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Tightening the plumbing

Thu 13, Mar 2014

Thanks to earlier detection rates and advances in surgical techniques, the odds of surviving prostate cancer have never been better, with mortality rates in Australia dropping from 34 deaths per 100,000 males to 31 in the past 30 years.

However, the quality of life for men post-surgery hasn’t shown the same comparable improvement, with only modest advances made in the management of incontinence, which affects the majority of men who have had prostate surgery.

The Continence Foundation of Australia and the Prostate Cancer Foundation of Australia recommend that men undertake pelvic floor training, preferably before surgery, and always after surgery. But despite the generally good adherence to the regime, there is a clear discrepancy in outcomes, with only some men reporting improvements in urinary control.

While there has been considerable research confirming the benefits of pelvic floor training for women, there has been little for men, which prompted University of Sydney researcher and men’s continence physiotherapist Stuart Baptist to investigate the issue.

“There is no research being done on the quality of exercises for men. The literature shows that some men benefit and some men don’t, whereas for women, the results are impressive,” Baptist said.

Using real time ultrasound, Baptist and co-researchers Roger Adams and Trudy Rebbeck studied the progress of 91 men with prostate cancer as they were trained in pelvic floor motor control, some before and some after their prostatectomy.

Their study found that while some were quick to learn the feel of the muscles, others were working just as hard but getting nowhere.

According to Baptist, these men appeared to be focussing on the easy-to-locate muscle around the anus instead of the muscle in the urethral area – the anterior puboperineal muscle.

“Some of the men were working really hard, but predominantly in the anal area, which is great for holding in farts but not for holding in wee,” Baptist said.

“So then we gave them different cues for isolating independent muscles, and got them to slow down and feel subtle changes in the feel of the muscles, and work them gently. This can be seen on the ultrasound monitor.

“Before, they were focussing on strength, but now they were learning to experience these new sensations, and improving motor control.”

Baptist said there was promising research about the value of ultrasound to assess pelvic floor muscle function in men. His view is that men require more specific, guided cues, principally as a result of their physiology as well as their male psychology.

“In my experience, men are naturally impatient and visually driven, and want to see evidence that what they’re doing is working. Using ultrasound biofeedback is a better way of keying in the cues,” he said.

Baptist’s next step will be to work on developing more effective pelvic floor muscle strength training techniques for the treatment of incontinence in men.

The prescribed regimen of 10 repetitions of 10-second pelvic floor contractions also needed reviewing, he said.

“I feel that you have to get the right ‘feel’ before you continue, and aiming for 10 by 10-second holds makes little sense in terms of muscle hypertrophy (increasing the size of muscle cells).”

He said a recent study revealed that pelvic floor muscle function in men improved when resistance, in the form of intra-abdominal pressure, was increased.

“That’s where I hope to take the next level of research. To see if we can use increasing intra-abdominal pressure (by breath-holding) as a form of progressive resistance,” he said.

In the meantime, the full-time physiotherapist and father of four young children acknowledged his need for patience as a researcher in a relatively new field.

Similarly, the restoration of continence in men post-surgery required patience, he said.

“My take-home message to men is that learning anything new takes time, practice and patience, just like any motor training – like your golf swing,” Baptist said.

He encouraged men to seek specialist training from a continence physiotherapist with a special interest in men.

“And if they can’t find one, the National Continence Helpline (1800 33 00 66) can refer them to one, or they’re welcome to contact me at Sydney Men’s Health and Physiotherapy.”

Stuart Baptist may contacted by emailing stuartbaptist@ssop.com.au

 


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