Transcription:
Pelvic Floor Physical Therapy for Post Prostatectomy Patients

Melanie Cole (Host): If you’ve had your prostate removed and you experience urinary leakage, you are not alone and there are things that you can do to help your situation. My guest today is Anne Ellis. She’s a physical therapist at Palmdale Regional Medical Center. Anne I’m so glad to have you with us as this is something that so many men that develop prostate cancer experience. What happens when a man has treatment for prostate cancer and what are some of those side effects that we’re going to be discussing today?

Anne Ellis (Guest): Well first of all, hello Melanie I’m glad to join you, and some of the – what happens with men who have had a prostatectomy is they can have urinary incontinence, which means that they leak urine, and another issue that they may have is erectile dysfunction after the surgery as well. So some of – like I said those are some of the side effects and that’s something that I help out with is those two main issues. There are other things that can occur after a prostatectomy but those are things that they would be referred back to their surgeon for, and those are things that I would monitor for but not necessarily treat. So those things could be a hernia or a blood clot, but other than that, I treat for urinary incontinence and erectile dysfunction.

Host: So then tell us a little bit about pelvic floor physical therapy. We typically think of it for women. You know women have heard about Kegel exercises for ever so long. Tell us about men and pelvic floor physical therapy. How do men even find their pelvic floor muscles and what can you do for them?

Anne: Okay so pelvic floor physical therapy is much like regular physical therapy in that we try to get people back to as normal of a functioning level as possible, but us pelvic floor physical therapists, we’re more concerned with issues in the pelvis like urinary or fecal incontinence, constipation, chronic pelvic pain, pain with intercourse, and some pelvic floor physical therapists, myself included, will work with prenatal and postpartum issue like diaphysis recti, clogged milk ducts, obviously this would be for women, pain, like pain – like back pain, shoulder pain, or any other pain as it pertains to pregnancy or caring for your new baby, and then men and women as well, they can find their pelvic floor muscles a lot with visualization. You can look at your biceps muscle and you can contract it and you can see that it’s contracting. The thing with pelvic floor is that you can’t ever see it contract usually, so what we do is we use visualization, and with men thinking of shortening the penis, pulling up the testicles, image walking into a cold lake, those are all things that can help them get to their pelvic floor muscles, or another thing is holding back urine or gas.

Host: Are men comfortable getting this type of treatment? I mean we know, Anne, that men are not necessarily comfortable getting any type of doctor treatment. You know it’s hard to get them to go to a urologist or even their primary care provider, and so when you are offering this type of treatment, are they receptive or is it usually their partners that shove them into getting this?

Anne: That’s a good question, and a lot of the times it’s – I have great surgeons that I work with and they refer their patients over to me, and I think they do a good job at explaining to them why pelvic floor physical therapy is so important, and most of the men are comfortable enough. They have gone through so many issues and they’ve had surgery to remove the prostate, so they’ve gone through a lot of discomfort before they get to me, so usually by the time they get to me they’ll say well you know let’s do what we have to do because I don’t like having to wear adult diapers or my erectile dysfunction is something that they don’t want to deal with so they do what they need to do to get things done, but there are a few men who are not comfortable, and I’ve had patients who come in for the initial evaluation, they find out what’s involved, and then they say well you know not for me, but that’s rare. Most of the men stay and they do well during physical therapy.

Host: So when is the time to start this? If they know they’re going to have a prostatectomy, does that type of therapy instituted prior to the surgery, can that help in earlier achievement of help for urinary incontinence and erectile dysfunction?

Anne: Yeah so there were some studies that were done that showed significant improvement if the patient started physical therapy prior to a prostatectomy surgery and that idea is called pre-habilitation, so it’s basically going in for rehab before you go to have any kind of surgery, and they use that in ortho like with a knee replacement, a hip replacement, the same type of deal applies to physical therapy for the pelvic floor as well with the post prostatectomy. So it’s not common though, most of the patients that I see they come in after surgery, and it depends on the surgeon, but some of them have them come in two weeks after surgery, some four weeks after surgery, so it just depends on your surgeon and what they want for the patient, but as I said before there are some studies out there that say that there is significant improvement if the patient starts before surgery.

Host: So tell us what the training is like, what is a therapy session like? What can a man expect when he comes to see you that you will do with him?

Anne: Okay, so first day I like to see that he can do a Kegel or a pelvic floor muscle contraction correctly, and the best way to do that is to use an internal assessment, and it’s basically a digital assessment of the pelvic floor muscles, so I would go in through the rectum and check to see – they would do a Kegel and just make sure that they are doing it correctly, and once I know that they can do that correctly, then I will have them do exercises, not only Kegel exercises, but exercises that strengthen the muscles – the surrounding muscles of the hips. There were some studies that were done that showed that if a patient worked on not only Kegel exercises, Kegel exercises with functional movement, like picking up something from the floor or before they shovel something or getting – do a Kegel before you step up to a high step, all of those things will help with getting back to a continent level, and then the other thing is to work on muscles that surround the hip as well because all the muscles they work in tandem and they help each other, balance each other out, so I would do a little bit of all of those things. Now if a patient is not comfortable with an internal examination, then I would just explain to them how to do a Kegel, and hopefully they’re doing it correctly. What they can do or what I could do is check out the perineum while they do a Kegel, and that would be the area in between the anus and the testicles, and when somebody does a Kegel, that area should lift up closer towards the patient’s head. So if they do that, most likely they’re doing a Kegel correctly.

