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Healing From a Prostatectomy: How Pelvic Floor Therapy Can Help

By Dr. Christine Martirez PT, DPT on 9/25/2024

Healing from a Prostatectomy: How Pelvic Floor Physical Therapy Can Help

A prostatectomy is a major surgical procedure commonly performed to treat prostate cancer. While the removal of the prostate can be life-saving, it also brings significant changes to the body, particularly in the pelvic region. One of the key challenges many men face after a prostatectomy is regaining control over pelvic floor function, especially regarding urinary continence and sexual health.

In this blog post, we’ll explore what happens during a prostatectomy, why pelvic floor function is so important in recovery, and how pelvic floor physical therapy can be an essential part of the rehabilitation process.

What Happens During a Prostatectomy?

A prostatectomy is the surgical removal of the prostate gland. The prostate is a small organ located between the bladder and the penis and surrounds the urethra. Its primary function is to produce seminal fluid, which nourishes and transports sperm. During the procedure, depending on the type of prostatectomy, the prostate gland is removed, along with surrounding tissues, which may include part of the urethra.

One of the most significant consequences of a prostatectomy is the removal of the

internal urethral sphincter

. This muscle, which sits at the junction between the bladder and urethra, plays a critical role in maintaining urinary continence by automatically closing off the bladder. Once removed, the burden of maintaining continence shifts to the

external urethral sphincter

, a voluntary muscle located further down the urethra.

Common Pelvic Health Issues After a Prostatectomy

1. Urinary Incontinence

Urinary incontinence is one of the most common issues following a prostatectomy. Since the internal urethral sphincter is no longer present, the external urethral sphincter becomes the primary defense against urine leakage. However, this muscle often weakens after surgery, leading to issues like stress urinary incontinence (leakage with activities like coughing, sneezing, or lifting) or urge incontinence (leakage with a sudden, strong need to urinate).

1. Erectile Dysfunction

Erectile dysfunction (ED) is another frequent concern after a prostatectomy. The nerves responsible for erections (the

neurovascular bundles

) are often located near or within the tissue that is removed during surgery. Damage or disruption to these nerves can result in difficulty achieving or maintaining an erection.

1. Pelvic Pain

Some men experience pelvic pain or discomfort following a prostatectomy. This can be due to surgical trauma, muscle tension, or changes in the pelvic floor muscles’ function as they compensate for the loss of the prostate and surrounding tissues.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy plays a crucial role in the recovery process after a prostatectomy, helping men regain control over their urinary and sexual function and addressing any pelvic pain.

Here are the key ways pelvic floor therapy can assist:

• Strengthening the External Urethral Sphincter

Since the external urethral sphincter becomes the primary muscle responsible for urinary control post-surgery, strengthening this muscle is vital. A pelvic floor physical therapist will teach you how to properly engage and strengthen the muscles of the pelvic floor, focusing on the external sphincter and anterior pelvic floor musculature. These exercises, often referred to as

Kegels

, help men regain control over urine flow and reduce incontinence episodes.

• Improving Pelvic Floor Muscle Function

Beyond just strengthening, pelvic floor physical therapy focuses on improving the overall function and coordination of the pelvic floor muscles. A physical therapist will assess whether the pelvic floor muscles are working too hard (hypertonic) or too weak (hypotonic) and design a personalized program to address these imbalances. In some cases, pelvic floor muscles may be overcompensating, causing tightness or discomfort that can be resolved with manual therapy and relaxation techniques.

• Erectile Dysfunction Rehabilitation

For men experiencing erectile dysfunction post-prostatectomy, pelvic floor physical therapy can be instrumental. The

ischiocavernosus

and

bulbospongiosus

muscles, both part of the pelvic floor, play an essential role in maintaining erections by helping trap blood in the penis during arousal. Strengthening these muscles can improve blood flow and erectile function over time. Additionally, a pelvic floor therapist can provide guidance on relaxation techniques and nerve stimulation exercises that may aid in the recovery of erectile function.

• Bladder Training and Behavioral Strategies

Pelvic floor physical therapists also offer bladder training techniques to help restore normal bladder function after surgery. This can involve gradually increasing the time between bathroom trips, learning to control urges, and understanding how to manage fluid intake to reduce leakage. Bladder training can help men regain confidence in controlling their bladder.

1. Postural and Core Muscle Re-Education

Postural and core stability is another focus in pelvic floor rehabilitation. The pelvic floor muscles work in coordination with the diaphragm and the deep core muscles, including the

transverse abdominis

, to maintain stability and function in the pelvic region. Physical therapy can help men re-learn how to properly engage these muscles for overall pelvic health and to reduce stress on the pelvic floor during daily activities.

1. Managing Post-Surgical Pelvic Pain

If pelvic pain is present, physical therapists use manual techniques, such as myofascial release, to relieve tension in the pelvic floor muscles and surrounding tissues. These techniques, combined with relaxation strategies, can help alleviate post-surgical pain and improve overall pelvic health.

Why You Should Consider Pelvic Floor Physical Therapy After a Prostatectomy

Recovering from a prostatectomy can be a challenging process, particularly when dealing with issues like urinary incontinence and erectile dysfunction. Pelvic floor physical therapy provides a comprehensive, non-invasive approach to help men regain control over their pelvic floor muscles and improve their quality of life.

Whether you’re seeking to manage incontinence, improve erectile function, or alleviate pelvic pain, a trained pelvic floor physical therapist can assess your specific needs and guide you through a tailored recovery program. By addressing the underlying muscle dysfunction and improving pelvic floor coordination, pelvic floor therapy can help men restore normal function and return to their daily activities with confidence.

Looking to be on the road to recovery following a prostatectomy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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