Prostate Health: Prehab or Rehab for a Prostate Surgery

With 1 in 9 men diagnosed with prostate cancer during their lifetime, incontinence and/or erectile dysfunction are common side effects following a prostatectomy or a surgical removal of the prostate.

Depending on your individual case, there are several surgical techniques to remove the prostate, the goal being to remove as much cancerous tissue as possible for the best outcome. No matter the surgical technique or treatment, options are hard to understand and find.

 Pelvic floor physical therapy can address 2 of the most common side effects:

RE-HAB FOR PROSTATECTOMY 

Loss of Bladder control (Incontinence)

The prostate is located below the bladder and surrounds the urethra; both of these anatomical structures provide support in urinary control. Because this surgery removes the prostate, the bladder and urethra lose this support and this loss can cause incontinence. This is extremely common and can resolve after a prostatectomy; however, it can take anywhere from 2 months to 2 years. Physical therapy or prostatectomy rehab can include strengthening, coordination training, and building endurance of the muscles of the pelvic floor. These are ‘sling-like’ muscles that are below where the prostate used to be and can be strengthened to provide the support that was lost during the surgery. Rehabilitation of this muscle group can lift the pelvic floor position, and assist in bladder control to reduce or eliminate incontinence.

Erectile dysfunction

Erectile dysfunction can be extremely disheartening after this surgery and occurs due to injury to the nerves and tissues that control arousal. Even with nerve-sparing surgical procedures, it is common to have a disruption of these nerves with healing taking up to 2 years after surgery to return to normal. Promoting tissue healing can be directly related to increased muscle strength, improved blood flow and increased perfusion (or ability for blood to get into the tissues). Physical therapy, both rehabilitation after your procedure and prehabilitation before your procedure, are great ways to ensure a maximal amount of blood flow and perfusion to these tissues at all stages of the process.

PRE-HAB FOR PROSTATECTOMY 

Although there is not enough research being performed on the preventative effects of performing ‘prehab’ for this specific surgery, there is an amazing amount of evidence showing better outcomes from surgery of those who performed a ‘prehab’ routine vs. those who did not. Because muscular health and function provide significant control in both common side effects, I recommend to my clients who are scheduled to have a prostatectomy to ask their doctors about visiting a pelvic floor physical therapist specialist before surgery as well as after.

So far so good, just need a rest Your ‘prehab’ visit may include education to start performing core strengthening exercises, pelvic floor strengthening exercises, breathing and stretching techniques to improve overall muscular strength and blood flow for ideal healing and improved support around the penis and bladder. Ideally, you would be performing these exercises about 6 weeks before your scheduled surgery.


If you have questions about how physical therapy, contact us or call (407) 753-2192.

Most insurances cover physical therapy services, and you don’t need a physician’s referral to get started. 

We accept Tricare and Medicare Insurance.

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by: Bri McCormick PT, DPT

Physical Therapist and Pelvic Floor PT

Activcore Orlando

 

References: 

  1. American Cancer Society
  2. Clavel-Hernandez J, Wang, R. The controversy surrounding penile rehabilitation after radical prostatectomy. Translational Andrology and Urology. Vol 6 No. 1, 2017.
  3. Santa, D. Matthew, Andrew, Hilton, W. Au, D. Awasthi R, Shabbir A, Clarke H. Ritvo P. Trachtenberg, J. Fleshner N. Finelli, A. Wijeysundera D. Aprikian A. Tanguay S. Carli F. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surgery :89. 2018