2016 has been an inspiring year for further developing and expanding my knowledge and skills within the speciality of Pelvic Health. Who would have thought Maternity Leave could be so productive. Today’s blog will concentrate on my growth within Men’s Health Physiotherapy.
Since specialising in Pelvic Health Physiotherapy in 2010 I have always treated men. Never to the same volume as female referrals but a steady flow none the less. You may be wondering why men attend a Pelvic Health Clinic. Various reasons actually including incontinence (bladder or bowel), chronic pelvic pain, obstructive defecation, and believe it or not…for penile rehab in relation to erectile dysfunction.
For men, especially with each year beyond 50, chances of experiencing trouble with their prostate gland increases. The prostate is a walnut sized gland (found only in men) that sits below the bladder surrounding the urethra. It produces fluid to carry and enrich semen and therefore plays a role in male fertility. Enlargement of the prostate can be a normal part of ageing, however changes in the prostate and symptoms relating to it should always be investigated as prostate cancer is the most common type of cancer in men with over 41,000 males in the UK diagnosed each year.
I was fortunate to attend Jo Milios course “Nuts and Bolts of Men’s Health” in Dublin, September 2016. Jo is an internationally renowned Men’s Health Physiotherapist from Australia who has not only helped pioneer the role of Physio for Men’s Health but is also a researcher in the field. Learning with Jo opened my eyes to the disparity existing across the world when it comes to services and care available to men undergoing Prostate surgery. In Australia, the role of physio with prostate patients is well established and referrals are routinely made by Urologists, Oncologists or the patient themselves to Physiotherapists like Jo for “Prehab” prior to surgery and “Rehab” following surgery.
Both prehab AND rehab are important to ensure best outcomes following surgery. In the prehab stage, men are assessed to get an insight into their pelvic floor function and penile baseline along with bladder/bowel habits. Education is provided to inform patients about common problems that can be experienced after surgery and the importance of pelvic floor rehab to prevent and help overcome them. This education is important to dispel fear and anxiety around post-op issues like incontinence and erectile dysfunction and facilitate compliance to rehab. Bladder and pelvic floor training is commenced and the patient is guided through the correct technique for recruiting their pelvic floor. You would be amazed at how many people (men and women alike) think they are doing pelvic floor exercises correctly when they are not.
Specialist Physiotherapists can assess pelvic floor function directly using digital palpation if appropriate, or by visualising with Real-Time Ultrasound (abdominal or via the perineum). Prehab gives men a head-start into their post-op rehab. Once the prostate gland is removed, the bladder neck no longer has the same support and therefore the urethra may not seal over completely when required to maintain continence. This is why leaking urine following prostate surgeries can be such an issue. Men need to strengthen, co-ordinate and specifically train their pelvic floor to recruit and lift in order to help seal off the bladder neck and compensate for the lack of support that the prostate previously provided.
What does the evidence say?
The importance of specialist physio for prostate patients has been highlighted in a 2014 review of clinical trials(5) which found pelvic floor muscle training to be better than no treatment or placebo; pre and post-operative pelvic floor muscle training superior than only post op intervention; and post-operative pelvic floor muscle training to be better than information only.
Unfortunately in the UK the role of physiotherapy before and after prostate surgeries is not as well developed or recognised. Some postcodes are luckier than others and I was actually delighted to recently hear that two Pelvic Health colleagues in the Health and Social Care Trust in Northern Ireland are currently involved in a specialist physio service pilot for Prostate patients in Belfast City Hospital. (Thamra actually gave me my first insight and induction into Pelvic Health and is pretty much responsible for my passion in this area). You can read more about this pilot by clicking here. Hopefully this will open the door to further service development regionally so that ALL patients in Northern Ireland can access help easily.
For anyone who is struggling to access specialist physio in relation to prostate surgery we provide this service at ABSolute.Physio’s Pelvic Health Clinic. We accept everything from self-referrals, to GP/Consultant referrals to Health Insurance referrals and we will communicate with your GP and NHS Consultants so that everyone is up to date and informed.
We all have a role in spreading the word and bringing awareness to men about the importance of prostate health. Here are 2 Infographics I created to easily highlight information about the prostate and what symptoms to look out for. Please feel free to share this blog or the infographics and help empower men near and far to look after themselves. Lastly, if you know anyone undergoing prostate surgery please advise them to seek help from a specialist physio in order to prepare for and maximise recovery from surgery.
“Prevention is better than cure”
“Early intervention improves treatment outcome”
“Knowledge is power”
“Prehab to maximise Rehab”
“Nuts to Guts”
“Physio for Prostate?!…..ABSolutely”
- Milios J, 2016, “Nuts and Bolts of Men’s Health” course
- Stafford et al 2015, “Validity of Estimation of Pelvic Floor Muscle Activity from Transperineal Ultrasound Imaging in Men”
- Donnelly G, ABSolute.Physio 2016
- Bo et al 2015, “Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice”
ABsolute-Physio Pelvic Health Clinic, Erectile Dysfunction, evidence based practice, Men's Health, Nuts to Guts, Pelvic Floor Rehab, physiotherapy, Post-op, Prehab to maximise Rehab, Prostate, RTUS, treatment, Urinary Incontinence