September Is Prostate Cancer Awareness Month

Prostate Cancer is the most common cancer in men in the western world making up 15% of cancer diagnoses in men in the US. Though the incidence is high, Prostate Cancer is a very treatable disease with high long-term survival rates after treatment. Though the treatment for Prostate Cancer is extremely effective (the gold standard treatment in the United States being the radical prostatectomy in which the entire prostate is removed), the side effects can be detrimental for survivors.  With September being Prostate Cancer Awareness Month, I want to take the opportunity to provide information about Prostate Cancer, common side effects post treatment, and how Physical Therapy can be a helpful resource for all survivors!

The most common side effect from a prostatectomy is urinary incontinence. The incidence of incontinence following a prostatectomy can be as high as 87% of patients experiencing urinary incontinence 6 months post surgery (Van Kempen 2000). This is a very costly side effect both to someone’s quality of life due to the frustration and fear of losing bladder control in front of others and financially due to the high cost of pads and incontinence undergarments. The reason for urine leakage with a prostatectomy is that one of the mechanisms that helps with continence is removed along with the prostate and cancer during the surgery. This means your body and your supporting musculature (your pelvic floor) have to relearn how to turn on and when in order to keep urine in your bladder. 

Did you know that Physical Therapy is the most commonly recommended conservative treatment for Post-Prostatectomy Urinary Incontinence and the time period to continence has been shown to decrease if PT is started immediately after the catheter is removed (Filocamo 2005)?  As a pelvic floor specialist, it is my job to help you strengthen these muscles with guidance on how many strengthening exercises to do, what kinds of exercises to do, and in what position to do them in.  These specific strengthening exercises are called ‘Kegels,’ or ‘Pelvic Floor Contractions.’ It is a common misconception that ‘Kegels’ are only for women. Men have a pelvic floor too and sometimes need to strengthen these muscles to help with urinary leakage and sexual dysfunction.

Here are some tips and tricks for how to strengthen your pelvic floor muscles to help manage incontinence after a prostatectomy that I commonly give to my patients: 

Kegels

  • Pelvic Floor strengthening exercises are going to be your quickest and most direct way to reduce urinary leakage by way of strengthening the muscles that support your bladder and bowel.  For men, the way to perform a kegel for urinary leakage is to think about the cue ‘shorten your penis’ or ‘retract your penis’ by using your pelvic floor muscles to gently pull your penis into your body. This will target the muscles in the front of your pelvic floor. Avoid holding your breath! You should be able to do this while exhaling (for more information on breathing, see my blog post on performing a 360 degree diaphragmatic breath!). It will be easiest for you to do kegels laying on your back first as gravity and your body weight aren’t pushing against your pelvic floor muscles. Then transition to sitting when laying on your back gets easy. Then standing, then with activities such as walking, lunging, or squatting.  
  • When you go from sitting to standing (a common time that men report to me that they have leaked), take a deep breath in, then exhale and contract your muscles by ‘shortening the penis’ before you initiate standing.  Keep exhaling as you stand up and keep your muscles contracted. This will greatly improve your chances of not leaking! Once standing, slowly relax your pelvic floor muscles with control instead of letting them completely relax all at once. Remember, the pelvic floor is a dimmer switch, not a light switch!
  • With kegels, it is all about QUALITY contractions over QUANTITY. There is very little research to support how many kegels to do a day to help build up muscle bulk, strength, and endurance. I find that having a goal of 50-80 repetitions/day is plenty to get the job done for people post-prostatectomy. This means being very thoughtful when doing your kegels, making sure you are getting a quality strong contraction of the muscles in the front of your body (meaning you aren’t just squeezing your bottom). I recommend performing them in sets of 10 in various positions throughout the day moving toward performing them with functional movements such as with climbing stairs, bending over to pick something up, or sitting to standing.
  • If you need help isolating your kegel or aren’t sure if you’re doing it right, connect with a pelvic floor physical therapist in your area even if just for one appointment to ensure you are doing these contractions correctly and in the best positions and repetition range for you! One notable research article found that verbal or written instruction alone was not enough preparation to adequately perform kegels. In fact, it found that 50% of people tested were unable to perform an effective kegel, and 50% of those people were performing a maneuver that could worsen their incontinence (Bump,1991)! Please don’t hesitate to connect with a specialist to ensure you’re on the path to success.  Check out pelvicrehab.com to find a great pelvic health physical therapist in your area.

At Physical Therapy appointments, we review all of the above and curtail it to your individual needs. We have much more information to share to help you achieve continence and also have Biofeedback in the clinic which is a great visual way to get feedback on the timing of your pelvic floor contractions with breathing and movement. 

What is also important is knowing how many and what type of exercises to do once you have reached your goal, also known as a maintenance program.  A common question I get asked is ‘will I have to keep doing these exercises forever?” and the answer is “yes,” however with less frequency and more specificity to your daily functional tasks so it doesn’t feel like you are taking time out of your day to perform your exercises — it’s just automatic. 

Stay tuned for Part 2 where I will cover other helpful tips and tricks to help manage incontinence post-prostatectomy. Kegels are helpful and directly strengthen the muscles that need to relearn how to function, but they’re really only part of the story! In the next post we will be talking about fluid intake, urge suppression, exercise, and other helpful tips for returning to feeling like yourself again post prostate surgery.  

If you are experiencing urinary leakage, urinary urgency, urge incontinence, or pain with urination, please call Life’s Work PT at (503)295-2585 or send us a message at info@lifesworkpt.com. For more information on how to find a good physical therapist in your area read our blog ‘How to Find a Good PT’ and visit pelvicrehab.com.

References

Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165(2):322-329. doi:10.1016/0002-9378(91)90085-6

Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48(5):734-738. doi:10.1016/j.eururo.2005.06.004


Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355(9198):98-102. doi:10.1016/S0140-6736(99)03473-X