On average, 80% of men following a radical prostatectomy experience urinary incontinence. Urinary incontinence is defined as an involuntary loss of urine, which can be from muscle weakness or poor pressure management. Approaches to manage urinary leaking may include muscle strengthening through proper breathing mechanics/pressure management and possible lifestyle modifications such as diet.
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CC: Urinary Incontinence and Pain
Adam was a 63-year-old male presenting with discomfort and urinary incontinence following a radical laparoscopic prostatectomy, which was performed 10 days prior to our visit. Prior to surgery, he was given a sheet of paper with pelvic floor exercises to complete, and he noted discomfort with contractions that made urination difficult prior to surgery, so he did not continue to work on those exercises pre and post-operation.
At evaluation, he reported the use of adult diapers and using, on average, 6-8 diapers a day. He noted having to change since the diaper was full/heavy, but if he were talking, that would make him leak more urine with little to no control to stop the leaking. He is still working and needs to travel, which he is worried about due to the fear of having enough diapers or having an issue with leaking while with a prospective buyer of his products for work.
Additional History:
Due to medication to assist with discomfort management, he noted increased constipation with straining to have a bowel movement. He also disclosed that he has an abdominal aortic aneurysm, which is monitored once a year and leads to some dizziness when he changes positions. This is actually due to increased pressure on the walls of the aorta, which can be from poor breathing mechanics leading to poor pelvic floor mechanics.
He notes that he sees the dermatologist for body scans every month for melanoma. His grandfather passed from prostate cancer. He currently lives at home alone but has a personal trainer come daily for 1 hour, 5 days a week. He does eat out at times, but his wife comes over to cook meals with no sugar, fruits, or veggies but with plant-based protein and minimal carbs.
Interventions:
The following guidelines were discussed:
Proper Hydration
A lot of the time, people can experience constipation post-operation due to medication but also due to not being properly hydrated. Reduction in water intake is not uncommon for people who experience uncontrollable leaking as well. We discussed using half his body weight in ounces as a guideline to start with and then using the color of his urine to gauge if he was truly properly hydrated.
Pelvic Floor Relaxation
This is the first place to start in order to make sure we are starting at an even baseline for the pelvic floor muscles. This was accomplished with proper breathing mechanics as our foundation to build off of.
Pelvic Floor Activation/Integration
We started in laying, progressed into seated, standing, and lastly, with movement to work on integration into lifestyle. All while still balancing with relaxation to work on the full range of the pelvic floor to truly support the pelvic floor muscles. We worked on the different muscle fiber types of slow twitch and fast twitch to help the muscles have not only power but also endurance. Working on spinal mobility in the warm-up and cool-down was important to understand the pelvic connection through the spine and the importance of proper mobility throughout the body. The exercises completed once a day 5 days a week for 1 hour were as follows:
Follow Up
10 months into the sessions, the patient reports having better urinary control. He no longer wears adult diapers and uses a thin liner. His ability to manage leaking has improved significantly, and he can travel with little to no worries about urinary leaking. He currently uses 3-4 thin pads a day that are not saturated but lightly damp. Not only does he feel he has better control of contracting his pelvic floor muscles to manage leaking if it happens, he feels he is straining less to have a bowel movement.
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Summary
This case shows the importance of setting the right foundation with breath work and building on that to help integrate the pelvic floor into daily life to help make the biggest impact on managing urinary leaking. Supporting the pelvic floor is not just about activation. It is also about allowing the muscles to relax to help support the full range of the muscles. It is also important to follow dietary and lifestyle habits that have an impact on the organs supported by the pelvic floor.
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