Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain

Abstract

Background

The rehabilitation of post-prostatectomy urinary incontinence has traditionally focused on pelvic floor strengthening exercise. The goal of this study was to determine whether an individualized pelvic physical therapy (PT) program aimed at normalizing both underactive and overactive pelvic floor dysfunction (PFD) can result in improvement in post-prostatectomy stress urinary incontinence (SUI) and pelvic pain.

Methods

A retrospective chart review of 136 patients with post-prostatectomy SUI and treated with pelvic PT. Patients were identified as having either underactive, overactive, or mixed-type PFD and treated accordingly with a tailored program to normalize pelvic floor function. Outcomes including decrease in SUI as measured in pad usage per day and pain rated on the numeric pain rating scale.

Results

Twenty five patients were found to have underactive PFD and were treated with strengthening. Thirteen patients had overactive PFD and were treated with relaxation training. Ninety eight patients had mixed-type PFD and were treated with a combination of relaxation training followed by strengthening. Patients demonstrated statistically significant decrease in pad usage per day (p < 0.001), decreased pelvic pain (p < 0.001), and increased pelvic floor strength (p = 0.049), even in patients who received predominantly pelvic floor relaxation training to normalize pelvic floor overactivity.

Conclusions

A majority of post-prostatectomy men with SUI have pelvic floor overactivity in addition to pelvic floor underactivity. An individualized pelvic PT program aimed at normalizing pelvic floor function (as opposed to a pure Kegel strengthening program) can be helpful in reducing SUI and pelvic pain.

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Acknowledgements

This work was supported by a grant from the David M. Crowley Foundation to the Department of Urology at UT Southwestern Medical Center.

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Correspondence to Kelly M. Scott.

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Scott, K.M., Gosai, E., Bradley, M.H. et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain. Int Urol Nephrol 52, 655–659 (2020). https://doi.org/10.1007/s11255-019-02343-7

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Keywords

  • Male stress urinary incontinence
  • Post-prostatectomy
  • Male pelvic pain
  • Pelvic floor dysfunction
  • Pelvic physical therapy