Pelvic Floor Therapy for Incontinence
Incontinence is a regular side effect of radical prostatectomy surgery. However, the majority of patients experience the return of normal function with time. Patients who have continued problems with urinary incontinence often improve with physical therapy.
Physical therapists work with prostatectomy patients to teach them appropriate pelvic floor muscle exercises that serve to squeeze the urethra and prevent the leakage of urine. Prior to surgery, closure of the urethra occurs primarily where it passes through the prostate, but this closure mechanism is removed with the surgery. Physical therapy is occasionally ordered prior to the prostatectomy surgery to allow patients to learn the proper technique. Otherwise, therapy typically begins about 8 to 10 weeks after surgery.
Physical therapy begins with an evaluation which and testing of the strength and duration of the pelvic floor contractions.
Therapy concentrates on isolation of the pelvic floor from other muscle groups that are commonly activated when a patient attempts to contract the pelvic floor. These muscles include the abdominals, hip and thigh muscle groups. Some of these muscle groups can work in opposition to the pelvic floor; for example, the abdominal muscles can increase the pressure placed on the bladder which can increase, not decrease leakage. Biofeedback is often used in therapy to allow a visual reference to the contraction. Based on the performance of the pelvic floor, a program of home exercises is developed and taught to the patient. For example, a patient with a weak pelvic floor often needs to begin exercises while lying down and can progress with time to sitting, and standing, and then to exercises with other activities such as during a golf swing.
Post-Prostatectomy Erectile Dysfunction Rehabilitation
Treatment to restore erectile function should be a part of every patient’s recovery plan following prostatectomy, but early return of erectile function is not always possible. St. Joseph Hospital physicians are committed to a program of early erectile dysfunction rehabilitation for patients after radical prostatectomy.
Physicians often use a combined approach including oral medication, intra-urethral suppositories and vacuum erection devices. When these approaches are not sufficient, the use of penile injection therapy or insertion of a penile prosthesis may be appropriate. The recovery of erectile ability may not be complete for as long as two years, even though some patients recover much sooner. Age and erectile ability prior to surgery are important determinants of postoperative recovery of erections sufficient for intercourse.
Current and future studies of post-prostatectomy erectile dysfunction are focusing on improving penile rehabilitation, enhancing nerve regeneration and preserving penile length. In addition, researchers are developing drugs to help protect the nerves spared during prostatectomy, a novel approach that may help prevent post-prostatectomy erectile dysfunction.