Resolving Incontinence and Pain
This retrospective review was conducted to determine how well patients responded to individual types of PFMT. For the study, the researchers reviewed the charts of 136 patients who had undergone robotic-assisted prostatectomy performed by the same urologic surgeon. All the patients had developed urinary incontinence and were referred to the physical therapy department between 2009 and 2014.
Reduced incontinence The patients were referred to physical therapists who specialized in evaluating and treating pelvic floor dysfunction. They determined that only 25 of the patients had underactive or weak pelvic floor muscles, whereas 13 had overactive or tight muscles. Of note, 98 patients were determined to have had mixed-type PFD. Their pelvic floor muscles were both weak and tight, components of underactivity and overactivity, respectively. All patients received individual physical therapy for their type of PFD, and 87% experienced significant improvement in their incontinence.
Reduced pain Pelvic pain was also a problem experienced by 27% of the patients, most often manifesting in those patients with mixed-type PFD. Pelvic physical therapy reduced that to 14%. The authors explained that patients with a component of overactivity have shortened pelvic muscles and develop trigger points, leaving them unable to contract strongly enough to prevent incontinence. Individualized physical therapy increases muscle length by relaxing the pelvic floor, enabling stronger and more functional contractions and reducing pain.
The UT Southwestern group report theirs is the first study to demonstrate that pelvic physical therapy can lead to decreased pain for a statistically significant portion of men who experience pain after prostatectomy, and call for more research on helping postprostatectomy patients.
1. Scott KM, Gosai E, Bradley MH, et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain [published online December 5, 2019]. Int Urol Nephrol. doi: 10.1007/s11255-019-02343-7.