One in eight men will develop prostate cancer at some point during their life, according to official research. But the mortality rate has been dropping since 1992 and the survival rate for men aged 70 and over, if the diagnosis is made before the cancer becomes aggressive, is 87 per cent. A hero of mine, Billy Connolly has just been diagnosed with the disease. Speaking about it, he said: “This is f*****g terrifying. I feel like I’m going out of my mind.” A typical response to anything from Billy!
Bladder weakness, or urinary incontinence, is experienced by many men following surgery for prostate cancer. This is a common problem, however many men find this the biggest challenge they have to cope with during the recovery process. Most men regain their bladder control over time and are fully recovered within 6 to 12 months.
So what is the prostate? Billy Connolly describes it well in this video recorded many years ago.
So why does the pelvic floor get weak after surgery?
At the point where the bladder and urethra join, there is a ring of muscles, known as the bladder neck sphincter, which opens and closes like a camera-shutter. The bladder neck sphincter is closed most of the time to prevent urine leaking out but when it gets permission from the brain, it opens to allow urine to be passed. Another (external) sphincter is part of another set of muscles below the prostate called the pelvic floor. These muscles are also involved in bladder control. If the bladder neck sphincter is damaged during prostate cancer surgery, the pelvic floor muscles are now relied on to control the bladder more often. If the pelvic floor is weak you may experience urinary incontinence.
A man’s pelvic floor supports the bladder and the bowel. The urethra and rectum (back passage) pass through these muscles to the outside. By doing pelvic floor exercises, you can strengthen these muscles and improve bladder and the bowel control.
So how do you strengthen the pelvic floor?
Like anything in life you need to know that you’re doing it right. The best way to make sure your pelvic floor is working correctly is to have it checkied using a real-time ultrasound unit. Go Go Physio has a mobile unit and can assess the pelvic floor in the comfort of your home. Correct technique is very important when doing pelvic floor muscle exercises. You should feel a ‘lift and a squeeze’ inside your pelvis. My verbal cue to clients is to try lifting your “nuts to your guts”,this seems to work every time! The lower abdomen may flatten slightly, but try to keep everything above the belly button relaxed, and breathe normally.
Every time the pressure in your abdomen increases you are potentially pushing urine out of the bladder. Identify the activities that cause urine to spurt out such as coughing, standing up or lifting, and tighten your muscles first to prevent urine escaping. Practice this control until it is automatic. This is called ‘the knack’.
You should also try to use your pelvic floor muscles throughout the day. Some examples of when you could use them are:
- Whilst walking – try lifting your pelvic floor about 50% of maximum squeeze.
- When you feel the urge to pass urine – squeeze your pelvic floor to hold on until you get to the toilet.
- After you have passed urine – tighten your pelvic floor, which may help prevent the embarrassment of an after-dribble leak of urine as the squeeze expels the last few drops of urine from the urethra.
- After opening your bowels – tighten around your back passage.
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