In Your Pants with Dr. Susie G - After prostate cancer

Episode Date: September 2, 2023

After prostate cancer, men often grapple with urinary incontinence, sexual dysfunction, and other pelvic floor challenges. The significance of pelvic floor rehabilitation is that it can mitigate symptoms after prostate cancer and help you quickly get back to enjoying the activities you love. Whether it's regaining intimacy or achieving better bladder control, getting an early start can set you years ahead on your recovery path.  While it's expected to face new and persistent symptoms, it's empowering to know that with tailored rehabilitation methods, these challenges can be temporary. In this special 4-part series featuring Dr. William Mills, PT, DPT and Dr. Susie Gronski, PT, DPT we delve into insights and solutions centered on the treatment and rehabilitation of men's pelvic and sexual health following prostate cancer. Dr. William Mills, PT, DPT is a physical therapist who specializes in male pelvic rehabilitation, particularly post-prostatectomy and chronic pelvic pain. With a forte in manual therapy and corrective exercises, he enhances outcomes, enabling men to regain urinary control, bowel function, erectile function, and overcome pain. Together with his colleagues at Alinea Performance, he is committed to assisting men of all ages in enhancing their quality of life. Our episode covers topics including: 00:00 Introduction 00:35 Deciding on radiation or prostatectomy for prostate cancer 02:01 Urinary incontinence post-prostatectomy 04:26 Sexual function challenges post-prostatectomy 06:04 Viagra and Cialis post-prostatectomy 07:03 Treatment approaches for post-prostatectomy 11:44 Should I go to the doctor for post-prostatectomy symptoms? **Delaying Treatment:** You're not alone. Many men experience sexual difficulties and urinary incontinence post prostatectomy. When concerns are not addressed early on, they may become more difficult to treat as time goes on, leading to unnecessary long-term suffering and reduced quality of life. There's help and there's hope.  **Prostate Cancer Rehabilitation Options:** A comprehensive understanding of post-treatment rehabilitation for prostate cancer is key. While the key decision may feel like deciding between radiation and prostatectomy, there are many decisions for after-cancer care. **Intimacy After Prostate Treatment:** Some men experience reduced sensation in their penis and erectile dysfunction, feeling less connected to physical stimuli and their sexual selves. Nerve injury and diminished blood circulation, which can be a result of prostate cancer treatment like prostatectomy, can lead to reduced penis sensation and erectile dysfunction. Penile vibratory therapy, a penis pump, and medications are just a few treatment options that can help in improving blood circulation and erectile function. An individualized approach is best.  **Urinary Incontinence After Prostate Treatment:** By addressing bladder habits, such as hydration and reducing potential bladder irritants, and with functional pelvic floor exercises, recovery can be expedited and post-treatment symptoms like incontinence can be mitigated. Proactively seeking knowledge and tailored rehabilitation strategies enables you to regain urinary control, greatly enhancing your quality of life outside the bathroom. RESOURCES: Free sex and pelvic pain resources https://drsusieg.com/resources Online Pelvic Pain Relief Program for Men https://drsusieg.com/pelvic-pain-in-men-online-program CONNECT WITH DR. WILLIAM MILLS: Website: www.alineaperformance.com Instagram and Facebook: docmills.dpt Twitch: docmillsdpt CONNECT WITH ME (DR. SUSIE) AND TEAM: Website: https://drsusieg.com/ Instagram: https://www.instagram.com/dr.susieg/ ___________________________________________________________________________ Disclaimer: This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional. #prostatehealth #prostatecancer #prostatectomy

you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below So Dr. Mills, talk to us about before and after prostate cancer treatment, and we can talk about radiation and expectations around that and tissue changes and also prostate removal and anatomical changes. So what should men expect? Yeah, so I talk with guys a lot about how leading up to, usually when a guy's leading up to either making the decision between radiation or prostatectomy, it's been a minute of dealing with symptoms. Usually it's fairly common that they will have an enlarged prostate for a certain period of time,

or they will be told that they have an enlarged prostate. And then this is why you've had all of these urinary issues. I find that a lot of those things are habit-based, that they pick things up over the years. They decrease their efficiency when they're urinating. And, you know, they pick up these, these things that they carry over with them, either post-surgical or when they have radiation. So very big on habits. I'm very big on hydration, um, either setting that up to make positive changes before surgery. So we're increasing bladder efficiency and capacity. Um, you know, a lot of the guys that I treat that have had chronic incontinence, it's almost like they have these little baby bladders that can't tolerate more than 30 or 45 minutes before they

have this super strong urge to rush to the bathroom. Um, and that's not, that's not correct, right? We, we should be able to hold it for two to four hours, you know, if we need to more than four hours. Um, so, so anatomical changes when having the surgery, you're going to have your prostate removed, right? There's, there's things that come with that. There's this big inflammatory response after a surgery, just like with any surgery. And we know that inflammation decreases muscle use. It's inhibitory. There's nerve damage, even if you're having a nerve sparing surgery. So, so we need to be gentle to those tissues down there. And when it comes to setting expectations, it's pretty normal for the first few weeks. Like you haven't been moving all that

much. You've had a catheter. It's pretty common to have a large amount of leakage in the first three to four weeks. Once you get your catheter out, you've had your prostate removed in that prostate. You've had a sphincter, which is basically a valve that keeps the, keeps the closed one of my patients uh in the past said whenever i feel leakage the horse is out the barn and i use that all the time now because it's like we got to keep the horse in the barn like if if you already feel like it's out then it's too late and it's past you know past the valve that you still have which is the external urethral sphincter and the rest of the muscles on the front side of your pelvic floor so we need to learn how to utilize those we need to learn how

