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Prostate Surgery and Bladder Control

After radical prostate surgery, men can have problems with bladder control (the bladder can leak urine unexpectedly). This is because the ‘internal sphincter’ muscle at the base of the bladder, which helps to control urine flow, has to be removed with the prostate gland. But there is a ‘back-up system’ – the ‘external sphincter’ and the muscles of the pelvic floor – which can be trained for a bigger role in bladder control. The physiotherapists at South Terrace Urology are experts in training the pelvic floor muscles.

The physiotherapists at South Terrace Urology

Dr Trish Neumann, a Specialist Continence Physiotherapist, has been providing physiotherapy services for men having robotically-assisted prostate surgery at a dedicated pre-admission clinic at South Terrace Urology since 2012. She has led research at South Terrace Urology into the use of transperineal ultrasound, a novel form of biofeedback treatment, to show men their pelvic floor muscles in action. She presented a paper about this new technology for prostate cancer patients at the World Prostate Cancer Conference in Melbourne in 2013.

Alycia Scannell, Kerry Schneider and Ali Burnett, three experienced physiotherapists, have joined her in 2014 to provide a comprehensive service so that men can receive physiotherapy care after their surgery as well. Trish Neumann provides mentoring and clinical supervision in this specialized area of physiotherapy.

What to expect from physiotherapy at South Terrace Urology

The Pre-Admission Clinic

This clinic conveniently provides an opportunity to see a nurse and physiotherapist at the same clinic visit, a week or two before surgery. The one one-hour physiotherapy appointment will normally provide all the information and training in pelvic floor exercise needed before surgery. The pelvic floor muscles are scanned on transperineal ultrasound and seeing the muscles active on the screen is a real confidence-booster. Men are asked to attend this appointment with a 2-day ‘bladder diary’ to assess bladder function before surgery. The diary is posted out prior to the appointment to allow time for its completion.

After surgery

A follow-up appointment is made for a 30-minute physiotherapy review 1-2 weeks after catheter removal (the catheter is usually in for 7 days). Men are asked to complete a ‘bladder and pad-weight diary’ and a questionnaire for this appointment to help assess bladder control. An individual home exercise program is provided. Ongoing physiotherapy support and training aims to help men achieve complete bladder control as soon as possible. The exercises can also assist with erectile function.

Why Physiotherapy is important

The physiotherapists at South Terrace Urology provide education about the pelvic floor muscles and training in how to activate them correctly. Research shows that starting pelvic floor exercises before surgery helps men regain bladder control faster^1-3. However, if it is not possible to start pre-operatively, pelvic floor exercises can be beneficial even if they are started after surgery.
There is a lot of information available on how to do pelvic floor exercises but getting the technique right is very important. It’s a bit like trying to learn to play tennis from a brochure – ie it doesn’t really work and getting a coach is best!
At South Terrace Urology, the physiotherapists provide the necessary coaching to exercise the pelvic floor muscles correctly. With the help of ultrasound-guided biofeedback, men can be reassured that their pelvic floor muscles are working correctly and feel confident about practicing the exercises at home.

Bladder control after surgery

It is not possible to predict who will have problems with bladder control after prostate surgery or how long it will take to regain control. Some men have good bladder control within a week or two of the catheter coming out. For others, it can take longer, but most achieve control 3-6 months after surgery.  We teach men the correct technique and the skills of pelvic floor muscle control to speed up the recovery process. After surgery, we provide ongoing support and training to achieve the best possible bladder control.

1. Tienforti et al (2012) Efficacy of an assisted low-intensity program of peri-operative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJUI 110,1004-1011
2. Centemero et al (2010) Pre-operative pelvic floor muscle exercise for early continence after radical prostatectomy: a RCT. European Urology 57;1039-1044
3. Burgio et al  (2006).Pre-operative biofeedback assisted behavioral training to reduce post-prostatectomy urinary incontinence: a RCT. J Urol 175:196-201

Pelvic floor physios

The physiotherapists at South Terrace Urology provide education about the pelvic floor muscles and training in how to activate them correctly.

There is a lot of information available on how to do pelvic floor exercises but getting the technique right is very important. It’s a bit like trying to learn to play tennis from a brochure – ie it doesn’t really work and getting a coach is best!

At South Terrace Urology, the physiotherapists provide the necessary coaching to exercise the pelvic floor muscles correctly. With the help of ultrasound-guided biofeedback, patients can be reassured that their pelvic floor muscles are working correctly and feel confident about practicing the exercises at home.