A large majority of our patients include men who have, or are about to undergo a prostatectomy. I thought it would be fitting to educate not only these patients, but the rest of us on the function, and repercussions of removing this vital structure.
First of all… what in the world is the prostate? And what does it do? Well, the prostate is a gland in the male reproductive system found below the bladder and in front of the rectum. The prostate surrounds the urethra, the tube through which urine flows.
This walnut sized gland contributes to the production of seminal fluid. During orgasm, this seminal fluid helps carry sperm out of the man’s body as part of semen. (NCI.org)
Why do men have this gland removed you might ask?…. Primarily due to cancer of the prostate. Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the prostate. Normal cells in the prostate and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. (NCI.org)
According to the National Cancer Institute, there will be 238,590 new cases of prostate cancer in 2013 and ~ 29, 720 deaths in the United States. That is a lot of cancer, and if treated via a prostatectomy, that is a TON of males who may need the help of a skilled pelvic floor physical therapist.
During a prostatectomy a surgeon removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid-filled sacs next to the prostate, are sometimes also removed. The surgeon tries carefully not to damage nerves and blood vessels. Once the prostate is removed, the surgeon reattaches the urethra to a part of the bladder called the bladder neck. Following the surgery, a urinary catheter is left in the bladder to drain urine.
Some risks of this procedure include:
– Difficulty controlling bowel movements (bowel incontinence)
– Difficulty controlling urine (urinary incontinence); Incidence after radical prostatectomy varies from 2.5-87%. At 6 months 5-72% (Cooperberg J Urology 2003; 170: 512-515)
– Erection problems (impotence)
– Injury to the rectum
– Urethral stricture (tightening of the urinary opening due to scar tissue)
Now, as the urethra and bladder neck are healing the control of urinary continence is left to the pelvic floor muscles.
These muscles wrap around the urethra and rectum, maintaining continence, and must fully relax to allow complete urine and bowel emptying (Check out this amazing video to learn more about this muscle group). Many men benefit from pelvic floor muscle retraining prior to surgery to increase their awareness, strength, and endurance of the pelvic floor. Research has also shown that men who participate in skilled PT pre-operatively are less likely to struggle with chronic urinary incontinence (Burgio J Urology 2006; 175: 196-201).
The sad part is, post-operatively, many men are not even informed that PT is an option to improve continence. They may struggle with the embarrassment of leaking urine, difficulty returning to work, depression, and the list goes on and on.
Do you know someone with prostate cancer or who has had their prostate removed? If so, guide them to the National Institute of Cancer, show them this blog, and remember that education is key to improving our quality of life and general health.
Written by: Jenna Sires PT, DPT
Pictures: http://www.uchospitals.edu , http://www.continence.org.au