Mend Physical Therapy Blog and Injury Information

What is the best exercise prescription for for reducing incontinence after prostate surgery?

September 3, 2020


According to the American Cancer Society, prostate cancer is the most common cancer in men, aside from skin cancer. A radical prostatectomy (RP) is a common and highly effective treatment for men with prostate cancer in which the prostate is surgically removed. Despite being an effective treatment option, it is not without negative side effects such as stress urinary incontinence (SUI). SUI is defined as involuntary loss of urine that typically occurs with coughing, laughing, sneezing, bending over, and exercise. It is estimated that between 69-98% of men will experience urinary incontinence after a prostatectomy (Ficarra et al. 2009). 

Previous studies pose conflicting views on the benefits of pelvic floor muscle training to assist men with resumming continence following a radical prostatectomy. A recent study by Milios et al. published in BMC Urology in 2019 supports the idea that pelvic floor muscle training not only leads to faster return to continence, but men also experience a smaller volume of leakage in the early post-op period. This study differs from past research on postprostatectomy incontinence in a number of important ways. Pelvic floor muscle training was initiated 5 weeks prior to surgery and continued 12 weeks after. The intervention group also utilized high-volume training compared to the low-volume (a more traditional pelvic floor muscle training protocol). Both groups received specific verbal cueing and biofeedback with a real time ultrasound to ensure good pelvic floor muscle contraction and isolation. 

“Low-Volume Exercise” Control group: received traditional instruction of 10 reps of pelvic floor contraction, with hold for 10 seconds, performing 3 sets/day for a total of 30 reps/day. The exercises were performed with 1 set in each position: laying down, sitting and standing. 

“High Volume Exercise” Intervention group: received specific instruction for both fast and slow twitch muscle fiber including 10 reps of fast pelvic floor contractions, and 10 reps slow pelvic floor contraction, with hold for 10 seconds, performing 6 sets/day for a total of 120 contraction; in standing only.

The same protocol was performed for 5 weeks prior to surgery and for 12 weeks post-op after the catheter was removed. In each stage of the study, at 2 weeks, 6 weeks and 12 weeks post-op, the high-volume exercise intervention group reported greater rates of continence compared to the control group with the largest difference between groups at 12 weeks post-op where 74% of the high-volume exercise group were dry compared to 43% of the control group who received lower intensity PFM training.

Schedule your first physical therapy appointment during the typical 6 week waiting period between prostate biopsy and subsequent surgery to ensure you are performing the exercise program correctly and reduce the occurrence of incontinence.

Click Here to learn which exercises are best for accelerating your recovery from surgery