Prostate Cancer is the most commonly diagnosed cancer for New Zealand men, with more than 3000 new cases each year. Many of these men undergo surgery to remove the prostate (radical prostatectomy). The side effects of this are:
• urinary incontinence
• erectile dysfunction

These issues can be very distressing, however treatment with a trained pelvic floor physiotherapist can make a big difference.

What is the prostate?
The prostate is an organ that produces fluid that protects and nourishes sperm. It is located immediately below the bladder, just in front of the bowel, and is about the size of a walnut.

What causes loss of bladder control after prostate surgery?
The prostate surrounds the urethra, and when the prostate is removed there is damage to the mechanisms that stop the bladder from leaking urine. This now means there is a reliance on the pelvic floor muscles to maintain continence. Most men do not have good pelvic floor muscle function, and it takes time to build this up after the surgery.

What causes loss of erectile function after surgery?
The nerves that control erections surround the prostate, and there is usually damage to these nerves during the surgery, resulting in loss of erectile function. The good news though is that you can get help.

What can you do to help the bladder leakage?
There is good evidence that after prostate removal, getting the pelvic floor muscles working well reduces both the severity of the leakage, and the length of time men experience it for. Pelvic health physios have extra skills and training to help with this. We can make sure that you are isolating these muscles and doing the exercises correctly, so that you get the best strength gains. It takes around three months of pelvic floor training to develop enough strength and function in the muscles to stop the bladder from leaking.

We know that if you are able to see a physio prior to your surgery, the results are even better. You can learn how to do the exercises correctly and strengthen up the muscles so that you can begin immediately after the catheter is removed (usually about a week after surgery). The sooner you can start these exercises the better.

Why see a pelvic floor physio?
Getting a proper assessment means you know you’re doing your exercises correctly. We can check your technique and tailor the strengthening program based on what you can currently do. We are able to see you regularly to progress the exercises, and teach you how to use the pelvic floor in a functional way with your daily activities. We provide feedback and motivation, and give advice on pad use and weaning from pads, as well as helping you return to physical exercise.

If possible, we like to see you before the surgery so we can teach you the exercises before you are having to deal with recovery from the surgery, and trying to cope with the leakage.

What can you do to help with erectile dysfunction?
After radical prostatectomy, there is nearly always a loss of ability to get an erection. Sometimes (when the cancer has spread) the nerves have to be removed, but even if the nerves are left intact, there is trauma to them. The surgeon needs to carefully move the nerves out of the way so that the prostate can be removed. This can cause problems as nerves are delicate structures and it can take some time to recover.

Your surgeon may offer medication to help with return of erections. Pelvic health physiotherapists can also help you, both with pelvic floor training and advice on penile rehabilitation. We can advise on use of vacuum pumps. Pumps enable erections to occur, and if used regularly can help prevent shortening and fibrosis, and help maintain good blood flow until normal function returns.

Contact us here to make an appointment with Liz, our Men’s Health expert, or call us on (04) 802 4225