Restore the Core After Prostate Surgery

Many men who are diagnosed with prostate cancer elect to have a prostatectomy, which is the complete surgical removal of the prostate. While this surgery helps to eliminate the cancer, oftentimes a number of less desirable consequences may occur. One of these symptoms can be urinary incontinence. This can occur for up to two years after surgery, and in rare cases, longer than that. One way to help reduce this risk as well as speed along the recovery process is to enlist the help of a physical therapist.

A physical therapist that is trained in pelvic floor dysfunction can help men who are experiencing bladder symptoms post-operatively. They do this by addressing tight or weak pelvic floor muscles.

Let’s start by discussing anatomy. There are two sphincters associated with urination. There is the internal urethral sphincter which is located where the bladder and urethra meet. This muscle is controlled by the autonomic nervous system and its default state is “on.” The second sphincter is called the external urethral sphincter which is a volitional muscle, meaning it is entirely controlled by active effort. The prostate is located around the urethra just below the level of the bladder. Each person’s anatomy is slightly different, but the prostate can be either just below or at the level of the internal sphincter, meaning that sometimes, part of the internal sphincter can be damaged or removed during prostate surgery.

How can this be remedied? To begin, you can come in to see a trained pelvic health physical therapist before surgery to complete “pre-hab,” where your pelvic muscles will be up-trained to be able to provide support to your external urethral sphincter so that they have the muscle memory before surgery even occurs. You will gain knowledge on how to properly complete Kegels (pelvic floor contractions) and reverse Kegels (pelvic floor lengthening) to coordinate your muscles. From these basic exercises, we will progress in your program, focusing on pelvic floor and core strengthening to empower you to have the best outcomes.

Post-operatively, patients will have a catheter for 5-10 days. After the catheter is removed and you are cleared to resume normal activity, you can start right back into working on some of the exercises that you tried in pre-hab. If any leakage or ED symptoms persist, it’s time to seek out help from your pelvic floor PT again! Your pelvic floor PT can help mobilize what may be stuck and increase muscle length to relax the pelvic floor, which in turn enables stronger and more functional pelvic floor contractions.

So what can you do in the meantime before getting set up with your pelvic floor therapist for your initial evaluation? Try to relax the muscles of the pelvic floor through deep diaphragmatic breathing or stretching (see below example). The pelvic diaphragm (pelvic floor muscles) and respiratory diaphragm work together like a piston or canister. During inhalation, the pelvic floor muscles expand and relax. During exhalation, the pelvic floor muscles will contract and shorten. Once muscles are properly lengthened, they will be able to more easily perform contractions and move through a full range of motion. The theory behind this is to “lengthen before you strengthen.”