to manage your pressure because any kind of downward force on top of the bladder you know you're taking the path of least resistance right now and right now because you just had surgery or because you've had radiation your pelvic floor muscles are you know that that hole in the armor right and it's going to take the path of least resistance and that's going to look like incontinence let's talk about sexual function and why that might be different and distressing for someone who's gone through prostate cancer treatment? Yeah. So should we, should we start with like what the initial looks like? Okay. Sorry. Okay. So it's, it's pretty common. Um, I feel like you could kind of put in most, most of the guys following prostatectomy surgery

into two buckets where there's there's guys that they they feel like there's nothing there um and it's like they just say that their their erections are dead like there's nothing they don't have a whole lot of sensation uh then there's guys that have a little bit they still have a certain amount of arousal um they're more exploratory and they're they're doing things to increase their arousal whether it's exploration in the shower whether it's their partner is still interested in sex so they may not be having penetrative sex but they're still fooling around you know and you know taking those two paths it's like okay well even if there isn't a whole lot of sensation we still want to do things to stimulate right um a very easy way to do that

is getting on viagra cialis or daily cialis to encourage blood flow down there i always talk to guys about how it's like okay well right now your body can't do this on its own so it needs a little bit of help. So more help is better. Um, on the front end, when things are more leaky, usually I'm not encouraging initiation of penis pump use until four to six weeks after, uh, after the catheter, just because it can be a mess. Um, uh, and whenever, whenever they're going through the initial phases of learning how to keep the horse in the barn. Um, I don't want to add too much complexity, but I'm pro starting to use the penis pump as soon as possible. Now, you know, given, given the context of a lot of people that I treat,

you know, we talked about the chronicity of a lot of these guys. Um, I get way better results with earlier engagement in therapy right but i hear all of i don't want to say horror stories but like i hear sad stories all day about how long this has been going on and how they only thought that you know it was just going to get better and they were going to do kegels they were going to do kegels all day sitting in a chair um and there was just going to be this magical bridge of incontinent to fully continent that was formed by doing you know a squeeze that usually they don't do correctly anyway because they were taught on a sheet from 1997 um to do it right and it was going to get better and there was no there was not a lot of depth to the instruction

right so so in that lack of depth usually they've been given a penis pump um but they were just given the penis pump and said here read the instructions don't leave it on for more than 20 minutes or it might fall off and use it a lot and that's it there's no there's no homework there's no uh gradual build there's no talks about how to use it the most effectively and why you should be using it, um, to be effective. And, you know, it's, I like to boil it down to a blood flow issue. The more blood flow we can encourage to those tissues, the better, um, under normal circumstances, if you haven't had, you know, prostate prostatectomy or prostate radiation um having an erection a day is a very healthy thing you know we we make the joke an

erection a day keeps the doctor away right uh so so under normal circumstances like and then more research is being found that there's a lot of just general mortality statistics and and vitality uh as a as a measure of having an erection so we want there to be erections um and and doing things to encourage that in the in the context of your body might not be able to do it it's best right now so we are going to do as many things to encourage that as possible really has is going to have the best results in the long run exactly and and as far as what folks can expect knowing that your general population is coming to see you several years or several months later if things are not necessarily working as they should in in that time it sounds to me that just

going through this process that your body can change and that this you can optimize your function we may not know how much to what degree to what extent but for improvement absolutely like with nerve uh neuropraxia after or nerve injury or irritation after such a surgery if it was spared you know that can take up to the literature says what two years and yeah a year and a half to two years yeah we i don't know if i don't know if all physical therapists say this but in in pt school i learned the mantra a millimeter a day or a centimeter a month when it comes to neuropraxia so you know the conversation with most guys is like most come in knowing that knowing that it could take a year and a half to two years

and it's one of those things where it's like the idea of not having a process not having a rehab process is well i'm just hoping it'll get better by then and it's a very like i call it the possum approach it's like lay on the ground and play dead until enough time passes that it might get better. That's not very proactive, right? That's not utilizing knowledge and science that we have at our use today. So, and the body is wildly adaptable, even if it's been going on for a long time. You know, I like what you said about the, we don't know until we try, right? I use that conversation in the habit forming process of unless you were utilizing positive habits like you know not being chronically dehydrated knowing how to stick to a bladder schedule

create a bladder schedule and track progress we don't know how good it's going to get or how much positive changes are going to happen until we start to optimize those things so until we have optimized those things if you've just been you know doing the possum thing you haven't been and that's no that's typically no fault of a patient it's usually the the you know the whole system um not encouraging a proactive approach and that's a big part of you know what i'm trying to trailblaze in the in the sphere of like there is a process uh there's a research back process there's a results-based process and we could do that as long as you know the typical curveball in this is if there's no sensation it makes things tough uh but if there is sensation even if it's

not sensation so when i say sensation i mean sensation of the genitals and then sensation that there's incontinence occurring that the horse is out of the barn if sensation is intact to a certain degree there's you know a typical process of there's going to be progress radiation tends to make that a little bit more of a problem um those are the those are the more ups and downs patients that i've experienced uh because radiation does tend to affect the nerves a little bit more than a nerve sparing surgery but there's always there's always a chance that if you optimize your habits learn how to manage your pressure in your abdomen and learn how to do a coordinated kegel things are going to get better

and then you do that over the course of learning how to put it together with every part of your day right it's it's all application thanks for listening to today's episode be sure to visit my website drsusig.com for show notes and related resources on today's topic if you like what you're hearing head on over to youtube and subscribe to my channel on my youtube channel you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my channel be sure to type it in the comment box below