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Bethany Navajeevan Physiotherapy Clinic
& Rehabilitation Centre
MEN'S HEALTH physiotherapy
There are a variety of existing conditions that concern men only. These health problems include conditions that are associated with the prostate and / or genitalia. Much of the problems men experience may be largely age related or they may be caused by trauma, disease, cancer, infection, nerve damage and / or obesity to name a but a few
FAECAL INCONTINENCE
CONSITIPATION
STRESS INCONTINENCE
URINARY RETENTION
URGE INCONTINENCE
NEUROGENIC DETRUSOR OVERACTIVITY
PROSTRATE SURGERY (TURP)
PROSTATECTOMY
URGE INCONTINENCE
INTRODUCTION
Controlling the bladder and storing urine depends on the function of the urinary tract, kidneys, and nervous system. Urine is continuously collected in the bladder after it leaves the kidneys. A bladder is a muscle called the detrusor, which expands when filled with urine. A sphincter keeps the bladder closed as it fills up. Together with the detrusor muscle, the sphincter controls urine flow. It is the nervous system that allows the bladder to continue to fill and informs you when you must urinate. To force urine out of the bladder, the detrusor muscle must contract. When the bladder is full, part of the brain helps prevent bladder contraction so that urination can be delayed until you are ready to use the bathroom.
Urge incontinence in men is the strong, sudden need to urinate due to uncontrolled bladder spasms of contractions. An overactive bladder results in involuntary bladder muscle contractions which are caused by bladder irritation or problems in the nervous system.
CAUSES
Infection
Bladder cancer
Bladder inflammation
Bladder outlet obstruction
Bladder stones
Neurological diseases – such as Parkinson’s or multiple sclerosis
Neurological injury – such as spinal cord injury or stroke
Prostate enlargement or cancer
Prostate surgery or other surgery to the area around the bladder
Weakness in pelvic floor muscles / abdominal muscles
SYMPTOMS
Involuntary release of urine
Regular urination at any time of day or night
A sudden urgent need to pass urines
PHYSIOTHERAPY TREATMENT
Exercises to strengthen pelvic floor muscles
Strengthening exercises for the abdominal muscles
Bladder training to help the bladder return to normal function
Biofeedback training to show you how well you are using your pelvic floor muscles
Electrical stimulation to improve muscle function
Home exercise programme instruction to improve pelvic floor function
Instructions on how to control pelvic floor and abdominal muscles when feeling the urge to urinate
Controlled breathing and relaxation exercises
Education on how to make lifestyle changes that may affect the bladder
FAECAL INCONTINENCE
INTRODUCTION
Faecal incontinence is when there is a leakage of faeces (stools) out of rectum. The inability to control wind is also a characteristic of faecal incontinence. Physiotherapy is an effective way to help reduce symptoms that are associated with faecal incontinence.
CAUSES
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Muscle imbalance and weakness around the anus
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Anxiety
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Neurological conditions such as Parkinson’s, spinal cord injury, stroke and multiple sclerosis
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Pelvic Floor and Abdominal muscle weakness
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Medication
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Trauma
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Surgery on the prostate surgery or other surgery to areas around the bladder
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Cancer or enlargement of the prostate
SYMPTOMS
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Lack of control over bowel movements
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Involuntary wind
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Urgency to go to the toilet even when stool (faeces) leakage is minimal
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Leakage of stools (faeces) in large or small amounts before being able to get to the toilet
PHYSIOTHERAPY MANAGEMENT
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Strengthening of sphincter and pelvic floor muscles
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Advice about lifestyle and diet changes
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Bladder charts
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Biofeedback (to retrain your muscles)
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Advice on moving and handling techniques
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Cardiovascular activity
CONSTIPATION
INTRODUCTION
Constipation occurs when bowel movements become abnormally infrequent and can affect men of all ages.Constipation is when faeces (stools) become hard, and difficult or painful to pass. This can mean that stools are not passed as often as they normally should i.e. less than three times a week. You may have to strain more than usual and you may be unable to fully empty your bowels. The severity of constipation can vary significantly and constipation can be experienced for a short period of time or symptoms may be experienced more long term.
