Introduction:
June is Male Pelvic Health awareness month. Hence I thought I would write about some of the most common diagnoses that affect men and I have treated successfully. As a pelvic therapist I am well trained, comfortable and experienced in treating men.
Prostate Cancer
According to CDC prostate cancer is one of the most common types of male cancers and according to the American Cancer Society 1 in 7 men will receive this diagnosis.
The diagnosis is usually made by
- Medical exam -Rectal exam
- Prostate -Specific Antigen (PSA) levels
- Biopsy
- Transrectal Ultrasound ( as deemed appropriate by MD)
Prostate Cancer Treatment Options
Depending on the stage of cancer it can include
- Active Surveillance.
- Chemotherapy
- Radiation – External beam and Seed Implants ( Brachytherapy) https://www.mayoclinic.org/tests-procedures/prostate-brachytherapy/about/pac-20384949
- Surgical Castration
- Cryotherapy https://zerocancer.org/learn/current-patients/types-of-treatment/cryotherapy/
- Radical Prostatectomy
- Laparoscopic Radical Prostatectomy (Robotic) https://youtu.be/j4rQSdcyFDs
- Most of the patient’s I see are men post prostatectomy and with complaints of Urinary incontinence.
General Pelvic PT includes the following.
- For Urge Incontinence (UI) behavioural intervention is utilised .The individual is instructed in contracting the PFM (Pelvic floor muscles) to inhibit bladder contractions and suppress the urgency to urinate (urge control technique).
- The individual is instructed in proper engagement and isolation of the PFM contraction, using verbal and tactile cues and biofeedback is used if appropriate, and the individual is cautioned against using Valsalva maneuver.
- The individual is instructed in using “ the knack” ,which is contracting the PFM prior to coughing sneezing or changing positions such as sit to stand or any physical exertion that increases the intra abdominal pressure.
- Education on Bladder training and lifestyle modification ,for eg avoiding bladder irritants.https://www.hopkinsmedicine.org/johns_hopkins_bayview/_docs/medical_services/gynecology_obstetrics/bladder_irritants.pdf
- Abdominal exercises focusing on Transverse Abdominus because of the role of core strength in PFM .
- Home exercise program of PFM contractions of Quick contractions and slow contractions as deemed appropriate based on the findings during the pelvic therapy evaluation.
A case report of the article in the reference and a article on the blog of Herman Wallace, Physical Therapy Interventions for Male Urinary Incontinence Post Radical Prostatectomy reported an interesting fact .The patient saw an improvement in Urinary incontinence , of frequency and urgency even after attempting Pelvic PT 10 years post Radical Prostatectomy
Conclusion
Pelvic Physical Therapy is effective in improving Urinary Incontinence in men after radical prostatectomy. The patient saw an improvement in Urinary incontinence, of frequency and urgency even after attempting Pelvic PT 10 years post Radical Prostatectomy.
Refences
Physical Therapy Interventions for Male Urinary Incontinence Post Radical Prostatectomy by Rachel Kilgore DPT, COMT,OCS ,Herman and Wallace Blog .
Pelvic Floor Function, Dysfunction and Treatment (2A ) Manual , Herman and Wallace Pelvic Institute
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.