Holistic Incontinence Physiotherapy for Prostate Cancer Survivors

Holistic Physiotherapy for Prostate Cancer Survivors

In the past few years, there are an increasing number of prostate cancer survivors seeking physiotherapy services to help treat side effects of treatment. Maybe due to increasing evidence of pelvic floor muscle training (PFMT) helping to manage some of the symptoms, more physiotherapists are becoming interested in treating this population. However, it is important to note that there are other areas that will affect this population recovery outcome, and that PFMT is only a part of it.

I have been working in this area for over 10 years, and learned that not everyone will benefit from PFMT. Clinically it makes sense, but we have to look at biology as part of the equation, which is influenced by the central nervous system, people’s expectations and social support.

There are over 23000 men diagnosed with prostate cancer every year in Canada. Medical advancement and early detection and treatment resulted in increasing number of prostate cancer survivors. However side effects of treatment can greatly impact men’s mental status and quality of life. The most common side effects of treatment are urinary incontinence (UI) and erectile dysfunction (ED). These symptoms, especially with younger men, violates expectations regarding urinary and erectile function age norms and often negatively impact the psychological well-being of patients. Mental status can also influence UI, ED and healing speed. One in six men with prostate cancer diagnosis will experience clinically significant depression. These rates are higher than the general population, and depression and anxiety can significantly be associated with worse surgical outcomes and higher risk for UI. To address and screen mental health is probably more important than PFMT when treating this population.

For someone who has been treating the pelvis for over 12 years, I have greatly appreciated the importance of screening mental health status of my clients. The pelvis seems to be an area where people tend to guard and respond to emotions, especially stress. There is a strong correlation between anxiety and depression and bladder symptoms. Anxiety and depression is a risk factor for UI and UI is a predictor for the onset of depression and anxiety.

How can you treat prostate cancer survivors holistically?

As a therapist you need to have a deeper appreciation of how much prostate cancer affects people’s lives (patients and their family members). Starting a therapy section with compassion and understanding and providing a safe place for collaboration, trustworthiness and empowerment is the priority. When addressing UI it is important to look at all the variables that will influence improvement, such as: mental / emotional status, surgical outcome, goals and expectations, behaviours and muscles performance. The most important thing to consider when developing a treatment plan is how much urinary incontinence is affecting one’s life. It may not be correlated with the amount of leakage or pad usage. There are many effective treatments that can be prescribed by a physiotherapist to help modulate the nervous system. If severe depression is identified, it is the physiotherapist job to refer to mental health professionals and programs. Mental health screening can save lives.

Sam Hughes, MScPT

Registered Physiotherapist

www.samhughes.ca

Author of: The Guide to Optimizing Recovery after Prostate Cancer Surgery

This blog can also be viewed at https://www.pelvichealthsupport.ca/

References:

https://www.canada.ca/en/public-health/services/publications/diseases-conditions/prostate-cancer.html
Fervaha G, Izard JP, Tripp DA, Rajan S, Leong DP, Siemens DR. Depression and prostate cancer: a focused review for the clinician. Urol Oncol. (2019)37:282–8.
Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S. Depression andanxiety in prostate cancer: a systematic review and meta-analysis of prevalencerates. BMJ Open. (2014) 13:
Pompe et al. The Impact of Anxiety and Depression on Surgical and Functional Outcomes in Patients Who Underwent Radical Prostatectomy. European Urology Focus. Volume 6, Issue 6, 15 November 2020, Pages 1199-1204
Ilie G, Rutledge R, Sweeney E. Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer. Psychooncology. (2020) 29:280–6.
G Felde, M H Ebbesen, S Hunskaar, Anxiety and depression associated with urinary incontinence. A 10-year follow-up study from the Norwegian HUNT study (EPINCONT) Ne urourol. Urodynam. 36:322–328, 2017.