SYMPTOMS
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Inability to produce regular bowel movements – less than three times a week
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Difficulty or pain when passing motions
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Abdominal pain or cramps
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Feeling of being ‘bloated’ or sick
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General discomfort
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Tiredness and reduced energy levels
CAUSES
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Insufficient fibre intake
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Dehydration – not drinking enough fluids
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Medication
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Stress / emotions
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Trauma
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Neurological diseases – such as Parkinson’s or multiple sclerosis
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Neurological injury – such as spinal cord injury or stroke
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Prostate enlargement or cancer
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Prostate surgery or other surgery to the area around the bladder
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Weakness in pelvic floor muscles / abdominal muscles
PHYSIOTHERAPY MANAGEMENT
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Relaxation of sphincter muscles
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Strengthening exercises for the pelvic floor muscles
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Biofeedback training to show you how well you are using your pelvic floor muscles
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Electrical stimulation to improve muscle function
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Education on how to make lifestyle changes that may affect the bowels
STRESS INCONTINENCE
INTRODUCTION
Urine is constantly travelling from your kidneys and is collected in your bladder. Your bladder then expands as it fills with urine. The bladder is a muscle and is kept closed by a valve called the sphincter until the bladder becomes full. When the bladder is full, the sphincter opens and urine is taken via a tube called the urethra to be passed.
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Stress incontinence in men is when urine accidentally leaks due to a sudden increase in pressure or stress on the bladder, sphincter and urethra. This can occur in incidences such as sudden laughing, coughing or sneezing.
SYMPTOMS
Stress incontinence in men causes symptoms such as leaking of urine when you:
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Cough, laugh or sneeze
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Exercise (particularly jumping)
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Lift or do any movement that puts pressure on the bladder e.g. bending
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During sex
CAUSES
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Stress incontinence in men is caused by weakness of the pelvic floor muscles so that these muscles, the bladder, sphincter and urethra cannot withstand any extra pressure or stress. The extra pressure in the abdomen means that the sphincter has difficulty staying closed and urine is leaked.
Stress incontinence in men can be caused by a number of reasons that result in weakening of the pelvic floor muscles.
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SI can be caused by any disease, condition or injury that results in damage to the nerves that activate the muscles in the pelvic area. Diabetes, Parkinson’s, stroke, spinal cord injuries and other neurological conditions are likely to cause decreased bladder control.
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The prostate gland surrounds the urethra and is responsible for producing semen.
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Problems with the prostate such as prostate cancer of enlargement of the prostate can cause decreased bladder control. Also, surgery of the prostate can result in significant weakening of the pelvic floor muscles and therefore bladder problems.
PHYSIOTHERAPY MANAGEMENT
Treatment methods include:
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Strengthening exercises for the pelvic floor muscles
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Bladder training to help the bladder return to normal function
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Biofeedback training to show you how well you are using your pelvic floor muscles
-
Electrical stimulation to improve muscle function
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Instruction for home exercise programme to improve pelvic floor function
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Instructions on how to control pelvic floor and abdominal muscles during coughing, sneezing and laughing etc.
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Education on how to make lifestyle changes that may affect the bladder
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URINARY RETENTION
INTRODUCTION​
Urinary retention in men is when you are unable to pass urine despite your bladder being full. It can also be characterised by feeling the need to pass urine although not being able to.
SYMPTOMS
If you have urinary retention you may be experiencing a number of symptoms.
-Urinary retention in men is characterised by the inability to pass much urine at any one time and the frequent, strong urge to urinate.
-You may experience some leakage or dribbling during the day and while you are asleep.
-You may find that you need to force yourself to pass urine.
-You may also suffer from some lower back pain as well as some pain when attempting to urinate.
