What Every Man Should Know about Pelvic Floor Therapy

Marvin Herring loves to run. The 78-year-old can knock out a 5K in 28.50 thanks to a dedicated weekly fitness routine that includes regular laps around TCU track and light weight workouts out 24 Hour Fitness. 

When he was diagnosed with prostate cancer, Herring couldn’t imagine his life without running, so he was concerned about side-effects that might follow a robot-assisted prostatectomy. He talked with Scott Thurman, MD, a urologist and surgeon at USMD Prostate Cancer Center.

“I asked him, ‘How much will I leak?’ He said, ‘Well, you’re going to leak for a little while. It depends on you and what you do. I want you to go to rehabilitation afterward. They’ll give you some moves that will help stop any kind of leakage you have if you do all the exercise.’”

By August 20, Herring was jogging and running again. By September 20 he was back in race form.

“I got my 5K time back to 33:05. Pre-surgery it was 28:50, but I don’t have any leakage running or walking,” Herring says.  

Dr. Thurman, Dr. Rich Bevan-Thomas, and Dr. Justin Lee often prescribe pelvic floor therapy for their prostatectomy patients. And for good reason.

“In men, the position of the prostate gland applies pressure which partially shuts off the bladder and prevents leakage,” says NaKisha Jackson, PT, DPT, WCS, a certified pelvic floor therapist at USMD Hospital in Arlington. “When the prostate is removed, the pelvic floor has to apply that pressure by itself. I train men how to properly engage their pelvic floor muscles so they react a little bit more quickly and work in coordination with their bladder and brain. When the bladder, pelvic floor, brain and abdominals work together, incontinence isn’t an issue.”

Jackson begins by getting a picture of what the coordination looks like and then reorients the whole system. She likens it to pressing “ctrl-alt-delete” on your computer. The reprogramming process begins by checking the integrity of the pelvic floor through a rectal exam and biofeedback, or simply using biofeedback when a man isn’t comfortable having a rectal exam.

“With biofeedback we’re testing muscle recruitment, the ability for the muscle to relax and contract. The rest of the exam is to test the patient’s sensation, and whether or not he can identify the various quadrants of the pelvic cavity. This gives us a better idea of how well he’s able to use his pelvic floor,” she says.

Along with the pelvic floor muscle, Jackson checks the alignment of the sacroiliac joint—the joint that connects the sacrum (the triangular bone at the bottom of the spine) with ilium and is the attachment of the pelvic floor.

“If the joint is not in alignment we teach patients how to get their joint into a better position,” she says.

Together, the pelvic exam and biofeedback help Jackson to determine why patients are leaking. When she knows the cause, she develops an individualized treatment to successfully retrain patients about the way they move.

“Your pelvic floor muscles have a role in every movement you make during the course or your day,” she explains. “Getting out of your car, bending over to feed your dog, lifting a heavy box at work, mowing the lawn, coughing, sneezing, laughing—everything!”

“If your pelvic floor muscles haven’t been functioning properly every day, every week, every month, every year for the six years that you’ve been leaking, then a whole new pattern has developed that isn’t beneficial to you. We have to undo that pattern, teach a new pattern and build enough repetition so your brain will start following the new pattern automatically.”

Jackson typically sees patients once a week for four to six weeks to ensure they are using their pelvic floor properly throughout their day and troubleshoot any issues they may encounter.

“A patient may come in after a few weeks and say, ‘Now I only leak when I walk the dog,’ so
I hook them up to biofeedback so I can see what’s happening with their pelvic floor muscles while they’re walking or squatting. I watch them as they go through the sequence, making sure they’re not missing any steps.”
 
The results are gratifying.

“When men come in, they’re not used to leaking,” Jackson says. “Their dad didn’t leak. Their best friends don’t leak. So as far as he’s concerned, this is a problem and it needs to be addressed immediately. I’ve even had men tell me, ‘If I’d known the leaking was going to be this bad, I wouldn’t have had my prostate taken out.’ I really want to help them so they can have the quality of life they want to have after their prostate cancer surgery.”

Fortunately, pelvic therapy has very good results. 

“It absolutely makes a difference,” Jackson says.

It did for Herring, who calls himself the “poster boy for enjoying life free from prostate cancer.

“I don’t jump out of my recliner quickly and I don’t lean over at my gate and pick up my paper quickly—that presses against my bladder, but I met with a physical therapist four times during rehab and learned exercises that help with bladder control. The main thing was I didn’t want to leak when I was running or walking and that doesn’t happen.”

Nearly 60 percent of Jackson’s patients are men and she says they often show improvement faster than women patients.  
 
“I get calls all the time, ‘Oh my gosh, I sneezed and I didn’t pee,” she laughs. It may seem like a small thing, but Jackson knows pelvic floor therapy has been a life changer for many men following prostate cancer treatment.

If you’d like to know more about pelvic floor therapy or schedule a consultation with NaKisha Jackson, call the Pelvic Floor Therapy Program at 817-472-3798. The team will be happy to reach out directly to your physician to see about a referral.



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