International Continence Awareness Week is June 17th to 23rd . Urinary Incontinence is one of the major side effect of prostate cancer surgery.
Like any cancer diagnosis – prostate cancer is a game changer for so many reasons. The symptoms most men suffer following treatment can be even more of a challenge than the cancer itself. Every year 3,300 men are diagnosed with prostate cancer meaning that one in seven men will be diagnosed in their lifetime. At present, certain treatments for prostate cancer in particular surgery (radical prostatectomy) have two main side effects – urinary incontinence and erectile dysfunction both of which can be managed and treated through seeing a specialist Chartered Physiotherapist.
The prostate gland is the size of a walnut and is found at base of the bladder. Along with the internal urethra sphincter it works like a tap to turn off the flow of urine through the urethra, which is a soft, pliable, collapsible tube carrying urine from the bladder through the penis. When the muscles in the pelvic floor contracts they work along with the prostate and the sphincter to collapse this tube preventing leakage – this is an important mechanism to remember when recovering from your prostatectomy.
During a radical prostatectomy the sphincter, is compromised and takes time to recover fully. It is prone to fatigue during the recovery from surgery therefore contributing to urinary leakage during the afternoon or later in the day.
The floor of the pelvis is made up layers of muscles working like a hammock to support the pelvic floor from the tailbone at the back to the pubic bone at the front. These muscles can have two different fibre types – fast and slow twitch which have slightly different functions and need to be exercised differently. The pelvic floor muscles play an important role in bladder and bowel control. Understanding the impact of surgery on these muscles is vital as during the rehabilitation process.
Urinary symptoms are the most common side effects after prostate cancer treatment especially in the early weeks after surgery. These include leaking urine that is not controlled, passing urine frequently, a sudden urge to go to the toilet quickly, needing to go to the toilet quickly and leaking urine before you get there, difficulty emptying the bladder fully and getting up more than twice at night to pass urine.
For many men after they have their treatment is the first time that they will experience urinary incontinence. Urinary incontinence and erectile dysfunction are the most common side effects following surgery and they are the cause of a lot of stress, anxiety and social isolation. The consultant will have discussed likelihood of these symptoms occurring pre-surgery however the reality of the situation is very different. Urinary incontinence can vary from leaking just a few drops of urine when you cough, laugh or exercise to a constant drip or trickle of urine throughout the day.
The reason for the poor urinary control following surgery can be due to the lack of bladder control as the prostate gland itself assisted with that, weakness in the pelvic floor muscles, reduced sensation and blood supply to the muscles and stress caused by the cancer diagnosis. Symptoms should improve over a period of weeks to months however for some men it takes a much longer period of time.
How does seeing a Chartered Physiotherapist help?
The pelvic floor muscles work like a hammock to support the pelvic organs and like any other muscle in the body they can be strengthened if weak with appropriate exercises.
Seeing a specialist Chartered Physiotherapist both before and after your prostate surgery can be really helpful in reducing the incidence and time effected by urinary incontinence and erectile dysfunction. Therefore, reducing the impact on your quality of life.
Research has shown that when men underwent a physiotherapy guided pelvic floor muscle strengthening four weeks prior to the surgery they experienced a significant improvement in the duration and severity of their early incontinence following radical prostatectomy. Starting the pelvic floor strengthening exercises before the surgery allows time establish a new exercise habit that is difficult but very important. However, it is never too late to start regardless of how long you are post-surgery or the severity of your urinary incontinence. Following your surgery, the main benefit from seeing a specialist Chartered Physiotherapist is to ensure that you are learning to master the skill of controlling the bladder without the assistance of the prostate gland and strengthening the pelvic floor muscles. This means learning to use the correct muscles with the correct technique and having the correct exercise prescription.
Tips to help with urinary symptoms;
- Learn where your pelvic floor muscles are and how to contract them properly. Get a rehabilitation program that is appropriate to your ability and work with a Chartered Physiotherapist to progress this achieve your goals.
- Avoid caffeine as this is a bladder irritant. Caffeine is found in tea, coffee, chocolate. Try cutting down or change to decaffeinated drinks.
- Alcohol can increase the amount of urine produced therefore it is worth avoiding.
- Avoid carbonated, fizzy or acidic drinks.
- Water is the best drink followed by herbal teas, decaffeinated options.
- Drink plenty of fluids every day – aim for two litres (average 6-8cups). Not drinking enough water will make the urine more acidic therefore causing more irritation.
- Maintain a healthy weight and eat a balanced diet. Your diet should be rich in non-processed foods and fibre as this will help avoid constipation. Constipation can put pressure on the bladder and make urinary problems worse.
- Exercise regularly to maintain a healthy weight and this will also help with bowel function.
- Nicola Bolger is a Chartered Physiotherapist based in Carlow with her own private practice specialising in Men’s and Women’s Pelvic Health and Pelvic Floor rehabilitation – Active Life Physiotherapy activelifephysiotherapy.ie
- Chartered Physiotherapists specializing in Pelvic Floor rehabilitation can be found on the Irish Society of Chartered Physiotherapy Website – iscp.ie
- The Irish Cancer Society website cancer.ie has lots of information and resources
- Local Cancer Support Services may know of specialist Chartered Physiotherapists in your area