PROSTATE CANCER: THE CASE FOR KEGELS IN MEN

We know that in a clinic that has a focus in pelvic health, men sometimes get lost in the mix. Most of our caseload does consist of women, but we definitely see men as well. Hey, men have pelvises too! 

We want to address how physiotherapy helps men who have undergone a prostatectomy and talk about the importance of men’s pelvic health. For the women reading this: don’t exit yet. You can help play a role in encouraging the men in your life to get checked out if something doesn’t seem right.

First off, a few little facts. 1 in 7 men will be diagnosed with prostate cancer in their lifetime according to Prostate Cancer Canada. Some risk factors for prostate cancer include:

· being over the age of 50

· being overweight

· having a family history of prostate cancer

· poor diet

Some common signs and symptoms for prostate cancer include: difficulty/inability urinating, urgency with urination, having to urinate very frequently, burning or painful urination, pain with ejaculation and blood in the urine or semen. These symptoms may not show up in early stages but as with most diseases, early detection is always better.

There are many treatment options available to those diagnosed with prostate cancer, however usually what ends up in my door are those who underwent surgery. One of the most common surgeries that we see is those who underwent a radical prostatectomy. 

A Radical Prostatectomy is a surgery that completely removes the prostate gland as well as the seminal vesicles and part of the urethra. This can be done laparoscopically or through an open surgery. If you have an open surgery, the incision is made below the belly button to the pubic bone, which ends up being about 6-9cm long.

The reasons that these patients come through our door is typically due to urinary incontinence and erectile dysfunction. Incontinence is quite common after this surgery and is generally temporary, but there will still be a portion of men who will continue to have stress incontinence. They may lose urine during a cough, sneeze or during certain movements.

So how can physiotherapy help? 

During the surgery, often the sphincters to help you maintain continence are damaged and for that reason you leak urine. This is why now the pelvic floor muscles are so important, they have to make up for that lack of sphincteric control! Physiotherapy helps to strengthen the surrounding pelvic floor muscles to help you maintain continence. A physiotherapist that is trained in the pelvic floor, will guide you through progressions of your exercises to help those muscles regain strength.

There is also some evidence to suggest that pre-hab or doing pelvic floor muscle strengthening before surgery may be valuable to assist with recovery post-surgery.

In a study done in 2005, researchers found that physiotherapy was able to help men regain full continence or great improvements (use of only 1 pad per day) in 96% of patients in 6 months and 98.7% in 1 year post surgery ¹. 

MEN CAN KEGEL? 

 Yes, men can also do pelvic floor muscle contractions or “Kegels”. Similar to women, we can use cues like “hold back pee or hold back gas”. One cue that we find helps is “shorten your penis, or bring the penis into the body”. The cool thing about men, is that when they do a pelvic floor muscle contraction you will actually see the penis shorten slightly and the scrotum will also lift. If you have a mirror you can also see the anus draw up and in. However, just like in women, if you were to do a pelvic floor muscle contraction with clothing on, no one should be able to tell if you are doing a contraction. You shouldn’t hold your breath, bear down with your abs or squeeze the glutes.

What else can Physio do?

Not only will we specifically look at the pelvic floor muscles and their ability to contract, we can also help you with function in your day to day life. Many times men will leak with a change in position (sit to stand), or maybe they will do certain movements that without fail, will leak every time. Physiotherapists will help identify those movements and impairments and work with you to change your movement strategies. We will help you coordinate your breath, pelvic floor muscle contraction and movement so the sequencing is optimal for your pelvic floor.

Sometimes the buy into these strategies takes a few visits but we always say to my patients “who cares if your strength is really poor or really good, if you still pee every time you get up from a chair?” We need to look at how your whole body reacts to the change in position to ensure the least amount of strain is put through the pelvic floor.

Often times, a small change in strategy goes a long way, and these changes can be made easily and often with a big pay off (not peeing every time you do the movement).

We will also pay attention to the scars from the surgery to make sure they are healing properly and so that the movement of the tissue is optimized.

Physiotherapists are also trained to guide you in cardiovascular fitness post-surgery. A big complaint that we hear is patients come out feeling lethargic and deconditioned after surgery. One way to combat the exhaustion, is to add cardiovascular exercise into the mix. This should be done under the direction of a physiotherapist or a trained health care professional. There can be a fine line of too much exercise during recovery. We can also assist you in other strengthening exercises that would be helpful for you and your body.

Overall, our goal is to try and get. you back to the things you love doing and keep you healthy!