Prostate cancer is the most common type of cancer in men. Learn how with the appropriate guidance and exercise, the majority of men will make a full recovery.
Understanding your Anatomy and Continence Mechanism
The prostate is a walnut-shaped gland that lives just below the urinary bladder in men*. The prostate is an importantpart of the reproductive system as it supplies a portion of the seminal fluid. The seminal vesicles that sit on top of the prostate secrete the remainder of the ejaculate to combine with sperm from the testes. Along each side of the prostate is a neurovascular bundle (nerves and vessels), that help control erectile function.
Above the prostate is the urinary bladder which, like a balloon, increases in size as it fills with urine. The urethra is a narrow tube travelling from the bladder through the centre of the prostate and along the length of the penis. The urethra is responsible for transporting both urine and semen out of the body like a hose.
The control of urine is a complex mechanism that is largely controlled by the nervous system which acts on the muscles surrounding the urethra to maintain urethral pressure (similar to kinking a hose). These muscles are either smooth muscle, that are under the control of the nervous system, or skeletal muscle than can actively be squeezed to generate pressure. During a prostatectomy, the smooth muscle of the urethra is impacted and requires greater effort from the skeletal muscles (pelvic floor).
What Happens During Prostate Surgery?
There are a few common techniques for performing a prostatectomy. However, one of the most common procedures is a Robot-Assisted Laparoscopic Prostatectomy (RALP), where the surgeon will make small incisions to pass through the robotic arms and camera to visualise the surgical region. These robotic tools are control by the surgeon and are used to remove the prostate gland, seminal vesicles and sometimes lymph nodes. This procedure often takes 2-4 hours to complete.
You will wake up with a urinary catheter, which can be expected to remain in place for approximately one week. During this initial recovery period, you may experience some discomfort around the surgical incisions and in the prostate region (typically felt just below the testes).
Common Side Effects from Prostate Surgery
The two most common side effects after a prostatectomy are urinary incontinence and erectile dysfunction. Many men find these side effects to be very distressing. However, for the vast majority, these symptoms can be resolved or drastically improved.
Urinary incontinence is present in approximately 95% of men who undergo a prostatectomy. This typically resolves within the first 3-12 months post-surgery. The urinary incontinence experienced is due to the disruption in the ability to generate urethral closure pressure and relies on the pelvic floor muscles to compensate for this change.
Similarly, erectile dysfunction will be problematic for majority of men. The prognosis for return of spontaneous erections will depend on whether the surgeon was able to complete a nerve sparing procedure (i.e. nerves not removed). This will likely be dictated by the severity of the cancer and whether it has spread beyond the prostate gland. For men who have had nerve sparing procedures, the mechanism of erectile dysfunction is believed to be temporary nerve damage from being stretched during the procedure and the localised swelling from the procedure. Gradually over time with assistance from medications such as Viagra or Cialis, and manual stimulation of the area, erectile function can return. Some men will need to utilise vacuum penile pumps or other forms of medications such as penile injections.
Learn How Physiotherapy can help with Post Prostatectomy Incontinence
The role of a Physiotherapist in Your Recovery
1. Education and support
We aim to meet with you prior to your RALP procedure to ensure that you understand the impacts of the surgery and what you should expect during the post-operative period. A typical pre-operative consultation will include some education on the continence mechanism and how this is impacted by the procedure; advice regarding appropriate fluid intake; how to avoid constipation; rest and physical activity restrictions; and pelvic floor muscle exercises.
2. Pelvic Floor muscle training
As discussed earlier, the pelvic floor muscles are an important part of the continence mechanism. These muscles are skeletal muscles, which means that we can improve their strength and endurance through appropriate exercise.
When performing pelvic floor muscle exercises, the technique is the most important thing. An ultrasound machine will be utilised to provide visual feedback of the technique and an individualised exercise regime will be prescribed.
3. General physical activity
In the first 6-12 weeks post-operatively, it is important to avoid any strenuous exercise or heavy lifting. This is to allow the surgical site to heal and prevent the development of any hernias. During this time, it is important to slowly get back to walking and usual daily activities. Your Physiotherapist will guide you with appropriate exercise progressions that will include your pelvic floor and deeper core muscles. This will slowly be progressed until you are feeling fit and strong and able to resume your usual activity.
The Path to a Full Recovery
The journey for a man diagnosed with prostate cancer can be very daunting and comes with many ups and downs. Our Physio team at Sydney Pelvic Clinic aim to provide support and guidance along your journey, to assist you getting back to your full life with confidence. Call us to book in with an experienced Physiotherapist.
Book a consultation with a qualified member of our team today.
*SPC acknowledges individuals in the transgender community and people who are non-binary who may not identify as men
