Elevation Physiotherapy | Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good
945
post-template-default,single,single-post,postid-945,single-format-standard,ajax_updown_fade,page_not_loaded,qode-page-loading-effect-enabled,,qode_grid_1300,qode-theme-ver-17.2,qode-theme-bridge,qode_header_in_grid,wpb-js-composer js-comp-ver-6.0.2,vc_responsive
 

Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good

Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good

Kegel Exercises for Men Post-Prostatectomy May Not Always Be Good

Pelvic floor physiotherapy does not equal Kegels. It also involves teaching each patient how to manage the increased pressure in the system when they cough, sneeze or move, and also learning how to appropriately engage their pelvic floor muscles as they are moving in certain ways.  Each patient is different: many men don’t properly engage their pelvic floor muscles, and other men might keep their pelvic floor muscles engaged too much of the time and need to learn to relax them.

A new study in International Urology and Nephrology, suggests there may be a subset of post-prostatectomy patients who need to learn to relax their pelvic floor in order to improve incontinence. Many men have significant incontinence initially following radical prostatectomy—not just stress urinary incontinence, but a consistent drip requiring the use of many pads through the day and night. Of course they improve as time goes on, and continence improves first when the man is not moving (sitting or lying down). Commonly, men continue to leak with movement for several months.  Many men get in the habit of engaging their pelvic floor consistently in an effort to prevent any leaking, and over months can lead to them having difficulty getting those muscles to relax.  Keeping the pelvic floor muscles tight too much of the time can lead to urinary urgency and frequency.  As well, men often urinate more frequently because they don’t want to leak, so over time their brain teaches the bladder to become less of a reservoir.

The above retrospective study had136 patients with post-RP SUI who were treated with pelvic physiotherapy. Of these, 25 had underactive pelvic floor muscles, 13 had overactive pelvic floor muscles, and 98 had evidence of both. All men received therapy to either relax or strengthen their pelvic muscles. The total number of pelvic physical therapy sessions depended on a patient’s progress. Incontinence improved in 87% of them, with 58% achieving what is considered the optimal improvement of needing 2 or fewer protective pads per day. Further, pain was a problem for 27% of the men, but that proportion dropped to 14% by the end of therapy.

The authors concluded that this study was the first to demonstrate that pelvic health physiotherapy can be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be due to pelvic floor muscle overactivity.

It appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence. Kegel exercises can worsen pelvic floor overactivity, and are not the best treatment for every patient.

Nearly all men have urinary incontinence immediately after a prostatectomy, but that percentage drops to about 5% to 20% within 24 months following RP. Men who have not seen improvement within 2 to 6 months should seek physiotherapy.

It was also concluded that pelvic floor training engages the patient in their rehabilitation process, and is a good resource to utilize postoperatively. It also underscores that personalized treatment of post-RP incontinence may be warranted, as some patients will benefit from strengthening work, while others need to learn to relax their pelvic floor muscles.

Reference  Scott, KM, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain

[published online December 5, 2019]

Pelvic floor physiotherapy does not equal Kegels. It also involves teaching each patient how to manage the increased pressure in the system when they cough, sneeze or move, and also learning how to appropriately engage their pelvic floor muscles as they are moving in certain ways.  Each patient is different: many men don’t properly engage their pelvic floor muscles, and other men might keep their pelvic floor muscles engaged too much of the time and need to learn to relax them.

A new study in International Urology and Nephrology, suggests there may be a subset of post-prostatectomy patients who need to learn to relax their pelvic floor in order to improve incontinence. Many men have significant incontinence initially following radical prostatectomy—not just stress urinary incontinence, but a consistent drip requiring the use of many pads through the day and night. Of course they improve as time goes on, and continence improves first when the man is not moving (sitting or lying down). Commonly, men continue to leak with movement for several months.  Many men get in the habit of engaging their pelvic floor consistently in an effort to prevent any leaking, and over months can lead to them having difficulty getting those muscles to relax.  Keeping the pelvic floor muscles tight too much of the time can lead to urinary urgency and frequency.  As well, men often urinate more frequently because they don’t want to leak, so over time their brain teaches the bladder to become less of a reservoir.

The above retrospective study had136 patients with post-RP SUI who were treated with pelvic physiotherapy. Of these, 25 had underactive pelvic floor muscles, 13 had overactive pelvic floor muscles, and 98 had evidence of both. All men received therapy to either relax or strengthen their pelvic muscles. The total number of pelvic physical therapy sessions depended on a patient’s progress. Incontinence improved in 87% of them, with 58% achieving what is considered the optimal improvement of needing 2 or fewer protective pads per day. Further, pain was a problem for 27% of the men, but that proportion dropped to 14% by the end of therapy.

The authors concluded that this study was the first to demonstrate that pelvic health physiotherapy can be a beneficial treatment modality for men who have pelvic pain after prostatectomy, because the pain for some men may be due to pelvic floor muscle overactivity.

It appears that men who have surgery often develop pelvic floor overactivity or muscle tightness postoperatively, and any type of pelvic floor dysfunction can lead to stress incontinence. Kegel exercises can worsen pelvic floor overactivity, and are not the best treatment for every patient.

Nearly all men have urinary incontinence immediately after a prostatectomy, but that percentage drops to about 5% to 20% within 24 months following RP. Men who have not seen improvement within 2 to 6 months should seek physiotherapy.

It was also concluded that pelvic floor training engages the patient in their rehabilitation process, and is a good resource to utilize postoperatively. It also underscores that personalized treatment of post-RP incontinence may be warranted, as some patients will benefit from strengthening work, while others need to learn to relax their pelvic floor muscles. Reference  Scott, KM, Gosai E, Bradley MH. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain [published online December 5, 2019]. Int Urol Nephrol