Following radical prostatectomy, most men experience several side effects. The most common complaints men have after prostate surgery are incontinence and erectile dysfunction. While it can be scary wondering if you will ever get better, with the right
treatment, you can.
So why do you get incontinence and erectile dysfunction after surgery? When the prostate is removed, your surgeon will need to remove part of the urethra (the tube that carries urine out of the body). Where the bladder meets the urethra is a small sphincter of muscle that is normally closed to prevent urine flowing out. This happens automatically without you even thinking. However during surgery this can often be damaged or irritated and therefore doesn’t work as well as it used to. This means that you are more reliant on the muscles you can actively control, a group commonly known as your pelvic floor. Using specific techniques we can teach you how to activate your pelvic floor more efficiently to control your bladder and gradually retrain your automatic continence system.
The cavernous nerves that help control an erection pass around the prostate. When the the prostate is removed, these nerves can also be damaged or in some cases removed. As as long as there is one functioning nerve remaining, the erectile function will return.
Erectile function is often a little slower to return than continence due to the fact that nerves just recover slower than muscle tissue. You will often be initially given some medication to help with this. If the medication fails to improve things then there are other short term options such as a pump or injections. Do realise these are all short term options. Normal function will return however this can take up to 18 months.
When should I first see the physiotherapist?
This is always dependent on each man’s individual circumstances. However as a rough guideline, first seeing the physiotherapist 2-4 weeks prior to surgery is a good idea. This will allow you to identify how to activate the three main muscles involved in continence, and develop some muscle control and strength prior to surgery. The trauma of surgery often tends to inhibit activation of one or more of these muscles. If you have no concept of how to activate these muscles prior to surgery, it can be much more difficult to get them working again afterwards. If you cannot come in prior to surgery, most men still do fine. It will likely just be more difficult to isolate the specific continence muscles, and also take a little longer to fully recover.
Physiotherapy helps to regain pelvic floor control to stop incontinence, and improve physical recovery to help you return to optimal function, as soon as possible.