Using Individualized Pelvic Physical Therapy to Improve Surgical Complications
Posted: Thursday, February 13, 2020
An individualized physical therapy program may benefit patients with stress urinary incontinence and pelvic pain undergoing rehabilitation after prostatectomy, according to a retrospective chart review published in International Urology and Nephrology. Physical therapy aimed at strengthening pelvic muscles has been the standard of care for men dealing with urinary incontinence after surgery; however, many men actually have muscle tightness and spasms, for which strengthening exercises may be counterproductive.
“This is perhaps the first study to look at the type of muscle dysfunction present in men after they’ve had this surgery,” stated Kelly M. Scott, MD, of UT Southwestern Medical Center, Dallas, in an institutional press release. “Are the muscles actually weak and [do they] need to be strengthened, or are they actually tight and just need to be relaxed and lengthened?”
The research team retrospectively analyzed 136 patients with post-prostatectomy stress urinary incontinence who were treated with pelvic physical therapy. The patients were identified as having underactive (n = 25), overactive (n = 13), or mixed-type (n = 98) pelvic floor dysfunction. Patients with underactive pelvic floor dysfunction received strengthening treatment, whereas those with overactive pelvic floor dysfunction were treated with relaxation training. Patients with mixed-type dysfunction engaged in relaxation training followed by strengthening.
Incontinence improved in 87% of patients. There was a significant decrease in patient pad usage per day (P < .001), and more than half of the patients (58%) achieved the “optimal” improvement of requiring two or fewer pads per day. The number of patients who reported pelvic pain also dropped from 27% at the start of the assessment to 13% (P < .001). Furthermore, pelvic floor strength improved (P = .049) even among those who predominantly received relaxation training.
Disclosure: The study authors reported no conflicts of interest.