Plastic Surgery for Men QotD: Are there prostatectomy penis exercises?

Post-prostatectomy Disorders After a radical prostatectomy (surgery to remove the prostate gland), a patient may suffer from urinary incontinence and erectile dysfunction. Physical therapy helps such patients to strengthen their pelvic floor muscles, significantly improving post-prostatectomy urinary incontinence, post-micturition dribble and erectile dysfunction. Whether they have had surgery or not, all men should master pelvic floor exercises to maintain normal function.

Incontinence
The prostate is a plum-sized gland below the bladder that sits in between the bladder and the urethra. The urethra, a tube which expels urine, starts at the bladder, runs through the prostate and ends in the penis. Before prostatectomy, three mechanisms hold back urine: the internal urinary sphincter, the prostate lobes that press against each other, and the external urinary sphincter. After an operation only the external urinary sphincter remains to control the flow of urine from the bladder. The external urinary sphincter responds well to Kegel exercises that strengthen the pelvic floor muscles, so it is essential that post-prostatectomy patients perform them in order to control incontinence. Weak pelvic floor muscles may contribute to urinary and fecal incontinence and sexual dysfunction.


Frequent urination is normal after a radical prostatectomy because the bladder wall becomes swollen and irritated. Normally, the bladder wall is thin and very elastic, with a capacity for storing eight to ten ounces of urine before a sense of pressure sets in. After surgery a swollen bladder cannot store much urine, so you may feel the urge to urinate as soon as it starts to fill up. In most cases, continence gradually improves with time but it can take up to two years and incontinence can recur.  Physical therapy accelerates continence and if spontaneous improvement does not happen, a PhysioDynamics program can maximize the potential for recovery.


Erectile Dysfunction Erectile dysfunction (ED) can begin immediately following the removal of the entire prostate and surrounding tissues, whether the nerve-sparing or non-nerve-sparing technique is used. If the nerve-sparing technique is used, recovery from ED may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing technique is unlikely but is possible.

The health of the penis depends on the blood flow and oxygen which the blood carries. Blood flow directlyaffects the ability to get and maintain an erection. Connective tissue massage done at PhysioDynamics increases local blood supply, and together with re-education of the pelvic floor muscles which are active during sexual intercourse, assists in speeding up your recovery.

When to See a Physician A post-prostatectomy patient usually has regular medical appointments to monitor the outcome of his surgery. If there is no apparent improvement in your incontinence condition after an appropriate length of time, then other treatment options are worth considering. Injecting fat or collagen to bulk up the urethra is one option, however, this type of procedure has a high failure rate. Another is to implant an artificial urinary sphincter, a prosthetic implantable cuff and pump, which mimics the function of the sphincters. A new device, an adjustable bone-anchored “male sling” has also proved to be helpful.


Certain medications and surgeries can improve ED. Whether used alone or in combination, medications such as Cialis, Levitra and Viagra promote erections by increasing the flow of blood into the penis. Patients needing more help can opt for a combination of oral and injection therapies, vacuum erectile devices and penile prosthesis.

PhysioDynamics' Approach to Treatment PhysioDynamics specializes in treating urinary incontinence and sexual dysfunction. We conduct a comprehensive initial evaluation to determine your underlying physical issues, posture, muscle strength, resting muscle tone and level of function. We determine your therapeutic program based on medical history, physical exam results and biofeedback assessments.


Our treatments also focus on retraining voiding techniques, urinary urge control, fluid intake education, penile rehabilitation, core strengthening exercises, weight control and fitness training. Apart from a comprehensive home exercise program, biofeedback and electrical stimulation may be added to help achieve better control.
Usually patients come for treatment at least once or twice a week to become aware of their pelvic muscles and to learn how to use them. Then appointments can be spaced out to twice a month with a home management program. Regular contact with your physical therapist offers you a source of information, support and encouragement with your progress.


Pelvic Health Like the rest of the body, pelvic health is improved by losing weight, not smoking, keeping physically fit and active, managing stress, eating well and getting enough sleep. Taking hot showers (preferably pulsating) or hot baths increases blood flow to the area. Additionally, pelvic health can be specifically helped by doing Kegel exercises.

Kegel Exercises

Kegel exercises are designed to strengthen your pelvic floor muscles. When you are doing Kegel exercises:

• Imagine that you are squeezing as if you were stopping the flow of urine (practice this when you are NOT urinating).
• “Lift up the penis” and actually see/feel the penis/scrotum lifting.

These subtle internal exercises are most effective when they become habitual. Woven into the activities of daily life, these motions can be performed every time you urinate, laugh, cough, sneeze, blow your nose, lift something or change position. They can be done anywhere, anytime, even in public while walking, climbing steps, or running!
resource: physiodynamics.net