Catheters are the worst. It’s out. And now you have incontinence.
The post-operative prostatectomy appointments are interesting from a physical therapist’s perspective. We get to witness an evolution. Patients go from fearful to angry to frustrated to hopeful to grateful. This is the first time we see the patient after surgery and the majority of patients are now cancer-free. While that is a relief, they are not truly relieved because they are dealing with urinary incontinence. This can be extensive leakage or just moderate leakage from time to time. Results vary based on several things: what needed to be done in surgery, the length of a specific portion of the urethra, whether or not the patient got pre-operative physical therapy and whether or not the patient adhered to the pre-operative physical therapy recommendations.
Many patients cannot remember what they were told in the pre-operative physical therapy appointment. Pre-surgery is a stressful time. You get the diagnosis of cancer and you dive into a world of questions and search for answers. You are ushered through several appointments posthaste and now have to absorb all of this before your surgery date. Sometimes you cannot hear what people are saying, as much as you try – the fear is too great. The stress, the fear, the anxiety can take over. In these cases we review some information. Others have posted all of their pre-operative information on their refrigerator and reflect on it daily. Meditatively. (In a meditative manner.)
After your prostatectomy…what to expect
At the post-operative appointment, guys want to know how long the indignity of urinary leakage will last. In general, most of my patients say that by three months post-operatively the urinary leakage has improved 90% since the removal of the catheter. This requires that you do your exercises…the kegels…the exercise men didn’t know that they could do.
In the first physical therapy appointment after your prostatectomy, I will ask about what sort of protection patients are using. This gives me a baseline to compare improvement to. I want to know how much protection patients are using in 24 hours and I can compare that picture to what patients say in future appointments. It’s true that I’m not getting a quantitative picture of the true volume of daily leakage, but that would require patients measuring their incontinence on a scale. Isn’t the leakage bad enough, already? I don’t want to make you weigh your leakage unless we really need to parse things out and get super specific.
I’m going to ask about what you are eating and drinking to see if this is contributing to your leakage. The food and drink that you consume can affect the volume of your leakage, but the food and drink you are consuming will not damage you. I always explain that this is a quality of life issue. You will not die from urinary leakage. So, enjoy life. But, know that you have some control in the leakage. If you want to socialize and not worry about leakage, we go over the food and drink that will help you avoid leaking more. But, if you want to socialize and enjoy the food and drink that is available to you, you learn that you will need to bring super protection. Maybe you need a Depends undergarment with a pad in it. I once knew a physical therapist that would not work with men after surgery if they did not strictly adhere to her dietary advice in regards to leakage. I’m a bit much, but that right there is a bit too much, don’t you think?
At this first physical therapy appointment after your prostatectomy, I’m going to ask to look at your anus, again. Yup, I am. I’m looking to make sure your skin is intact. I’m looking for irritation. I’m looking to see if I need to make any recommendations to change your padding more often or protect your skin with a cream or both. I’m also looking at the anus to determine if you are still performing kegels the right way. I cannot do an internal exam through the rectum until you are at least six weeks out of surgery, so until then a visual exam has to suffice.
If you are still doing a kegel correctly, then we can advise you on whether you should continue the same kegels you were issued before your appointment or if you need to be doing a harder home program. From that appointment on, we become your pelvic floor athletic trainer. You are expected to do your kegel home program every day exactly as we recommend. This means that we want you to respect the hold times, the rest times and the repetitions that we request of you. Every program is tailored specifically for you. If you have buddies going through physical therapy for prostate removal, you cannot compare your home program to theirs. Once we get you going on a kegel home program, we start seeing you less and less. We may see you two weeks after this first post-operative appointment, then we might ask you to return somewhere between every 2-6 weeks, depending on your specific situation.
Once you are at least six weeks out of surgery, we will then start discussing what we call “penile rehabilitation”. Think of lifting weights with your penis. Did you do it? Is that thought completed? Ok, good. Cuz that’s not what this is. Penile rehabilitation is when we start talking about things you can do to improve the blood flow to the penis, improve your ability to get erections in the future and optimize the environment for improved penile length. We discuss a recommended frequency for self-stimulation (otherwise known as masturbation) and the expectations while masturbating. We discuss ways to improve the blood flow to the penis to improve health, function and urinary leakage. The reality of erections after surgery is that many, many men have to use a device and/or pills and/or injections for some time or for a long time or permanently. The other reality is that it can take up to a few years to see your erections at their full potential. Pun intended? You’ll never know.
Q: What if you had a prostatectomy one year ago? Or five years ago? Or 20 years ago? Will post-physical therapy help you?
A: Most likely.
Now there are some cases where you improve your continence with pelvic floor physical therapy, but you cannot eliminate it. In these cases, we go over procedures that could help you. If you decide that you are not satisfied with what the remaining urinary incontinence, we advise you talk to your physician about these procedures. Additionally, if you are overweight, we then ask you to really try to lose weight. This will reduce pressure on your bladder and can make a dramatic difference.
Got a question? Cool. Hate what I wrote? Cool.
After your prostatectomy – This blog was written by Sara Sauder, PT, DPT
Contact me at email@example.com
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