PSA levels elevated?
Had an MRI?
Had a biopsy?
And you have decided for a Radical Robotic Prostatectomy with your urologist.
These can be overwhelming times however I would like to reassure you there is a pathway in place, a roadmap if you will.
Most likely you will gain your continence back. Most likely you will be able to do most things again like golf. Most likely you will not regret the procedure.
Technology has come a long way and the robotic approach for the removal of prostate cancer has made the delicate procedure much more precise than ever before.
But no matter how precise the procedure has become as with any surgical operation there will always be some degree of tissue trauma. There will be trauma to the nerves and muscles that surround the prostate. As a consequence of this trauma incontinence and erectile dysfunction may become symptoms post-operatively.
Following the operation most (but not all) men will experience some degree of incontinence. You will be faced with the question should I drink more or less? This is a double-edged sword paradox; if you drink more you may leak more but if you drink less the bladder will never fill and stretch. So, what should you do? Well…the bladder is a muscle and we ideally want the bladder muscle to stretch to gradually hold more and more volume. It’s a bit like an arm that has been in a sling for too long, the biceps muscle will shorten and form a “contracture” over time, losing the ability to straighten the elbow. We need to challenge the bladders natural function to be elastic by drinking moderate amounts of water whilst capping activity levels below a threshold where you experience overt incontinence. Store more but do less is a good mantra in the early stages.
You may find information on Pelvic floor muscle or Kegel exercises to prepare for your operation or maybe discovering this after the procedure to strengthen the pelvic floor, however, this is a blanket approach.
Pelvic floor exercises does not mean it is done exclusively lying down! It is a term used for a group of muscles that sit low in the pelvis. These muscles help to control both urinating and defecating (wee and poo).
Consider the pelvic floor (yes, we all have one, not just women) to consist of 3 main muscles. one for the back (anus) and two for the front (urethral/penile). These are internal muscles located deep inside our pelvis which means it is often hard to feel and see it in action. Currently the best method to observe which muscles are working is to utilise real-time ultrasound as a form of biofeedback and visually observe how accurately those muscles are working.
Once you know you can work the muscles accurately, we can target them for training to improve speed, strength and endurance. Like all muscles which have a high proportion of type 1 muscle fibres (slow twitch endurance muscle fibres) tonic muscle development only occurs over time in response to the ongoing stimulus of training. In a marathon runner for example resilience to fatigue often takes >16 weeks of solid training. So don’t expect development without time and training after surgery.
Finally, once you have developed the muscles to an appropriate level you can learn how to use the muscles of the pelvic floor voluntarily to assist you to stay dry when you move, consciously integrating them into activities of daily life.
Will you need to do these exercises consciously forever? Well you will need to practice for a while certainly, but you won’t need to practise forever. We are striving for a level of automaticity. Think about it like this… when you hold a pen, you don’t think of how you grip it anymore, it’s a process that has been repeated so often that although it is a voluntary action (we are choosing to do it) we do it with a level of automation (without thinking about it). This is a result of repeatedly doing the same thing over and over again (practise).
Finally, from an erectile perspective our aim is to guide you through the process of penile rehabilitation, maintaining optimal penile blood flow helps to keep the penis as an organ optimally healthy until the nerves recover from surgery, which in some cases can take upwards of 2 years.
So, to assess your pelvic floor muscle activation patterns and accuracy and to learn how to automate the process, and to get guidance on penile rehabilitation book in with a Men’s Health physio for a real-time ultrasound analysis of your pelvic floor muscles. Through this process, you can learn how to optimally and effectively train the pelvic floor to regain continence and to maintain good continence as you age and let us guide you in penile rehabilitation strategies to give you the best chance possible of return to potency too.