Prostate Surgery and Pelvic Floor Therapy

I've seen many men after prostate surgery, and I'm happy they are getting therapy after surgery. Pelvic floor therapy should be a part of any pelvic surgery rehabilitation.

Two things that are common after prostate surgery that pelvic floor therapy can help with are urinary incontinence and erectile dysfunction. These are typical things that occur after prostate surgery and are often unavoidable, however they will heal with time and therapy.

The surgeon is primarily trying to get rid of any cancer or bad tissue in and around the prostate and he is not thinking as much about the after effects from the surgery.

The bladder and prostate often have tissue that overlaps which can affect how well one recovers from urinary incontinence after surgery. There are some anatomical differences among people that may have better or worse outcomes and are unavoidable.

The good news is that if prostate cancer is detected early the survival rates are high! 98% survival rate if prostate cancer is caught early. That is great news, so get your prostate checked if you have one. The survival rate decreases drastically if the cancer has spread outside of the prostate, from 98% to 30% survival rate. Early detection is key.

Urinary incontinence occurs is most men after prostate surgery and pelvic floor therapy can help strengthen the muscles that control the bladder and urethra.

Pelvic floor therapy is not just about doing kegels, but we will teach you how to breathe properly to decrease incontinence, we will work on your surgical scars, help strengthen your abdominal muscles (most surgeries go through the abdomen so the abdominal muscles also need work), and teach you how to go longer periods of time between trips to the bathroom.

This all takes time, though, and I find that to be the most challenging thing to accept for these men. The normal timeline for completely eradicating incontinence after prostate surgery is 12-18 months. That is a long time! Especially for someone who had no prior bladder control issues. This can be really hard to deal with, but your PT should be able to assure you that you are on the right path by tracking your progress over time.

Besides measuring pelvic floor muscle strength we will track how many pads or depends you are using per day and night, how often you are going to the bathroom and how much you leak when you leak. Sometimes progress is small, but if you pay attention you will be able to see it.

You can also use a penile clamp to help control the urinary leakage. It is recommended to only use this for 2 hours at a time and then give the penile tissues a rest. Some men like this option to decrease the bladder leakage. Others find it uncomfortable and a nuisance.

The other common thing that happens after prostate surgery is erectile dysfunction. Because the surgery often interrupts some of the nerves in the pelvis, erectile dysfunction occurs. This takes longer to return, but working on it early will help. It can take 2-4 years for functional erections to return.

Physical therapy doesn't directly help with erectile dysfunction, but here are some of the common recommendations.

First, your doctor will probably prescribe Viagra or Cialis to help. Even in the early days after surgery when you think you aren't interested in being sexually active again I encourage my patients to take the medication in case they change their mind.

Also, early on you should start using a penile pump. Your doctor may prescribe one or you can find one on your own. On my recommended product page I will post a link to one I recommend. There are many different types so you can do your research to find one you like. Sex shops also sell penile pumps and you can find them on Amazon. Don't be embarrassed to buy one.

The reason you need to use a penile pump early on is to maintain the tissue length of the penis while you are not having spontaneous erections. Normally men have 3-5 spontaneous erections every night (it's normal!) and that maintains penile tissue length even when the man is not sexually active. When spontaneous erections are not happening it is important to use the pump to maintain blood flow and tissue length to the penis so it can function optimally once you are ready to resume sexual activity.

Penile pumps should be used 5-7 days/week for 20-25 minutes. You should do 4-5 cycles of 4 minutes on 1 minute off. This should be done for about 12 months or until spontaneous erection and the ability to maintain an erection for desirable sexual activity occur.

Most of the men I see for physical therapy after prostate surgery come for 12-18 months of therapy. At the beginning I will see them weekly and after 1-2 months we taper off to twice a month and eventually to once a month check ins.

If you had prostate surgery make sure to find a pelvic PT or ask your doctor for a referral. Starting PT earlier is always better, but I have had good results with men who started 6 months or more after surgery. It is never too late for therapy.

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Share this with your friends who have had or will be having prostate surgery. Often doctors don't talk about the after effects, but these are common and pelvic therapy can help.