What is Rehab after Prostatectomy?

As per the Canadian Cancer Society, it is estimated that in the year 2022, 24,600 Canadian people who are born with a penis/prostate were diagnosed with prostate cancer. 

Early detection through medical investigation and improved treatments has helped to increase the number of prostate cancer survivors. With this comes an increased number of people who experience post-prostatectomy symptoms on a daily basis. 

These symptoms include but are not limited to:

  • urinary incontinence (partial or total)

  • erectile dysfunction

  • scar adhesions

  • abdominal pain

  • bowel issues

  • retrograde ejaculation. 

Urinary incontinence is probably the most common symptom experienced after a prostatectomy. There are medical treatments to treat this such as medications and even artificial urinary sphincters (a pump that’s inserted into the testicle to pee). But, conservative rehabilitation including physiotherapy can also be helpful in combination with medical interventions. 

Beyond my private practice, I also work at the UBC Hospital Bladder Care Centre in Vancouver, BC. At this facility, I have supported many patients who are experiencing post-prostatectomy symptoms in various ways but these are my top five:

  1. Education on what the surgery entailed, how the body has changed, and options to manage these changes. 

  2. I give them a reality check. Symptoms can improve with consistent rehabilitation for the first 1-2 years post-prostatectomy (it really depends on the individual), and then things usually taper off. I believe that you need to really focus on rehabilitation to gain back function soon after your surgeon says ‘you’re good to start rehab.’

  3. We talk about how we measure improvement: This could be subjective, but it’s best to try objective methods such as weighing your pad/diaper daily to see if there are changes over time. We detail the scar descriptions and complete bladder and bowel diaries to ensure we are tracking fluid intake as well as output. 

  4. Hygiene, hygiene, hygiene! It’s vital to prevent infections and keep incision sites, as well as any sensitive areas, clean and dry. We talk a lot about how we can keep ourselves healthy through basic daily habits/lifestyle modifications. 

  5. Internal pelvic floor assessment. I offer an internal examination that will help determine the current state of the patient’s pelvic floor muscles including strength, endurance and coordination. With this information, a personalized care plan to support sexual, bowel and urinary function can be created. 

Research illustrates that there is an overall benefit from pelvic health physiotherapy in terms of reducing post-prostatectomy symptoms. With the increasing number of survivors, let’s spread the word that conservative management after prostate cancer can be helpful and effective.

Michiko Caringal