The majority of men undergoing radical prostatectomy will have some degree of urinary incontinence following surgery (studies suggest anywhere from 5% to 87%). As well, transurethral resection of the prostate (TURP) and other prostate procedures including radiation can adversely affect continence.
The pelvic floor forms a sling from the pubic bone in front to the tailbone in back as well as up the sides of the pelvic bowl. The role of the pelvic floor includes primary core stability of the back and pelvis, support of the internal pelvic organs, proper bowel and bladder control, and sexual health.
Prostate surgery can potentially damage the internal sphincter or ‘clamp’ which helps control urine flow. As well, removal of the prostate removes a component of the urethra (the tube from the bladder to the external world) which can affect the function of the urethra. The pelvic floor, once a secondary ‘worker’ to control continence, now takes on a primary role. Pelvic floor physiotherapy helps ensure the pelvic floor muscles do not remain tight and guarded post-surgery and the rehabilitation aims to improve the strength, endurance, and coordination of the pelvic floor to allow the body the optimal condition for regaining continence.
Pelvic floor physiotherapy will also address questions regarding when it is advisable to return to exercise, the effects of diet on urinary function, and what is the normal progression regarding continence after surgery. Pelvic floor physiotherapy can also help with different aspects of sexual health post prostate surgery.
A physiotherapy consult can also be useful prior to surgery to help prepare as well as to know what to expect post-surgery.
With pelvic floor physiotherapy, assessment will often include a rectal exam to determine the precise nature of the problem as well as allow a direct assessment of the pelvic floor musculature.
