What causes incontinence after radical prostatectomy?
Before I answer that question, let's just take a moment and acknowledge that you're alive! I know that leaking urine after radical prostatectomy or prostate surgery is that last thing you were hoping for, but it is a relatively small side effect of this surgery. And one that can be easily treated (more on that below).
After surgery, your prostate is gone. This leaves a sizable space in your groin or lower abdomen (see Pelvic Floor Anatomy). Your descending colon, and prostate sat behind the urethra and they helped stop the flow of urine from the bladder through the urethra. Now that your prostate is gone, you no longer have the support you need to stop the flow of urine.
Incontinence after radical prostatectomy does not mean your surgeon did anything wrong.* In fact it likely means they did what they were supposed to as the vast majority of men will be incontinent after radical prostatectomy.
What happens with Incontinence after Radical Prostatectomy?
Without a prostate to support your urethra and bladder, your pelvic floor muscles have to compensate. They need to get strong enough so that you can make up for some of the lost support that occurs after the radical prostatectomy. In order to gain strength in your pelvic floor, you need to do your pelvic floor muscle contractions or “Kegels.”
Just like a bodybuilder is going to go do exercises for the whole body so that they have a good tone, that's what you're doing for your pelvic floor. You are bulking up your pelvic floor to give yourself support, so that you stop leaking.
Pelvic Floor Physical Therapy after Radical Prostatectomy
Pelvic floor physical therapy is extremely effective at reducing incontinence after radical prostatectomy. With pelvic floor physical therapy most patients have regained continence within 3 months, without pelvic floor PT incontinence after radical prostatectomy usually takes about 12 months to resolve. Why would you wait a year when you could stop urine leaks in only 3 months with pelvic floor physical therapy?
You might think you can just do some Kegels with the handout your doctor gave you. The problem with that is most people do not know how to do a proper Kegel. This makes perfect sense; you cannot just see a Kegel being done, and your urologist does not have time in the clinic to make sure you are performing them correctly. With men, I use biofeedback to make sure that there is a nice strong pelvic floor muscle contraction. This ensures that you know what they should feel like and how to get the most from your exercise.
Not all pelvic floor physical therapists are comfortable or trained to work with men after radical prostatectomy. You need to make sure you have a pelvic floor physical therapist with experience treating male pelvic floor dysfunction.
Basic Men's Kegel Exercise Routine for Incontinence after Radical Prostatectomy
In order to get the most from your kegels, you need to do 3 sets, 3 times a day. Just like lifting weights to gain strength for any other muscle group, you cannot expect to do these sometimes or every once in a while and get the outcomes you want. It can take up to 8 weeks to notice the effects of consistent exercise on muscle growth (i.e., hypertrophy), and your pelvic floor muscles are no different, especially when they need to grow to fill a void.
3 Sets, 3 Times a Day
- 10 Kegels - Contract your pelvic floor muscles and hold for 10 seconds, then relax your pelvic floor muscles back to their resting position
- 10 Quick Flicks - Complete these are your 10 kegels for optimal effect. Contract and relax your pelvic floor muscles 10 times in just 10 seconds, each one should last no longer than 1 second
-FYZICAL Therapy & Balance Centers of Oklahoma City
FYZICAL Therapy & Balance Centers of Oklahoma City provides pelvic floor physical therapy in Lakeside, The Village, Nichols Hills and surrounding NW Oklahoma City. Our pelvic floor physical therapists are specially trained to treat all types of pelvic floor dysfunction including incontinence after radical prostatectomy in men. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.
*Surgery does come with risks, occasionally a nerve may be nicked or cut, this may require additional support from your urologist.