If you’ve had a prostatectomy (removal of the prostate), you might need the help of a pelvic-health trained physiotherapist to help guide you through post-surgery recovery.
What to Expect With Your Prostatectomy
When the prostate is removed, it disrupts the nerves and other tissues through the area, and you will experience pretty significant urinary incontinence (leaking of urine). The sphincter at the base of your bladder that typically is closed so that your bladder can fill will not be able to work properly for a period of time, meaning initially you are likely going to leak a lot, but IT WILL get better!
Immediately after surgery you will have to have a catheter in order to keep your urethra (the tube that drains urine from the bladder) open while it starts to heal, and your surgeon will remove that after more than a week.
Once the catheter comes out, you will be leaking pretty significantly—this is typical and expected. You will likely have to wear pull ups (adult diapers) at the start, but as you improve and are leaking less, you will be able to wear a pad inside your underwear—you can speak with your physiotherapist further about this.
Four weeks after surgery you can meet with your physiotherapist to get to work on your pelvic floor muscles, which have been shown to help everything improve faster. Your physio will need to check your pelvic floor muscles internally—the pelvic floor group of muscles works like every other muscle in your body, but is pretty completely ignored by everyone until they have a problem!
Many people do not know how to properly engage these muscles, so your physio needs to do an internal (rectal) assessment of the muscles when you are engaging them; she is able to give you feedback on your strength, endurance and control. This is not at all painful and will be done at your initial assessment. You and your physio both need to know that you are able to engage and relax these muscles properly, as everything else is based on this!
There is a pressure system in your core that you need to learn how to manage: you will learn that movements like sitting up from lying down, standing up from sitting, bending forward, and coughing/ sneezing will make you squirt out urine initially. This is due to the increased abdominal pressure, and you can lessen this by engaging your pelvic floor muscles before you move.
You will also be working on other core muscles, where you then bring in your pelvic floor. In life, your pelvic floor muscles never work on their own in isolation. If you do core exercise and add your pelvic floor, it builds a stronger core!
Your physiotherapist will guide you through your rehabilitation after your prostate surgery, and it will get better! You will be asked to do your homework twice daily, and it won’t take you long to do but it does need to be consistent!
Your Partner in Pelvic Health
Elevation Physiotherapy & Wellness is an excellent place to start addressing your problem. Many people have heard of Kegel exercises, but they are not appropriate for everyone and many people perform them incorrectly. It is very important to seek care from an experienced clinician trained in this area, who can do an internal exam to assess your muscle strength and look at other tight or weak tissues that contribute to your problem. Internal palpation is the gold standard of care, and we are sensitive to the fact that it can be difficult for some people to be comfortable with this. We will discuss our plan of action with you before initiating treatment.
At Your First Appointment
We will send you a form for you to describe your issue and return prior to being seen for your first appointment. This completed form allows the physiotherapist to effectively prepare further questions and plan what to focus on first.
Your physiotherapist will need a very detailed history of your issue, and will then start a physical examination of the joints, muscles and connective tissue of your pelvis, lower back and hips. Most of the time, this assessment will include an internal exam to evaluate the pelvic floor muscles and other tissues in that area, since these muscles are only accessible internally. If an internal exam can’t be tolerated initially, we can start treatment by focusing more externally and progress to internal work as you can.
On the initial visit, you’ll spend about one hour with your physiotherapist, and together you will discuss your goals of treatment and devise a plan to get there!
Your Pelvic Health Treatment
Your treatment will include education about your problem, and may also include manual therapy (hands-on work by your Physiotherapist), and performance of specialized exercises designed to help with pelvic floor problems. Some people may benefit from a muscle stimulation machine to help you get your pelvic floor muscles functioning properly, or a biofeedback machine to ensure proper contraction and relaxation of the pelvic floor muscle group.
You Will Have Homework!
At Elevation Physiotherapy & Wellness, we will devise a personal home program for you to work on daily between appointments to efficiently address your concerns. It will not take you more than 10 minutes at a time, and practicing these focused exercises regularly will allow for progressions to be made each time you see your Physiotherapist.
Contact Us to Book an Appointment
If you’re recovering from a prostatectomy or dealing with another type of pelvic health issue, we’d love to provide the treatment you need! Please contact our office to book your first appointment, or simply fill in our form and we’ll get in touch with you.
