The problem – unpredictability
After surgery the nerves that control your ability to pee are numb or confused meaning that you lose control of your pelvic floor muscles. So things can be pretty unpredictable. You may have the urge to pee and find that instead you pass wind or a stool or you even detect the beginnings of an erection! …….. or all of these! ……… or none of these!
This inability of the nerves and muscles to do the right thing when you want them to will almost certainly occur after prostate surgery. This is why before surgery you need to develop an awareness of which muscles control urination. This is quite simple to do. When we normally go to pee we just let go of it. It happens and we do it unconsciously. You now have to consciously control the letting go process, as well as practising stopping mid flow.
One of the side effects of prostate surgery is urinary incontinence – or inability to control your peeing. The bladder which holds the urine has a sphincter (muscle) which normally closes the bladder and prevents urine from flowing out.
Sometimes the nerves that control this sphincter get disturbed or damaged – as happens during surgery for prostate cancer. If this happens the sphincter stops working properly.
It’s very difficult – and sometimes impossible – for the surgeon to avoid this happening because these nerves which control the sphincter travel over the surface of the prostate on the way to the pelvic floor.
When the surgeon removes your prostate the nerves get disturbed, damaged or even need to be cut if they have become involved with the cancer.
This is one of the main reasons for removing the prostate early because the less any cancerous cells have spread, the less the nerves will be damaged in removing the prostate. If there’s not much damage to the nerves during surgery you’ll suffer less from incontinence and you’ll recover more quickly and easily afterwards.
But as long as your nerves haven’t been permanently damaged – which can happen if your cancer was quite advanced – you too can affect how fast you get back to normal – or as near normal as possible.
Improving your pelvic floor muscle tone can improve your recovery after surgery
What is important is that the greater your muscle tone and general strength before surgery, the quicker your overall recovery will be. This is especially important in the pelvic floor area. Good, strong muscle tone and your ability consciously to identify which muscles control what will help you get back to normal more quickly and easily.
Strengthening your pelvic floor muscles is key to success in recovering from the after effects of prostate surgery.
How to do it
There are two key things to focus on.
- getting to know which muscles control the different bodily functions in your pelvic area – that is urinating, ejaculating etc
- exercising your pelvic floor area so that you can control these functions consciously before surgery.
After surgery when your nerves are confused and/or damaged your ability to control the various muscles and sphincters in your pelvic region will help to get you back to normal function as quickly as possible.
Pelvic floor anatomy
It seems obvious that simply squeezing the muscles between your legs (that is the pelvic floor) will help to control the flow of urine through the pelvic floor. For that reason people have known about and practised pelvic floor exercises for many years.
However simply trying to squeeze the pelvic floor muscles like this isn’t always enough to control incontinence. There are three main reasons for this:
- people often find it difficult to identify which muscles they need to squeeze
- their pelvic floor muscles aren’t toned
- they don’t know how best to control them
So knowing something about the pelvic floor muscles and where they are is very helpful.
Here’s a detailed diagram of the male pelvic floor area showing the pelvic floor muscles (in red) stretching from the pelvic bone in the front to the coccyx bone (in grey) at the back.
There are two openings that go through the pelvic floor area – the rectum for the bowel at the back and the urethra for the bladder towards the front. The prostate rests virtually on the pelvic floor with the bladder behind it.
Here’s a different view of the male pubic floor muscles. In this diagram the horizontal line separating the back section from the front section (called the superficial transverse perineal muscle) is clearly illustrated.
The muscles around the openings for the rectum and the urethra control the sphincters which keep these openings tightly closed.
The bladder is a muscular bag for retaining urine and a circular muscle or sphincter keeps it closed most of the time. When you’re peeing this sphincter muscle relaxes to allow the fluid to pass into the urethra and finally through the muscles of the pelvic floor.
It’s these pelvic floor muscles that you need to strengthen and learn to control consciously before you have surgery.
The better you can strengthen and control them, the better your chances of minimising the effects of incontinence after your surgery.