Mens Health Physiotherapy

It is not glamorous, no one likes to talk about it…..but it is a HUGE problem.

One in ten men experience urinary incontinence.

It’s not just an old mans problem… the embarrassing after-dribble (also called post-micturition dribble) of urine after emptying the bladder can also be an issue for younger guys too. Nothing worse than leaving a toilet to go into a meeting with urine drops spreading across your groin.

And that’s before we even start to talk about prostate cancer!...

The most common form of cancer in men by a country mile. The good news for us fellows is that early detection with a simple blood test (to check the PSA levels in the blood stream) can lead to a complete cure for many guys. But the cure involves removal of the cancerous prostate…and along with that a small piece of our plumbing which leaves a guy incontinent.

Some guys recover, become dry….for those that remain wet, a life in nappies awaits.

But wait there’s more good news, the operation to remove the cancer can damage the tiny nerve bundles around the prostate, and leave you impotent too! (I’m being sarcastic now!)

So although you end up being cancer free…you could be incontinent and impotent for the rest of your life. This happens at 70 years old it’s bad enough, but what of you are 60?, 50?, 45?. Makes you think doesn’t it.

So what can you do about it?

Your pelvic floor is a sheet of muscle stretching from your coccyx to your pubic bone (that bit of bone just above the base of your penis) and between your seat bones (like a trampoline). It’s got 2 holes in it (one for wee to come out and one for your poo to exit) and the holes have sphincters around them to help keep them shut.

If these muscles are strong we can keep the holes shut…if they are weak we are going to struggle to stem the flow, and leak.

Following prostatectomy it is vital that these muscles are as strong as possible. The removal of part of the urethra during the operation means that our automatic (dry) system is compromised and we need to retrain our voluntary muscles to have improved strength and endurance to stay dry into the future.

Your Men’s Health physiotherapist can teach you where these muscles are and will use real time ultrasound scanning to view them so that you can see them and learn how to activate them effectively. They can also work out your strength and endurance capacity and put together an exercise program designed to prepare these muscles for the new job they are about to perform.

These exercises have also been shown to be of benefit in production and maintenance of erections (which is pretty handy thing to know if the prostatectomy has also left you with a degree of erectile dysfunction)
Research has shown that 40% of men who had experienced erectile difficulties for 6 months or more regained normal erections after performing pelvic floor exercises for 3 to 6 months. A further 35% of men improved their erectile function (Dorey et al 2004).

I commonly hear from guys I assess...”I’ve never had a problem before…I’ll be fine after the op” (or some other similar macho bravado statement!!). A very recent study was performed by Clinton et al (2009) which took 8 pre operative guys and showed them a DVD of how to do the exercises, gave them time to practice and then assessed their capacity on real time ultrasound. Out of the 8 guys not one was able to produce an effective contraction. Hearing/reading about how to do the exercises means very little…you have to feel it. Using the real time ultrasound improves the biofeedback to a point where effective teaching can be achieved in a very short period of time. If you are going to put the effort in …make it count.

So knowing how to activate these pelvic floor muscles and then being diligent with exercises designed to improve their strength and endurance has the capacity to turn your life around.

Worth the effort I reckon…

Contact Stuart, the specialist continence physiotherapist at SSOP to discuss and assess your problems and put together a plan for your rehabilitation. It’s embarrassing, yes…but the solution is well worth it.

References:

Dorey G, Speakman M, Feneley R et al. Brit J Gen Prac 2004;54(508):819–825. 5. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction.

Clinton C, Osmotherl P, Chiarelli P Aust and NZ Continence Journal 2009; 15(4):108 Pelvic floor muscle function in men following radiation therapy for prostate cancer: a preliminary exploration using real time ultrasound imaging.