CAUSES
Urinary retention in men can be caused by a number of reasons including:
-Damage to the nerves that inform the bladder to contract
-Enlargement of the prostate due to cancer or infection
-Trauma to the area
-Infection or inflammation
-Drug related effects
PHYSIOTHERAPY MANAGEMENT
-Pelvic floor muscle strengthening exercises
-Abdominal muscle strengthening exercises
-Controlled breathing and relaxation exercises
-Advice on comfortable positioning
-Biofeedback to show you how well you are using your internal muscles
-Electrical stimulation to help with pelvic floor muscle contraction and bladder control
-Hydrotherapy
-Bladder training to help the bladder return to normal function
-Instruction for home exercise program to improve pelvic floor function
-Education on how to make lifestyle changes that may affect the bladder
NEUROGENIC DETRUSOR OVERACTIVITY
INTRODUCTION
Neurogenic detrusor activity in men or detrusor hyperreflexia is a neurological abnormality that impairs the signalling systems between the central nervous system and the bladder. This abnormality results in the brain being unable to inhibit the detrusor muscles that control the bladder and urination. The detrusor muscles therefore contracts more frequently causing the involuntary release of urine from the bladder (urinary incontinence). The impairment of the signalling systems between the bladder and the brain is caused by a disruption of the nerves supplying the detrusor muscle.
CAUSE
The disruption of nerves that controls the bladder in men could be caused by a number factors including;
Neurological injury – such as spinal cord injury or stroke
Neurological diseases – such as Parkinson’s or multiple sclerosis
Prostate enlargement or cancer
Prostate surgery or other surgery to the area around the bladder
Trauma
Weakened pelvic floor and transverse abdominal muscles
Poor bladder control
Bladder problems such as inflammation, bladder stones or cancer
SYMPTOMS
Urinary incontinence – involuntary urination
Stress incontinence – leakage of urine during coughing, laughing or exercise
Urge incontinence – feeling the need to urinate and being unable to hold it in
More regular urination
Waking during the night to go to the toilet.
Physiotherapy management
Bladder training to help the bladder return to normal function
Strengthening exercises for the pelvic floor muscles
Strengthening exercises for the abdominal muscles
Biofeedback training to show you how well you are using your pelvic floor muscles
Electrical stimulation to improve muscle function
Controlled breathing and relaxation exercises
Instruction for home exercise programme to improve pelvic floor function
Instructions on how to control pelvic floor and abdominal muscles during coughing, sneezing and laughing etc
Education on how to make lifestyle changes that may affect the bladder
PROSTATE SURGERY - (TURP)
TRANSURETHRAL RESECTION
INTRODUCTION
Prostate surgery primarily involves surgical procedures that treat problems associated with the prostate. The most common problems men experience are prostate enlargement and cancer of the prostate. Symptoms that occur as a result of prostate problems include difficulty passing urine, pain when urinating, blood in the urine and frequent urinary tract infections. Prostate surgery can either involve the removal of part of the prostate (transurethral resection) or removal of the entire prostate (prostatectomy). Prostate surgery is critical in the attempt to cure cancer of the prostate and to significantly reduce symptoms associated prostate enlargement.
Transurethral resection of the prostate (TURP) is a minimally invasive surgical procedure that is used to remove part of an enlarged prostate gland. Transurethral resection of the prostate is necessary to significantly reduce symptoms that are associated with an enlarged prostate or prostate cancer. Physiotherapy after transurethral resection of the prostate (TURP) is crucial to aid a full recovery after prostate surgery.
TURP is the most common surgery performed for an enlarged prostate. An enlarged prostate is also known as benign prostatic hyperplasia (BPH). BPH refers to the increase in size of the prostate gland and is caused by an overgrowth of cells that can lead to an obstruction of the urethra which consequently interferes with the normal flow of urine. The urethra is the tube that carries urine from the bladder and out through the penis. An obstruction of the urethra leads to symptoms such as difficulty passing urine, pain on passing urine, frequent urination, blood in the urine or semen and an increased risk of urinary tract infections.
