Physical Therapy for Prostate Cancer and Male Urinary Incontinence

Introduction

June is Male Pelvic Health Awareness Month, so it's a good time to write about some of the diagnoses I treat most often in men. As a pelvic physical therapist, I'm trained, comfortable, and experienced in treating male patients.

Prostate Cancer

According to the CDC, prostate cancer is one of the most common types of cancer in men, and according to the American Cancer Society, about 1 in 7 men will receive this diagnosis.

Prostate cancer is usually diagnosed with:

• A medical exam, including a rectal exam
• Prostate-specific antigen (PSA) levels
• Biopsy
• Transrectal ultrasound, as deemed appropriate by the physician

Depending on the stage of the cancer, treatment options can include:

• Active surveillance
• Chemotherapy
• Radiation, including external beam therapy and seed implants (brachytherapy)
• Surgical castration
• Cryotherapy
• Radical prostatectomy
• Laparoscopic (robotic) radical prostatectomy

Most of the patients I see are men following a prostatectomy, with complaints of urinary incontinence.

What Pelvic Physical Therapy Includes

General pelvic PT for men recovering from prostate cancer treatment can include:

• For urge incontinence, behavioral intervention that trains the pelvic floor muscles to inhibit bladder contractions and suppress the urge to urinate
• Instruction in properly engaging and isolating the pelvic floor muscles, using verbal and tactile cues, with biofeedback used when appropriate, while avoiding the Valsalva maneuver
• Instruction in "the knack," contracting the pelvic floor muscles before coughing, sneezing, changing positions, or any activity that increases intra-abdominal pressure
• Education on bladder training and lifestyle modifications, such as avoiding bladder irritants
• Abdominal exercises focused on the transverse abdominis, given the role of core strength in pelvic floor function
• A home exercise program of pelvic floor muscle contractions, both quick and slow holds, based on findings from the pelvic PT evaluation

A case report referenced in a Herman & Wallace blog article, "Physical Therapy Interventions for Male Urinary Incontinence Post Radical Prostatectomy," described a patient who saw improvement in urinary incontinence, frequency, and urgency even after starting pelvic PT ten years after a radical prostatectomy.

Conclusion

Pelvic physical therapy is effective in improving urinary incontinence in men after radical prostatectomy. As the case report above shows, improvement is possible even years after surgery, so it's never too late to ask about pelvic PT.

References

• Kilgore, R., DPT, COMT, OCS. "Physical Therapy Interventions for Male Urinary Incontinence Post Radical Prostatectomy." Herman & Wallace Pelvic Rehabilitation Institute Blog.
• Roscow, A. S., & Borello-France, D. (2016). Treatment of Male Urinary Incontinence Post-Radical Prostatectomy Using Physical Therapy Interventions. Journal of Women's Health Physical Therapy, 40(3), 129-138.
• Herman & Wallace Pelvic Institute. Pelvic Floor Function, Dysfunction and Treatment (2A) Manual.