Host: Wow that’s cool how you can determine if they’re doing it correctly. So if they’re doing it that way with you, what’s to say they’re doing it that way at home when they’re practicing? Are there exercises you give them at home, things that you want them to do, and you mentioned flow and stopping and starting, those kinds of things they can actually see and know that they’re doing correctly. What would you like them to do at home?

Anne: So typically at home I will have them do Kegels and I will have them do two different types of Kegels. One is a quick Kegel where you just squeeze the pelvic floor muscles for about a second and then you relax the muscles completely in between and they’ll do 10 of those lying down with their knees bent, feet on the floor or whatever surface they’re lying on, sitting and standing. So they’ll do 10 in each position. So that’s 30 quick Kegels, and then they’ll do 10 endurance Kegels, and those are holding the pelvic floor muscles while you’re breathing, and it’s important to breathe and don’t hold your breath. You’ll do that for up to 20 seconds. Now a lot of the times patients will come in and they can hold for, I don’t know, somewhere around 3 to 6 seconds to start, and then eventually once they can do the 3 to 6 seconds while breathing and that feels comfortable, then they can start adding seconds after that up until they get to 20 seconds. Then they’ll do those endurance Kegels in those same three positions so lying down with their knees bent, feet on whatever surface they’re lying on, sitting and standing. So those are Kegels and then there’s something else that I have them do called a pelvic brace, and that’s where they hold their Kegel muscles and their abdominal muscles, and that action is suppose to happen milliseconds before you cough, sneeze, jump, any of those activities. So a lot of the patients who come in to see me have something called stress incontinence, and that happens with the force on the body like what I just said, coughing, sneezing, that type of thing. So if they do this pelvic brace beforehand, it’s like they’re reminding their muscles this is what you’re supposed to do before I do these activities. So it’s like, it’s called a neuromuscular reeducation, just retraining the muscles to do what they’re supposed to do and eventually the patient won’t have to think about those anymore. I will also give exercises that work on the muscles of the hips, and that’s basically what they’ll do at home.

Host: What a great explanation, and you made it so usable. People can take what you just said and they can try those things because you explained them so very clearly. What have you seen as far as outcomes before we wrap up and have you seen that men really have good success with these exercises for erectile dysfunction or for urinary incontinence? What have you seen?

Anne: So thank you first of all for the compliment, and I do see a lot of improvement with my patients and typically I will see them for about 6 months, and at that point, they are up to about 90% improved. Granted they must do their exercises, so their home exercises are very important. You know sometimes we’ll get patients that don’t do them very well and/or don’t do them at all and so they don’t have quite as good of an outcome as patients who are diligent and they do their homework, but like I said, I’ll see them for about 6 months, and I see a lot of improvement with most of my patients. If I don’t see improvement, usually there’s something going on and we’ll get to the bottom of that and send them to their doctor and see if there’s anything else that has been missed or that there’s something else going on. Like sometimes they have a urinary tract infection. Sometimes it’s very easy to know if you have a urinary tract infection and sometimes that UTI is impeding that healing process, so if we get that cleared up then they come back to me and they’re usually better but usually my patients do very well.

Host: That really is amazing. So give us your best advice for men that know that they’re going to have a prostatectomy or have had one about the importance of getting in and getting pelvic floor physical therapy if they are suffering from some of those side effects.

Anne: So I would suggest getting a referral from your surgeon to see a pelvic floor physical therapist. It’s not always common for the surgeons that I work with. As I said, they usually send their patients into see me, but there are some surgeons who maybe don’t know of a pelvic floor physical therapist in your area or they haven’t heard of pelvic floor physical therapy, so that’s the number one advice is just to get into see a pelvic floor physical therapist, and then you had mentioned earlier about the erectile dysfunction. That’s something else that I see improvement with that and men will typically have – can get back to a functional level. It may not always be the level that they were used to before, but they can show improvement with that erectile dysfunction as well, and then going back to my advice, like I said just going in to see a pelvic floor physical therapist and doing your exercises, that’s the biggest thing for those men, and like I said I typically see improvements with my patients. You can get back to a functioning level. It’s possible.

Host: Thank you so much for such great information and it’s really so important for people to hear, and that wraps up another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Head on over to our website at palmdaleregional.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with men you know, share with friends and family on social media so that they can learn with us all and be sure to check out all the other interesting podcasts in our library. Physicians are independent practioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Until next time, I’m Melanie Cole.