which also help to regulate the flow of urine. Training bladder and pelvic floor muscles helps the vast majority of men to gain full control. However, there is a small percentage of men who will suffer ongoing incontinence because of various other complications related to the surgery. It should be emphasized however that for most men, the prognosis is very good.
The importance of pre-treatment exercises
If possible, it is very important to start bladder control rehabilitation or “pre-habilitation” prior to surgery or radiotherapy. This ensures that the muscle control systems are optimised before the rigours of surgery. It also speeds up recovery of continence dramatically.
Generally it takes about twelve weeks to fully train these muscles. Therefore if you start “pre-habilitation” six weeks before the surgery, there is a good chance that you will be fully continent six weeks after the surgery. Similarly, if you start the “pre-habilitation” four weeks before the surgery, you should be dry by eight weeks post-surgery and so on.
Immediately after the surgery, you will have a catheter (tube in penis and bag strapped to your leg). This stays in place for about two weeks. During this time, you cannot do pelvic floor exercises. Your focus at this stage should be on resting and recovering from the surgery and gently resuming activities. Don’t overdo things!
However once the catheter has been removed, you can start your rehabilitation.
What if I had my surgery a long time ago and still have problems with incontinence?
There are several factors which may prevent or delay return of full bladder control. This may be something simple such as not being shown precisely how to carry out the pelvic floor exercises. These muscles can be very difficult for some people to isolate and often men think that they are contracting their pelvic floor muscles when in fact they are drawing in their abdominal muscles or using compensatory strategies such as holding their breath or bracing their tummy.
This is a less common complaint than urinary incontinence. However sometimes radiation therapy can affect bowel function. Treatment with specific pelvic floor exercises, advice and education can often help resolve this.
Treatment for erectile dysfunction following prostate cancer is multi-disciplinary. It is important that your doctors are involved. Depending on your situation, it may be important to involve your urologist, a sexual health physician or a general practitioner with a specialist interest in this area. From a physical point of view, exercises to optimise the muscle function in the area and also a general exercise program to improve cardiovascular function are essential components.
A number of research studies have demonstrated that a regular exercise programme can help alleviate these symptoms of fatigue.
How Physiotherapy Can Help
Usually individual physiotherapy is required to teach effective pelvic floor exercises, (or other relevant individual exercises) and provide individualized advice and education about how to manage any other side effects you may be experiencing.
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The Canadian Physiotherapy Association (CPA) represents physiotherapists, physiotherapist assistants and physiotherapist students across Canada. CPA members are rehabilitation professionals dedicated to the health, mobility and fitness of Canadians.
Physiotherapists are primary health care professionals who combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.
More than 20,000 registered physiotherapists work in Canada, in private clinics, general and rehabilitation hospitals, community health centres, residential care and assisted-living facilities, home visit agencies, workplaces, and schools.
The CPA presents its educational references as a public service and for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The opinions expressed do not necessarily represent the opinions of the CPA membership.