Prostate Pelvic Floor Prostate Pelvic Floor Physiotherapy Physiotherapy

Karen EdwardsKaren Edwards

Clinical Specialist PhysiotherapistClinical Specialist Physiotherapist

WGHWGH

Who am IWho am I

Clinical specialist PT at WGH for since 2006 Clinical specialist PT at WGH for since 2006

Background- General PT experience, women’s Background- General PT experience, women’s health continence at St John’s and in NZ, health continence at St John’s and in NZ, Scientific committee of ICSScientific committee of ICS

Current post- set up for joint consultant female Current post- set up for joint consultant female clinic and the male post was a creeping clinic and the male post was a creeping development, with no money attacheddevelopment, with no money attached

New prostate pre op service !!!!!!!!New prostate pre op service !!!!!!!!

What is my role with male patientsWhat is my role with male patients

Fully assess pelvic floor function Fully assess pelvic floor function Internal examination essential part of treatmentInternal examination essential part of treatment

Teach correct facilitation of pelvic floorTeach correct facilitation of pelvic floorProvide an individual tailored programme to improve PF, Provide an individual tailored programme to improve PF, awareness, strength, endurance and functionalityawareness, strength, endurance and functionalityTo provide monthly follow up and progress treatment To provide monthly follow up and progress treatment plan as ableplan as ableTo provide motivation and aid with compliance To provide motivation and aid with compliance techniquestechniquesTo liaise with consultant and nursing colleagues re To liaise with consultant and nursing colleagues re progressprogressTo refer on to Nursing or consultant colleagues if no To refer on to Nursing or consultant colleagues if no progress made in 6- 8 months progress made in 6- 8 months

Myths of the pelvic FloorMyths of the pelvic Floor

First mentioned in 400 BC- believed that air First mentioned in 400 BC- believed that air caused the male pelvic floor to contract and caused the male pelvic floor to contract and that blood flow alone was responsible for that blood flow alone was responsible for an erection.an erection.

1930- first time pelvic floor exercises were 1930- first time pelvic floor exercises were mentioned, malementioned, male

1996- 11996- 1stst recognized tool for recording recognized tool for recording method of assessmentmethod of assessment

Recent ICS papers 2011Recent ICS papers 2011

What is the pelvic floorWhat is the pelvic floor

The floor of the pelvis is made up of layers The floor of the pelvis is made up of layers of muscles. These layers stretch like a of muscles. These layers stretch like a hammock from the pubic bone to the base hammock from the pubic bone to the base of the spine at the backof the spine at the backDynamic mobile structure with the ability to Dynamic mobile structure with the ability to improve its functionimprove its functionMaintain continence, bowel and bladder as Maintain continence, bowel and bladder as it supports the urethra and back passage it supports the urethra and back passage through the pelvic floor muscles.through the pelvic floor muscles.

Pelvic floor hammockPelvic floor hammock

Laproscopic radical prostatectomyLaproscopic radical prostatectomy

SphinctersSphincters

Sphincters cont’dSphincters cont’d

Sphincter functionSphincter function

Stress incontinenceStress incontinence

The involuntary leakage of urine on any effort or activity

- (varies in volume and activity)

Stress IncontinenceStress Incontinence

Lets exercise them !Lets exercise them !

Positions- Sitting on a hard surface, separate Positions- Sitting on a hard surface, separate legs and bottom cheeks, standinglegs and bottom cheeks, standing

Find the max number without losing quality, Find the max number without losing quality, repeat. repeat.

Endurance- hold without losing qualityEndurance- hold without losing quality

Static- progress to functional activitiesStatic- progress to functional activities

Indicators- scrotal rise, penis indrawingIndicators- scrotal rise, penis indrawing

Eliminate the buttocksEliminate the buttocks

HOW OFTEN ???????????????HOW OFTEN ???????????????

WHY do themWHY do them

Internal urethral sphincter even with nerve Internal urethral sphincter even with nerve sparing, and laproscopic surgery had potential to sparing, and laproscopic surgery had potential to be effected.be effected.

Continence will therefore depend on a Continence will therefore depend on a competent external urethral sphincter reinforced competent external urethral sphincter reinforced with the pelvic floor.with the pelvic floor.

Studies have shown benefit of pre and post op Studies have shown benefit of pre and post op correct facilitation of pelvic floor in the first year correct facilitation of pelvic floor in the first year after surgery. Get started early !!after surgery. Get started early !!