Prostate Cancer: Regaining Control of the Pelvic Floor

Men undergoing prostate cancer treatment should give special attention to ensuring good pelvic floor strength in order to reduce side effects of treatment and maximize urinary and sexual function. Although the pelvic floor is often associated with women’s issues, both men and women have dysfunctions related to pelvic floor control.

The pelvic floor is a group of muscles and connective tissues that are found in the pelvic cavity, supporting the functions of the bowel, the bladder and sexual organs. The pelvic floor assists in urinary and fecal continence and stabilizes connecting joints of the pelvis. The pelvic floor muscles aid in sexual performance and contract during orgasm. In addition, the pelvic floor muscles aid the abdominals and back muscles in providing structural stability to the spine.

How does the pelvic floor relate to urinary and sexual function?

Urinary function: The pelvic floor muscles are important in controlling the flow of urine. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings to the anus and urethra, preventing output or leakage. When a person’s pelvic floor muscles are relaxed, they allow the passage of urine or bowel movements. Incontinence happens when someone leaks urine or is unable to control urine output. If the bladder and urethra are not properly supported, this can become a common and frustrating side effect during prostate cancer treatment.

Sexual function: In order to maintain an erection, the pelvic floor muscles assist in blocking the escape of blood from the penis. Contraction of the ischiocavernosus muscle, which is one of the pelvic floor muscles, creates much higher blood pressure within the penis, maintaining rigidity and helping to sustain an erection. If the pelvic floor muscles are weakened, then they are not able to inhibit this outflow of blood, which can lead to partial flaccidity.

How is the pelvic floor compromised in men with prostate cancer?

The prostate is a gland that is located under the bladder and surrounds the urethra. During cancer treatment, oftentimes the prostate is removed or treated with radiation, damaging the surrounding tissues, including the supporting pelvic floor muscles. When the muscles of the pelvic floor are compromised, this leads to weakness and even pain.

How can I strengthen my pelvic floor?

Because the pelvic floor is composed of muscles, it can be strengthened just like any other muscle in the body. To strengthen the arms, someone may perform bicep curls or pushups. Similarly, strengthening the pelvic floor involves actively engaging the muscles. Pelvic floor exercises are typically referred to as Kegel exercises.

Here are some tips on doing these exercises:

To find your pelvic floor muscles, imagine trying to lift the base of your penis up or trying to stop the flow of urine mid-stream. The muscles you are activating are your pelvic floor muscles. Don’t feel badly if you initially have difficulty isolating them. It may take a little practice. It is usually easier to isolate your pelvic floor muscles if you lie on your back with your feet flat and knees bent. Allow yourself to relax. Then, try to contract the muscles.

The contraction should feel like you are lifting up instead of bearing down. You should try to lift the perineum, which is the area between your scrotum and anus. There should be little activation of the abdominals, thighs or buttocks. Never hold your breath.

To exercise your pelvic floor, contract and hold your pelvic floor muscles for a count of 5 seconds. Then relax fully. Repeat this contract/relax sequence for 20 repetitions. You should aim to do these 20 repetitions three to five times per day. Kegels are great exercises because they can be done virtually anywhere and in any position. They require no equipment and can be performed without anyone noticing.

When should I begin pelvic floor strengthening?

Ideally, pelvic floor strengthening should begin before surgery for men undergoing prostate cancer treatment. The earlier they strengthen the pelvic floor muscles and make these exercises part of a regular routine, the better the outcomes. Of course, it is never too late to strengthen the pelvic floor. After surgery, it is recommended that men begin strengthening right away. As with any other muscle group, it takes four to six weeks to make changes in the muscle fibers and see noticeable improvement in strength.

Remember that muscle control is only one aspect of urinary and sexual function. Nerve damage may limit improvement, despite regular pelvic floor strengthening. Those having difficulty with control of their urinary or sexual functions should seek guidance from their oncology medical teams or a physical therapist.

Amy Vant is a doctor of physical therapy and the lead clinician for ActiveRx in Hinsdale, Ill., which provides rehabilitation services to mature adults. Vant has a clinical interest in cancer treatment and rehabilitation and writes frequently on the topic.