Prostate cancer is the most common type of cancer in men over the age 65 but is also found in men in their 40s and 50s. After treatment for prostate cancer, men can experience urinary leaking, sexual dysfunction like erectile dysfunction, and general fatigue and weakness from treatment. Physical therapy plays a key role in improving our patient’s return to activities after prostate cancer treatments.
Treatments for prostate cancer can be surgical removal or radiation of the prostate gland. With either of these treatments, there are changes with urinary, bowel, or sexual function. Because the prostate lays in the area between the bladder and penis and the urethra travels through the gland, it is easy to see how removing or treating that tissue can cause changes. Luckily, many of these symptoms can improve with pelvic floor physical therapy.
When a patient comes in after cancer treatment, the physical therapist will talk to the patient about what kind of treatment they had and what symptoms they are experiencing. Then the pelvic floor physical therapist will do the assessment. This should include how well the patient’s hips and spine are moving. Also looking at how well the abdominal wall and diaphragm are moving and screening for pain. After this, the physical therapist should check the pelvic floor muscles. This is best checked with a rectal pelvic floor assessment. This is done to make sure there isn’t pain where the surgery or radiation occurred and to make sure that the muscles and surrounding tissues are able to move well. With radiation or surgery, scar tissue can form, and we want to make sure that the scars aren’t inhibiting how well the muscles can more. With the rectal assessment, we will also ask the patient to turn on and off the pelvic floor muscles and then elongate like they need to pass gas. This helps the PT to see if the leaking is caused by weakness in the pelvic floor or if coordination of the muscles is just a little delayed. Often, after surgery, the muscles get tight and then the pelvic floor cannot relax and becomes too tight. This can also contribute to leaking.
After this assessment, the PT will collaborate with the patient to come up with an exercise plan for them. This will often include coordination exercises between the abdominal wall and pelvic floor, glut activation, and pelvic floor patterns. Based on the patient’s goals, the exercises will change and advance. This can be basic tasks like standing up without leaking all the way to returning to running.
It is important to include PT in your prostate cancer treatment plan. Our goal is to help you get back to your favorite activities safely and with the best strategies after prostate cancer.