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I’m a pelvic floor physical therapist. What questions do you have for me?

Men following treatment for prostate cancer have engines that have been disrupted, but these cars still must be drivable. It's time to fix the issues around prostate cancer treatment with some tools and facts. I am here to answer any questions about you and what is going on. We can fix this together!

Becca Ironside, Moderator

  1. I have a prostatectomy and then a Bio-recurrence less then a year later, which resulted in Radiotherapy and one Lupron shot.
    After surgery my incontinence was getting better, only to get even worse after radiation therapy. Today, two years later, my incontinence is worse and continues to get worse. My question is why? I exercise regularly and continue to do kegal exercises. With physical exercises it worse, the longer the day goes and the tireder I get, the worse it gets.
    What can I do in hopes of helping this issue?

    1. This is such a good question. And I hear this all the time from men. If you had a prostatectomy, you likely recovered a lot of strength afterwards by doing your Kegels.

      If radiation therapy was then necessary down the road, this may have resulted in post-radiation fibrosis, where the tissues around your pelvic floor became shortened and less mobile. Muscles that have this fibrosis cannot lengthen as well; and with this shortening of tissues and resultant scarring comes a loss of coordination with Kegels.

      Many men after radiation treatment to their pelvic floors have tight muscles; and tight musculature can drive urinary leakage. Furthermore, the more a person tries to strengthen tight muscles, the more these muscles fatigue more rapidly.

      You may be doing Kegels faithfully. But if you have tight muscles, strengthening alone won't be as effective and can cause more leakage. Going for pelvic floor physical therapy can help. If that isn't an option, refraining from heavy lifting (this causes breath holding), sitting down to pee and learning to breathe deeply are great alternatives.

      Finally, the pelvic floor muscles start working in the morning, when you stand up. The reason why incontinence is worse for everyone at the end of the day is because these muscles are TIRED. They have held up the organs of your pelvis, abdomen, chest and head all day! My suggestion is to recline in a chair or bed with your legs elevated at 3 or 4 pm. Stay there for 15 minutes. This will eliminate the effects of gravity and allow your pelvic floor muscles a much deserved rest.

      Becca Ironside, Moderator

      1. Thank you

        1. Will these muscles continue to weaken over time or will the fatigue lessen and be more controllable?

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