Radical prostatectomy is a procedure that is often performed on men to remove cancerous prostate tissue after a prostate cancer diagnosis. Approximately 85% of men who undergo the surgery complain of erectile dysfunction (ED) after the procedure. Erectile dysfunction is defined as the inability to achieve and maintain an erection for satisfactory sexual performance.  Around 6-8% of men report urinary incontinence after radical prostatectomy.

What Causes Erectile Dysfunction after a Radical Prostatectomy?

During a nerve-sparing radical prostatectomy, the nerves and blood vessels surrounding the prostate can be damaged during the procedure. This trauma can contribute to the loss of oxygenated blood flow to the penile soft tissue which may further result in damage in the smooth muscles of the penis, thickening fibrosis of the penile tissue, and a decreased ability to hold blood in an erect penis. 

Pelvic Floor Therapy for Erectile Dysfunction and Urinary Incontinence after Radical Prostatectomy

Pelvic floor muscle training is can improve quality of life, continence and erectile function post-prostatectomy with the following interventions:

• Therapeutic exercises to strengthen the pelvic floor, which will help with both erectile dysfunction and urinary incontinence.
• Biofeedback technology to help the patient correctly isolate and contract the correct pelvic floor muscles implicated in erection and continence
• Electrical stimulation using the Attain Medical device
• Photobiomodulation Therapy for pain relief and encouraging cellular healing and desensitization of scar tissue adhesions, tender trigger points, and muscle spasm pain.
• Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, kidneys, and bladder) to improve motility and GI organ function
• Training in self treatment techniques so you can start to manage your symptoms at home
• Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion
• Patient Education and Empowerment
• Lifestyle modifications like sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake.
• Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
• Internal pelvic manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like frequency and urgency of urination, and pain with bowel movements

If you have recently had a radical prostatecomy and are experiencing issues with erectile dysfunction and/or urinary incontinece, schedule a visit with Fusion Wellness and Physical Therapy today!

Resources

Wong, C., Louie, D. R., & Beach, C. (2020). A Systematic Review of Pelvic Floor Muscle Training for Erectile Dysfunction After Prostatectomy and Recommendations to Guide Further Research. The Journal of Sexual Medicine. doi:10.1016/j.jsxm.2020.01.008 

Au, D., Matthew, A. G., Alibhai, S. M., Jones, J. M., Fleshner, N. E., Finelli, A., … Mina, D. S. (2019). Pfilates and Hypopressives for the Treatment of Urinary Incontinence after Radical Prostatectomy: Results of a Feasibility Randomized Controlled Trial. PM&R. doi:10.1002/pmrj.12157