TURP is also used in the treatment of prostate cancer and aims to remove part of a prostate cancer that is pressing on the urethra. TURP is not done to cure the cancer but it can significantly relieve the symptoms.
TURP surgery is usually performed under general anesthesia but can sometimes be done using a spinal anesthetic or epidural. TURP is carried out using a narrow, flexible tube called an endoscope that is inserted into the urethra. The endoscope has a camera attached to it so that the surgeon can see inside the urethra and prostate. The surgeon will then cut out and remove part of the enlarged prostate and unblock the urethra using specially adapted surgical instruments which are attached to the endoscope. Also, during the operation, the bladder will be flushed with a sterile solution to eradicate the pieces of prostate tissue.
Physiotherapy after TURP surgery is essential to maximise the success of the surgery, prevent future problems and to aid in a full or near to full recovery.
SYMPTOMS
After you have undergone TURP surgery you will feel drowsy until the anaesthetic wears off fully. If you received an epidural you may not be able to feel or move your legs for several hours after your surgery. You will feel some pain and discomfort after the surgery which you will be given pain killers for. During your stay in hospital, you will initially require a catheter for 2-3 days after your surgery to drain urine from your bladder and to wash out your bladder with a sterile solution. The catheter will be removed once your urine begins to run clear. You may also require a drip attached to your arm which will help prevent dehydration post-surgery. You will be encouraged to get out of bed and move around as much as possible to prevent blood clots and chest infections. The length of time you stay in hospital will depend on your recovery. You will be discharged approximately four days after your TURP surgery. Recovery after TURP surgery should take on average about eight weeks. You will not be able to drive for up to four weeks and you will be advised not to carry out any activities that involve heavy lifting for eight weeks. After your TURP surgery you may experience problems such as pain, urinary incontinence, bowel problems and weakness in and around your pelvic area. Physiotherapy after your TURP surgery is crucial to help overcome these problems and get you on your way to a full or near to full recovery.
PHYSICAL THERAPY MANAGEMENT
Physiotherapy focus on correcting the problems that you will be experiencing as a result of your TURP surgery. Physiotherapy treatments and activities include:
Pain modalities (to control pain)
Strengthening exercises for the pelvic floor muscles
Strengthening exercises for the abdominal muscles
Bladder training to help the bladder return to normal function
Biofeedback training to show you how well you are using your pelvic floor muscles
Electrical stimulation to improve muscle function
Instruction for home exercise programme to improve pelvic floor function
Instructions on how to control pelvic floor and abdominal muscles during coughing, sneezing and laughing etc.
Education on how to make lifestyle changes that may affect the bladder
Controlled breathing and relaxation exercises
Advice on comfortable positioning
Hydrotherapy
REDUCED MOBILITY
Introduction
Prostatectomy surgery is a procedure that is performed to remove all or part of the prostate so as to treat prostate cancer. Prostatectomy surgery is critical in the attempt to cure the cancer and to significantly reduce symptoms that are associated with enlargement of the prostate. A course of physiotherapy is required after prostatectomy surgery to aid a full or near to full recovery.
The prostate is a small gland about the size of a walnut which surrounds part of the urethra. The urethra is the tube that travels from the bladder and prostate to the penis and carries urine and semen. Cancer of the prostate results in the enlargement of the prostate which consequently causes the prostate to press on the urethra and block the normal flow of urine. Symptoms caused by prostate cancer include; difficulty passing urine, pain on passing urine, frequent urination, blood in the urine or semen and an increased risk of urinary tract infections.
