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!