Tailored Pelvic PT May Curb Post-Prostatectomy Stress Incontinence, Pain

By Marilynn Larkin

January 13, 2020

NEW YORK (Reuters Health) - After prostate surgery, individualized pelvic physical therapy to relax or strengthen the pelvic muscles may be more effective for reducing stress urinary incontinence (SUI) and pelvic pain than muscle strengthening alone, researchers suggest.

"Our findings suggest that we are doing a disservice to many patients with post-prostatectomy urinary incontinence by merely teaching them pelvic floor muscle exercises," urologist Dr. Gary Lemack of UT Southwestern Medical Center in Dallas told Reuters Health by email. "At the very least, if these exercises are unsuccessful, then referral to a comprehensive pelvic floor program for a more patient-specific approach is recommended to enhance recovery of bladder function."

The study was a retrospective chart review of 136 patients (mean age, 66) with post-prostatectomy SUI treated with pelvic physical therapy: 25 had underactive pelvic floor dysfunction (PFD) requiring only uptraining (strengthening) treatment; 13 had only overactive dysfunction and were treated with downtraining (relaxation); and 98 had mixed-type PFD with components of both underactivity and overactivity, and were treated with both uptraining and downtraining.

As reported in International Urology and Nephrology, those with uptraining, as well as those with downtraining, showed significant improvement in the number of pads used per day; decreased pelvic pain on a numeric pain rating scale; and increased pelvic floor strength - even for those who mainly received relaxation training to normalize pelvic floor overactivity.

Specifically, overall, there was a mean decrease in the initial resting tone while side-laying, as determined by biofeedback, from 3.30 to 2.30, and an increase in maximal contraction strength in the side-laying position from 22.49 to 28.97.

The mean pain score decreased with treatment from 0.88 to 0.30. Further, 79% of patients were compliant with all treatment recommendations.

Summing up, the authors state, "a majority of post-prostatectomy men with SUI have pelvic floor overactivity in addition to pelvic floor underactivity. An individualized pelvic PT program aimed at normalizing pelvic floor function (as opposed to a pure Kegel strengthening program) can be helpful in reducing SUI and pelvic pain."

Dr. Lemack said, "Improvements in the surgical treatment of prostate cancer have improved post-operative recovery substantially but have not eliminated the risk of urinary incontinence. Appropriate diagnosis and management of pelvic floor dysfunction in the post-operative setting by properly trained specialists in pelvic floor disorders may obviate the need for additional, potentially more morbid, invasive procedures."

Dr. Andrew Albright, a physical therapist at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, told Reuters Health, "I am not surprised by and do agree with the findings. From what I have seen within this specific patient population, performing strengthening exercises (Kegels) with an overactive and guarded pelvic floor can actually be counterproductive."

"With most surgeries, the immediate and surrounding regions can become weak, but these local and adjacent regions also can become guarded and overactive, leading to further dysfunction," he said by email. "We need to treat and correct these dysfunctions to (restore) optimal function to improve the quality of lives of our patients."

"This was a retrospective review of data," he added. "It would definitely be beneficial to have randomized, controlled trials in the future."

SOURCE: http://bit.ly/2R3hCeR International Urology and Nephrology, online December 5, 2019.