How Physical Therapy Can Help You Heal After Prostate Cancer
Prostate cancer is the second most commonly occurring cancer in men and prostate-owners worldwide, and about 1 in 8 will be diagnosed in their lifetime.
Like other cancers, the side effects related to prostate cancer treatment, including urinary incontinence and erectile dysfunction, can be reduced or eliminated with physical therapy. But before we talk about how physical therapy can help prostate cancer survivors with side effects from treatment, let’s talk about what interventions are used to treat prostate cancer.
Active surveillance: Since prostate cancer is typically slow-growing, your oncologist may recommend observation (sometimes called watchful waiting) or active surveillance.
Surgery: The main type of surgery for prostate cancer is a radical prostatectomy. In this type of surgery, the prostate and surrounding tissues around it, including the seminal vesicles, are removed.
Radiation Therapy: This treatment uses high doses of radiation to kill cancer cells. The two types of radiation for prostate cancer are external beam radiation and brachytherapy (internal radiation).
Hormone therapy (androgen suppression therapy): This treatment reduces levels of androgen hormones (testosterone and dihydrotestosterone) to stop them from fueling prostate cancer cells.
Chemotherapy: These drugs kill cancer cells and are sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working.
Cryotherapy: The use of very cold temperatures to freeze and kill prostate cancer cells as well as most of the prostate.
Immunotherapy: A biological therapy that simulates a person’s immune system to recognize and destroy cancer cells.
The more common treatments for prostate cancer are surgery and radiation, which can lead to erectile dysfunction and urinary incontinence. However, chemotherapy and hormone therapy can cause side effects like muscle weakness, fatigue, weight gain, and osteoporosis. If you’re looking for more details about prostate cancer treatments and side effects, the American Cancer Society has great information.
Now on to the role of physical therapy. Pelvic health physical therapists are specially trained medical providers who assess and treat pelvic health and pelvic floor muscle conditions. These include bladder, bowel, and sexual dysfunction, as well as different types of pelvic pain.
Your pelvic floor muscles sit at the bottom of your pelvis and have several important functions including controlling bladder and bowel function, stabilizing the pelvis, supporting the organs, and assisting with sexual function. If these muscles aren’t working properly, then you can experience bladder, bowel, sexual, and/or pain symptoms.
A typical first visit with a pelvic health physical therapist includes a general musculoskeletal exam to assess things like your posture, strength, and joint range of motion, as well as a pelvic exam (external and/or rectal) to assess the pelvic floor muscles. Based on the examination and your symptoms, your pelvic health physical therapist will prescribe you a treatment program. Due to the nature of the side effects experienced after prostate cancer treatment, pelvic health physical therapists are a perfect match for prostate cancer survivors.
Urinary incontinence
Urinary leakage is a very common and bothersome symptom after prostatectomy. It usually resolves by one to two years after surgery, however, studies show that working with a pelvic health physical therapist and performing Kegel exercises soon after surgery can help you get drier quicker. Kegel exercises are repeated pelvic floor contractions that are typically performed several times per day. Always check with your medical provider first before starting Kegel exercises, because they aren’t for everyone.
Leakage during climax
Climacturia, or urine leakage during climax, can also be experienced after a prostatectomy. An average of 30% of prostate cancer survivors experience this condition. A pelvic health physical therapist can provide you with an individualized Kegel exercise program to improve the strength and coordination of the pelvic floor muscles and to also train you how to contract them at the appropriate time so you don’t leak during sexual activity. Beyond Kegel exercises, pelvic health physical therapists can also utilize an intervention called biofeedback, in which you get realtime information about how your pelvic floor muscles are functioning.
Erectile dysfunction
Having trouble with achieving an erection, also called erectile dysfunction, is common after prostate cancer surgery and radiation treatment due to irritation and/or damage to the nerves that help with erectile function. Studies show that improving the strength, endurance, and coordination of pelvic floor muscles can help improve erectile function. So, this is another condition in which an individualized Kegel exercise program can be helpful.
Radiation fibrosis syndrome
Radiation therapy is a localized treatment that can cause bladder symptoms like incontinence, pain, or urgency, but also long-term side effects like radiation fibrosis. Tissues that are radiated can have permanent tissue changes, called radiation fibrosis, that can lead to damaged muscles, nerves, and other tissues. Pelvic health physical therapists can assess the tissues and provide interventions like exercises and manual therapy to address the radiation fibrosis and improve the associated symptoms.
Some of the non-pelvic-related side effects from treatment (muscle weakness, fatigue, weight gain, and osteoporosis) can be addressed in physical therapy as well – and you don’t need to see a pelvic health physical therapist for these conditions. Your strength, posture, joint range of motion, endurance, and balance will all be assessed in order to set you up with an individualized program to overcome the side effects you’re experiencing.
If you’re a prostate cancer survivor, make sure your Survivorship Care Plan includes physical therapy to address any side effects. There are several great resources to find a qualified pelvic health physical therapist near you. Call ahead to make sure they have training and experience in treating prostate cancer survivors.
