This is the first of (hopefully!) a series of blog posts by New Zealand specialists in prostate cancer treatment. Today we have Zee Sharif, a Physiotherapist at Return To Form in Auckland.

Life After Prostate Cancer -How Can Physiotherapy Help?

All mammals have a prostate gland – however for unknown reasons it only causes problems in men and dogs, hence a man’s best friend is the only one who truly understands his problem!

The prostate is a walnut sized gland located below the bladder. Its main function is to secrete fluid that nourishes and protects sperm.

Like any other body organ, it can become diseased. One of the malignant diseases is cancer.

Prostate cancer is the second leading killer in men after lung cancer. It is common in Australia in NZ, Prostate cancer is the most common cancer in men with over 3,129 new cases diagnosed each year.

Rates increase with age:

• 40-49 1 in 554
• 50-59 1 in 45
• 60-69 1 in 15
• 70-79 1 in 11

Not all men diagnosed with prostate cancer die from it by all means. One approach for treatment/cure is removal of the whole gland, a radical prostatectomy. There are various methods from open surgery to robotics.

Common side effects of treatment are, incontinence, which affects 99% of all patients and erectile dysfunction, which affects 68-99% of all patients.

Physiotherapy can help!

Research shows that strengthening exercises with the right technique can reduce the occurrence of leakage and aid in erections and orgasms. With pelvic floor exercises (PFE) most patients improve their incontinence within the first 3 to 6 months after the op and commonly further into the 1st and 2nd year.

There is now a large amount of international research showing compelling evidence that rehabilitation and physical exercise can have a dramatic positive effect on a person’s life when affected by cancer, including reducing the side effects of treatment, improving quality of life and prognosis.

Pre-op Support

At our clinic we aim to catch men pre-op when we can educate, using skeleton and images, the location and job of the pelvic floor muscles. Often men think pelvic floor muscles are just something that women have! How wrong they are.

A specialist physio provides pre-op advice in a number of areas:

• Teach the correct exercises in a few different positions to enable clients to perform them functionally in everyday life.
• Teach abdominal breathing, advice on lifting/handling, not to go chopping down trees or build that shed they’ve been meaning to do just because they have some time off work.
• Inform on use of pads suitable for men (not the girlie pads but ones that cater for the male anatomy and designed specifically to absorb urine).
• It is major surgery so they will need to pace back into activities. We discuss use of pads and types, lifestyle changes, and diet and bowel habits (constipation can cause incontinence).
• Educate on weight loss, this has been shown to decrease episodes of urinary incontinence.
• We give advice on beverages e.g. alcohol, coffee or tea or carbonated beverages, which are bladder irritants and the importance of increased water intake.
• At this stage do some bladder training: we all have bad bladder habits so, if we can address some of these pre-surgery, then episodes of loo visits can be decreased before even going into surgery.

We follow up a week later to check exercises, and correct where necessary, and answer any questions and then generally we don’t need to see the men again until after the catheter is removed.

We encourage clients to be sexually active pre-surgery because the better the function, muscle strength and activity beforehand, the better the outcome afterwards.

A study in January 2015 showed men with a history of brisk walking prior to a diagnosis of prostate cancer had healthier-looking, more normally shaped blood vessels in their prostate tumours after diagnosis.

The researchers had previously shown that small, irregularly shaped vessels in human prostate tumours were linked to an increased risk of death in men with prostate cancer. “We hypothesised that brisk walking and vigorous activity would be associated with larger, more regularly shaped vessels in human prostate tumours,” says the researchers.

Post-surgery Support

A week after the catheter is removed, we review and begin rehabilitation towards normal function. This includes discussion on sexual function with the aid of medication if necessary, such as Cialis/Viagra, penis pumps, pelvic floor strengthening and regaining confidence.

We progress as appropriate to load-bearing functional activities and progress work into our gym to incorporate Swiss balls and Pilates equipment to` challenge the muscles further and replicate everyday functions. So we work on the body as a whole not just the pelvic floor muscles in isolation. If they have specific goals e.g. running, getting back to golf/tennis etc, we make the exercises specific to their functional goals.

If incontinence is persistent we use different techniques to improve this:

• Biofeedback from pressure biofeedback units as well as teaching clients to use feel,touch, a mirror at home.
• Electrical stimulation: This is achieved via a digital electrical pelvic floor stimulator. Electrical muscle stimulation has been used effectively for many decades in muscle rehabilitation. Incontinence is amongst conditions that respond well to stimulation.
• This effortless and passive pelvic floor workout leads to gradual increase in muscle strength, muscle tone and muscle firmness, progressively reducing the symptoms of incontinence.
• Acupuncture: Needles are used locally over the sympathetic and parasympathetic nerves that innervate the bladder and external sphincter.
• Peripheral tibial nerve stimulation (PTNS) is said to interrupt abnormal reflex arcs that affect bladder dysfunction. Currently a treatment course is defined as one treatment a week for 12 weeks. Each treatment session lasts 30 minutes. “Maintenance treatment” is given at intervals determined by whether and when symptoms recur.

Physiotherapy can help men get back quality of life. It isn’t enough to get rid of the cancer, we firmly believe our clients should be able to get back to their everyday activities, sexual function with no incontinence.

Cancer rehabilitation should be aiming to return men to activities and sports they were doing prior to the cancer, pee free!

Zee Sharif is Physiotherapist at Return To Form in Auckland with a speciality in pelvic floor health and cancer rehabilitation. Her focus is on erectile dysfunction and helping cancer patients get back to sex! If you’d like to discuss any issues raised in the article give her a call on 09 551 4460