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Mens Health – pelvic floor retraining & penile rehabilitation

Man-Health

 

Following prostate cancer surgery the majority of men may lose some or all control over the passing of urine. This is not permanent. This reduction in control is called Incontinence.

What is incontinence?

Men health ProstateIncontinence is the accidental leakage of urine and can occur following prostate cancer surgery. Activities that may contribute to leakage include: coughing, sneezing, laughing, passing wind, lifting, walking or bending, moving from lying to sitting or sitting to standing positions. Leakage can also occur during every day activities that include; gardening, washing the car, mowing the lawn or playing golf or bowls.

All these activities that can contribute to incontinence increase the pressure inside the abdomen and push down on the bladder. Incontinence may result if the pelvic floor muscles and external sphincter are not working well enough to support these increases in downward pressure.

How long will it last?

  • 85-90% of men are continent ( not wearing pads) within 12 months
  • The severity of incontinence can vary from only very mild 1 pad per day ( < 100mls of urine in 24 hours) to more severe >8 pads per day ( >300mls of urine in 24 hours)
  • Mild incontinence can take up to several weeks to improve where as the more severe cases which are far less common can take up to 6 months with ongoing improvements expected up to 18 months or longer.

What can I do about it?

Exercising the muscles of the pelvic floor has helped most men with their bladder training program before after prostate cancer surgery.

What are the pelvic floor muscles?

The floor of the pelvis is made up of layers of muscle and other tissues.  These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front.

A man’s pelvic floor muscles support his bladder and bowel (colon).  The urine tube and the back passage pass through the pelvic floor muscles.  Your pelvic floor muscles help you to control your bladder and bowel.  They also help sexual function.  It is vital to keep your pelvic floor muscles strong.

Why should I do pelvic floor muscle training?

Men of all ages need to have strong pelvic floor muscles.

Pelvic floor muscles can be made weaker by:

  • Surgery for bladder or bowel problems
  • Constipation
  • Being overweight/obese
  • Heavy lifting
  • Coughing that goes on for a long time (such as smoker’s cough, bronchitis or asthma)
  • Not being fit
  • High impact exercise
  • Chronic low back pain

Men with stress incontinence – that is, men who wet themselves when they cough, sneeze or are active – will find pelvic floor muscle training can help in getting over this problem.

Pelvic floor muscle training may also be of use for men who have an urgent need to pass urine more often (called urge incontinence).

Men who have problems with bowel control might find pelvic floor muscle training can help the muscle that closes the back passage.  This muscle is one of the pelvic floor muscles.

 

Where are my pelvic floor muscles?

The first this to do is to find out which muscles you need to train.

1.     Sit or lie down with the muscles of your thighs and buttocks relaxed.  It may be helpful to use a hand mirror to watch your pelvic floor muscles as they pull up. You should be able to see or feel your scrotum rise up and your penis draw in without your stomach muscles moving.

2.     When you go to the toilet to empty your bladder, try to stop the stream of urine, then start it again.  Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.

3.     If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine as talked about in Point 2, or you do not see any lift of your scrotum and penis as talked about in Point 4, ask for help from our practice nurse or physiotherapist.  She will help you to get your pelvic floor muscles working right.  Men with very weak pelvic floor muscles can benefit from pelvic floor muscle training.

4.   The most effective way to ensure correct technique and isolation of your pelvic floor muscles is to seek the opinion of an experienced physiotherapist who will use an ultrasound machine with a monitor so you can visualise your pelvic floor muscle lift and learn to differentiate between correct and incorrect technique. By performing pelvic floor exercises incorrectly it can worsen urinary incontinence.

 

How do I do pelvic floor muscle training?

  • Pelvic floor muscle training needs to be individualised. As with all types of strengthening programmes men will vary in terms of their ability to first isolate the correct muscles then hold the contraction whilst being able to continue to breath.
  • An experienced physiotherapist should conduct a number of tests- i.e a speed test ( how many contractions that can be performed in 10 seconds) followed by an endurance test ( how long a contraction can be held for whilst maintaining normal restful breathing)- once these tests have been conducted the appropriate exercises can then be prescribed.
  • Pelvic floor muscle activation should be incorporated into all different types of positions. For example sitting, standing and lying. In addition to functional tasks such as walking, lifting, bending, pushing and carrying. For example prior to standing up from sitting or whilst pushing a lawn mower.

While doing your pelvic floor muscle training:

  • Keep breathing
  • Only squeeze and lift
  • Do NOT tighten your buttocks or your abdominal muscles
  • Keep your thighs relaxed

 

How do I know my incontinence is improving?

  • using less pads
  • waking up less than 2 times per night and remaining dry
  • being dry in the early part of the day
  • not leaking when you cough, lift or get out of a chair
  • Reduction in your 24 hour pad weights. For example immediately after surgery your total pad weight was 150mls of urine but after 4 weeks your leakage has reduced down to 20mls whilst your activity levels have increased.

Other things you can do to help your pelvic floor muscles are:

  • Share the lifting of heavy loads
  • Eat fruit and vegetables and drink 6 to 8 glasses of water daily
  • Don’t strain when using your bowels
  • Ask your doctor about hay fever, asthma and bronchitis to ease sneezing and coughing
  • Keep your weight within the right range for your height and age

Peyronie’s disease

What is Peyronie’s disease?
Not all curved erections or penile bumps are caused by Peyronie’s disease. It is imperative that all men consult a health care provider to obtain an accurate diagnosis.
Peyronie’s disease is a condition in which a males penis while erect can develop a curve which may or may not be painful. The curve is caused by a non-elastic plaque that develops in the penile tissues. A Peyronie’s plaque is non- cancerous and benign. However the diagnosis needs to be made by a health care professional usually via an ultrasound.

What causes Peyronie’s disease?
The cause is unclear. Some health care professionals believe that trauma to the penis during sexual activity resulting in abnormal scarring may contribute- however this is most definitely not always the case.

Impact of Peyronie’s disease
A diagnosis of Peyronie’s disease can impact men in many ways including; physically, sexually, psychologically, and socially

Can Peyronies disease get worse over time?
The natural history of Peyronie’s disease – 1/3 improve, 1/3 remain stable and 1/3 may deteriorate over 12-18 months. However we at Sans Souci Physiotherapy Centre have seen some complete resolution of symptoms after more than 4 years since symptoms first began

How do you treat Peyronies disease at Sans Souci Physiotherapy Centre?
We use ultrasound therapy and vacuum pump devices in addition to a referral to a men’s health psychologist.

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