I recently treated a man orthopedically, as I thought I was seeing him for knee pain.

As it turns out, he heard that I have experience treating pelvic floor dysfunction. He requested that we spend our time together educating him on how to prevent pelvic floor dysfunction secondary to his scheduled prostatectomy—instead of treating his knee.

Put plainly, this man was worried about his sexual and continent health, and rightly so! (Incontinence is insufficient voluntary control—or no control at all—over urination or defecation).

Impact of Surgery on the Body

In a study by Stanford et al, 8.4% of men were incontinent and 59.9% were impotent 18 months following radical prostatectomy. Like with any other surgery, the body is cut; with it, nerves, blood vessels and muscle are all affected.

I call any surgery a “controlled trauma.”

The body’s initial response is to work overtime to heal and make sure the body is intact and safe. Because of this, blood vessels damaged or cut will go through a process called neovascularization, where nerves and muscle will reproduce in their own time. In the time it takes for these structures to heal, the body may experience muscle spasm, localized or global swelling, and pain as a result of the body trying to stabilize and protect from additional trauma or loss.

Why Pelvic Floor “Pre-Rehab” is Important

You can imagine that an intact musculoskeletal and nervous system is the optimal environment for the body and brain to learn new or unfamiliar exercises. It is under these conditions that pre-rehab for pelvic floor muscles are significant prior to “controlled trauma” procedures such as prostatectomy.

The man I saw today obviously felt the value of physical therapy to his pelvic health, and thankfully knew the significance of pre-rehabilitation to prevent dysfunction post operatively. Numerous articles highlight and demonstrate the merits of exercise before and after surgery and its association with greater successful outcomes. A study by Hoogeboom et al acknowledges that a poorer preoperative physical condition may hamper postoperative recovery.

With this proactive type of thinking, every person who undergoes the controlled trauma of pelvic and abdominal surgery would have the opportunity to assess their baseline, and improve their chances of returning to optimal function instead of allowing the potential of weakness and instability to infect the body.

The decision to have a prostatectomy may, at times, come after years of dealing with symptoms of urinary frequency, urgency, incontinence and sexual dysfunction. Knowing this and the results of a prostatectomy, put your best foot forward and be seen by a pelvic floor physical therapist before and especially after a prostatectomy.

6 Things to Have Assessed Before Prostatectomy

Things that should be assessed by a pelvic floor physical therapist prior to surgery include: checking for diastasis recti, or split in the abdominal muscles, assessing proper engagement to transverse abdominal muscles, checking resting tone to pelvic floor muscles, determining strength and ability to concentrically contract pelvic floor muscles and even more importantly, be able to eccentrically lengthen pelvic floor muscles after a full contraction.

Not only will a therapist be able to provide symptom management techniques but will find deficiencies to address to make change to a system that can be strengthened and improved. The care and treatment to pelvic floor pre and post operatively can greatly impact the function.

All of her contributing factors (phenotypes) were:

• Pelvic floor muscles
• Irritable pudendal nerve
• Chronic recurrent yeast infections
• Stress (learn more about the pelvic floor / stress connection here)
• Hormones
• Diet

These are all phenotypes that caused her vulvodynia. In order for the patient in this example to heal, it is not the “vulvodynia” that needs to be treated. Rather, each and every underlying, perpetuating cause need to be addressed.

Please note: vulvodynia pain will vary widely from woman to woman. Symptoms may be primary (possessed consistently for a lifetime) or acquired (periodic, inconsistent pain symptoms).

So what’s the big deal?

The medical term out there right now, vulvodynia, does not tell us much. All it says is that you have burning or irritation in the vulva. This particular patient spent 11 years with doctors who looked only at the medical component of it, for its face value as a descriptor. Her “treatments” for those 11 years were medications of various types, including yeast suppressants, Vitacain (to stop the burning), and an anti-fungal diet. The muscles themselves? Completely ignored. When she came in to us, her pain was down within the first treatment.

I asked the question I always ask,

“Hey, did your OB/GYN doctor actually do a muscular exam of your pelvic floor?”
To which the answer was, and almost always is:

“No…”
Sure enough, one I went in and palpated, she had significant both superficial and deep muscle spasm.

This patient, though perturbed by 11 years without what she now knows are extremely important pelvic floor physical therapy treatments, now carries a significant amount of hope into her future healing journey.

I guess it’s true what they say…the truth sets you free! Whether you are a patient or clinician, be sure to dig deeper into descriptions of pain to find the (sometimes numerous) underlying causes of it.

The Pelvic Healing team believes healing is multi-modal, and requires a customized treatment plan for best results.