How Pelvic Floor Therapy Supports Recovery Before and After Prostatectomy
Introduction
Prostatectomy, the surgical removal of the prostate gland, is a common treatment for prostate cancer and other prostate-related conditions. While this procedure can be life-saving, it often results in side effects such as urinary incontinence and erectile dysfunction due to the impact on pelvic floor muscles and nerve function.
Pelvic floor physical therapy (PFPT) plays a crucial role in both preparing for and recovering from prostatectomy. By strengthening and retraining the pelvic floor muscles, men can improve urinary control, enhance sexual function, and accelerate their recovery process. This blog will explore how pelvic floor therapy can help before and after prostatectomy and why it should be an essential part of the healing journey.
Anatomy of the Pelvic Floor and How Prostatectomy Affects It
The pelvic floor is a group of muscles, ligaments, and connective tissues that support the bladder, rectum, and reproductive organs. Key structures affected by prostatectomy include:
1. The Urethral Sphincter and Its Role in Urinary Control
The urethral sphincter is a critical muscle that controls the release of urine. It consists of:
Internal Urethral Sphincter – A smooth muscle controlled involuntarily by the autonomic nervous system, located at the bladder neck.
External Urethral Sphincter – A skeletal muscle that can be voluntarily contracted to stop urine flow, located just below the prostate.
During a prostatectomy, the internal urethral sphincter is often damaged or removed because it is closely connected to the prostate. This leaves the external urethral sphincter as the sole muscle responsible for urinary control, making its function even more crucial after surgery.
2. The Pelvic Floor Muscles and Their Role in Recovery
Key muscles that assist in bladder and sexual function include:
Pubococcygeus and Iliococcygeus (part of the Levator Ani) – Support bladder and urethra, helping maintain continence.
Bulbospongiosus and Ischiocavernosus – Important for erectile function and ejaculation.
Transverse Perineal Muscles – Assist in urethral control and pelvic stability.
When the prostate is removed, these muscles must compensate for the lost structural support and increased strain on the external urethral sphincter. If these muscles are weak or uncoordinated, urinary leakage and erectile dysfunction can persist longer after surgery.
Before Prostatectomy: How Pelvic Floor Therapy Helps Prepare for Surgery
Many men wait until after surgery to begin pelvic floor therapy, but research shows that starting before the procedure can lead to better outcomes. A strong, well-coordinated pelvic floor before surgery can reduce the severity of post-surgical side effects and shorten recovery time.
Pre-Surgery Goals of Pelvic Floor Therapy:
Assessing Pelvic Floor Function
A pelvic floor physical therapist will evaluate your muscle strength, endurance, and coordination.
They will identify any muscle imbalances or areas of dysfunction that may contribute to post-surgical complications.
Strengthening the External Urethral Sphincter
Since the internal sphincter is often removed, therapy focuses on strengthening the external sphincter and surrounding muscles.
Targeted pelvic floor exercises, such as Kegels, help improve muscle tone and control.
Learning Proper Muscle Activation
Many men unknowingly contract the wrong muscles when trying to engage their pelvic floor.
A therapist will teach proper isolation of the external sphincter and surrounding pelvic floor muscles to optimize control.
Understanding Post-Surgical Expectations
Pre-surgical therapy includes education on what to expect after the procedure, such as managing catheter use and preventing muscle atrophy.
Having this knowledge reduces anxiety and prepares you for a smoother recovery.
After Prostatectomy: How Pelvic Floor Therapy Aids Recovery
Once the surgery is complete, the primary focus shifts to rehabilitation and regaining function. Pelvic floor therapy is vital in restoring continence, improving pelvic muscle coordination, and supporting erectile function.
Early Post-Surgical Phase (Weeks 1–6)
Gentle Pelvic Floor Activation:
Initially, therapy focuses on light contractions and relaxation exercises to stimulate healing without straining the area.
Bladder Control Strategies:
Your therapist will guide you through timed voiding techniques and urge suppression strategies to minimize leakage.
Breathwork and Core Engagement:
Learning to coordinate the diaphragm and pelvic floor reduces strain on healing tissues.
Intermediate Recovery Phase (Weeks 6–12)
Progressive Strengthening:
More structured pelvic floor muscle exercises improve endurance and coordination.
Biofeedback Training:
Some therapists use biofeedback devices to help visualize muscle activity and optimize contractions.
Functional Training:
Exercises are integrated into daily activities to improve bladder control in real-life situations.
Long-Term Rehabilitation (3–12 Months Post-Surgery and Beyond)
Erectile Function Recovery:
Pelvic floor therapy helps restore nerve function and blood flow, improving erectile quality.
Managing Pelvic Pain or Tension:
Some men develop tension in surrounding muscles due to compensatory patterns. Therapy can address this and promote relaxation.
Maintaining Pelvic Health for Life:
Long-term strengthening and coordination exercises help sustain continence and sexual function.
Benefits of Pelvic Floor Therapy Post-Prostatectomy
1. Improved Urinary Continence
Studies show that men who engage in pelvic floor therapy regain bladder control faster than those who do not.
Strengthening the external urethral sphincter provides better support for the bladder and urethra, reducing incontinence episodes.
2. Enhanced Sexual Function
The pelvic floor muscles play a role in erectile function and ejaculation.
Targeted therapy improves blood flow and neuromuscular coordination, helping to restore erections over time.
3. Faster Recovery and Better Quality of Life
Engaging in therapy before and after surgery leads to a smoother recovery and a higher likelihood of regaining normal function sooner.
Conclusion
Pelvic floor therapy is a powerful tool for men undergoing prostatectomy. By strengthening these muscles before surgery, patients set themselves up for a smoother recovery. After surgery, pelvic floor therapy helps regain bladder control, restore sexual function, and improve overall pelvic health.
If you or a loved one is preparing for or recovering from a prostatectomy, consider consulting a pelvic floor physical therapist to optimize your healing process.
Call to Action
Are you preparing for prostate surgery or struggling with recovery? A pelvic floor therapist can provide the guidance and exercises you need for a smoother, more effective healing journey. Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.