Do you have a burning question that you can’t ask your friends and shouldn’t ask Dr. Google? Then ask Evolve! Email questions to alex@evolveptroc.com with the subject “Ask Evolve”. All questions are completely confidential!
“Dear Evolve, I am scheduled to have my prostate removed in a few weeks and my doctor mentioned that I should expect to leak urine after the surgery. My wife has had a history of urine leakage and does “pelvic floor” exercises to help. She told me I should try them, but I didn’t even know that men had a pelvic floor, let alone how to exercise those muscles! Is this something that could help stop me from needing diapers? – Prostate-less and Peeing”
Dear Prostate-less,
It is true that when it comes to discussions about pelvic floor health, the general focus tends to be on women. However, EVERYONE has a pelvic floor, and issues there can affect men as well. The pelvic muscles play a crucial role in supporting bladder, bowel, and sexual function in both men and women. Therefore, thank you for your question, which allows me to shed light on pelvic floor health for men and address common issues they may face.
The pelvic floor consists of a group of muscles and tissues that form a sling-like structure at the base of the pelvis. These muscles support the pelvic organs, including the bladder, rectum, and prostate gland in men. Pelvic floor dysfunction in men can manifest in various ways, often leading to discomfort, urinary or fecal incontinence, constipation, sexual dysfunction, and / or pelvic pain. When talking about prostate surgery and prostatectomy surgery specifically, the removal of the prostate can lead to urinary incontinence and erectile dysfunction. These outcomes are due to removal or disruption of the internal urinary sphincter, impact to the bladder neck, changes to the length of the urethra, and possible injury to the nerves that affect the bladder, pelvic floor, and vascular response within the penis.
Despite the anatomical impacts of this surgery, addressing the pelvic floor, as well as body mechanics, breathing mechanics, and bladder habits, can have a marked impact on improved function. Take home message – you DO NOT have to accept a life in diapers. The exercises your wife is talking about, “pelvic floor exercises” are commonly known as Kegels. These exercises, when done correctly, create strength and endurance of the pelvic floor, improving their function and helping to alleviate symptoms both of incontinence and erectile dysfunction after surgery. Other interventions that may be helpful following a prostatectomy include biofeedback (a technique using manual or visual feedback, often via an ultrasound or electrical sensors to help “see” that you are doing the exercise correctly), behavior therapy (such as bladder training, dietary modification, or lifestyle changes), medications or other surgeries. While your physician will need to supply those last two, physical therapy can be extremely helpful and impactful for those first three interventions.
If you experience any symptoms of pelvic floor dysfunction, or especially if you are anticipating surgery that will impact your prostate, please do not hesitate to seek out a pelvic physical therapist. Prior to your surgery the physical therapist can make sure you are doing your pelvic strengthening, breathing, and functional body mechanics (getting out of bed!) as well as you possibly can. Following surgery, the PT can help facilitate healing, strengthening, and maximizing progress to allow you to return to your best health, manage your symptoms and improve your quality of life.
One last note: your physical therapist may mention “penis clamps” as part of the treatment for post-prostatectomy leakage. They are not as scary as they sound and can be really helpful. Hear them out, but don’t do too deep a google search!
I hope you found this helpful and thanks for a great question!
-Dr. Alex Wilkes PT, DPT, PRPC, OCS
Dr. Alex Wilkes PT, DPT, PRPC, OCS is a pelvic health physical therapist at Evolve Physical Therapy of Rochester. She has over 13 years of clinical experience with specialty certifications in both pelvic health and orthopedics.