There are two approaches to prostatectomy surgery including:
Radical prostatectomy
Laparoscopic prostatectomy
Radical prostatectomy
Radical prostatectomy is indicated if the cancer has not spread outside of the prostate and for younger males, with high grade tumours. The procedure is performed under general anaesthetic. The surgery is carried out by a specialist surgeon who makes a large incision into the abdomen or between the testicles and the back passage. The entire prostate is removed along with surrounding tissues with the aim of getting rid of the cancer. Once the malignant tissues have been removed, the area is checked and the wound is then closed.Laparoscopic prostatectomy.
Radical prostatectomy
Laparoscopic prostatectomy surgery has similar outcomes to radical prostatectomy surgery in that the prostate is removed along with surrounding tissue so as to eradicate the cancer. Laparoscopic prostatectomy surgery is performed using keyhole surgery (laparoscopic). Keyhole surgery involves a small incision being made to the abdomen. A narrow tube with an attached light and camera is inserted into the body so the surgeon can see the prostate clearly. Small instruments are also attached to the tube and the prostate gland is cut away along with surrounding tissues and removed through the incision in the abdomen. With laparoscopic prostatectomy surgery, there isn’t a big wound therefore there is a reduced risk of infection, a smaller scar and faster recovery post-surgery. Once the cancer has been removed, the small wound is the closed.
Special effort is made in both the procedures to spare any damage to the nerves located near the prostate to prevent any erection difficulties after the operation. However, in many cases damage to the nerves cannot be avoided.
Physiotherapy after prostatectomy surgery is essential to maximise the success of the surgery, prevent future problems and to aid in a full or near to full recovery.
Symptoms
During the initial period after you have undergone prostatectomy surgery, you will feel drowsy until the anaesthetic fully wears off. You will have a drip attached to your arm to replace bodily fluids which will be removed once you’re able to drink normally. You will be encouraged to drink as much fluid as possible. During your stay in hospital, you will initially require a catheter for 2-3 days after your surgery to drain urine from your bladder and to wash out your bladder with a sterile solution (bladder irrigation). The catheter will be removed once your urine begins to run clear and when you are urinating normally. After the surgery, you will experience some pain and discomfort around the wound which you will be given pain killers for. However, you will experience minimal pain if you underwent laparoscopic prostatectomy surgery. The length of time you stay in hospital will depend on your recovery. You will be discharged approximately four days after your prostatectomy surgery. You will be advised not to drive for up to four weeks after your surgery and full recovery may take eight or more weeks. You should avoid strenuous activities and heavy lifting after your prostatectomy.
After your prostatectomy, you may experience problems such as:
Pain
Urinary incontinence
Bowel problems
Weakness in and around your pelvic area
Physiotherapy after your prostatectomy surgery is crucial to help overcome these problems and get you on your way to a full or near to full recovery.
Causes
 older age
 degenerative conditions
 psychological problems
 low physical activity
 obesity
 impaired strength and balance, and
 chronic diseases such as diabetes and arthritis.
Physiotherapy Treatment
Physiotherapist will provide you with a personal rehabilitation programme which main goals focus on:
Minimising pain
Reducing urinary problems and incontinence
Reducing bowel problems
Improving muscle strength and endurance
Improving cardiovascular fitness
Re-establishing function and independence
After receiving a thorough assessment, we will highlight the main problems you will be experiencing after your prostatectomy surgery and set rehabilitation goals that are personal to you. We will provide you with a variety of treatment methods and activities that aim to correct these problems. Physiotherapy treatments and activities include:
Pain modalities (to control pain)
Strengthening exercises for the pelvic floor muscles
Strengthening exercises for the abdominal muscles
Bladder training to help the bladder return to normal function
Biofeedback training to show you how well you are using your pelvic floor muscles
Electrical stimulation to improve muscle function
Instruction for home exercise programme to improve pelvic floor function
Instructions on how to control pelvic floor and abdominal muscles during coughing, sneezing and laughing etc.
Education on how to make lifestyle changes that may affect the bladder
Controlled breathing and relaxation exercises
Advice on comfortable positioning
Hydrotherapy
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