Pelvic Floor Physical Therapy for Incontinence Following Radical Protatectomy
Early Conservative Treatment with PT to Improve Quality of Life - A Flyer Isn't Enough
Quality of Life post-prostatectomy is severely impacted by urinary incontinence. The financial costs of having to use incontinence pads, likely do not compare to the social costs that come with being incontinent including embarrassment, social isolation, and worker productivity due to condition management.
Conservative care for regaining continence consists of Pelvic Floor Physical Therapy. Marchiori and colleagues compared two groups of men beginning 40 days after radical prostatectomy. Patients were sent to a physical therapist with expertise who could guide them through proper pelvic floor contractions, and muscle and breathing co-coordination (Group A - Treatment). Alternatively, patients can be taught, briefly, to conduct pelvic floor muscle exercises in a home program (Group B - Control).
Immediately after surgery both groups were taught to perform pelvic floor muscle exercises at home. At 40 days post-prostatectomy, the treatment group began receiving daily Pelvic Floor Physical Therapy (for up to 3 weeks), whereas the control group continued to complete their home exercise program without feedback.
The treatment group on average regained continence only 4 days after starting Pelvic Floor Physical Therapy, with all 166 men regaining continence by the 6-month assessment. The control group took on average an additional month (76 days total) before regaining continence, with all men not regaining continence until the 12-month assessment.
The authors issued a note of caution for patients with concurrent low back pain and pelvic floor weakness. Because the majority of their sample presented with both pelvic tenderness and weakness, the authors note that weakness from overactivity (i.e., higher resting tone) is different than frank weakness. When conventional PTs assume an underlying weakness and emphasize strengthening, they may actually be making the pelvic floor symptoms worse.
“...continence recovery can be achieved sooner with dedicated re-educational physical therapy.” p. 556
Submitted by Dr. Lauren Collier Peterson, PT, DPT
Clinical Director FYZICAL Therapy & Balance Centers of Oklahoma City
Dr. Peterson and her staff provide Physical Therapy for patients with pelvic floor dysfunction, imbalance and falls risk, & orthopedic injuries in OKC.
She has treated hundreds of men and women with pelvic floor issues ranging from incontinence and constipation to pain and prolapse. While she has a particular clinical interest in pelvic pain disorders, she wants everyone to enjoy good pelvic health and to know that “Leaks are not normal!”
Marchiori, D., Bertaccini, A., Manferrari, F., Ferri, C., & Matorana, G. (2010). Pelvic floor rehabilitation for continence after radical prostatectomy: Role of a personal training re-education program. Anticancer Research, 30, 553-556.