Fri 19, Jun 2020
By Prof. Robert Ramsay
As someone who works in cancer research, I know how common prostate cancer is in Australia. But it didn’t lessen the impact of my own prostate cancer diagnosis two years ago.
I was fit, healthy and had no symptoms or family history.
The only clue was my annual PSA (prostate-specific antigen) test that had steadily climbed to a level that my GP decided was time to consult a specialist to investigate further.
For many blokes, prostate cancer is slow growing and patients can adopt a ‘watch and wait’ approach, but surveillance wasn’t an option in my case. I opted for a radical prostatectomy to completely remove the prostate and the cancer - and with it came the risk of problems with incontinence and impotency.
Removal of the prostate results in a major anatomical rearrangement, and all previous automatic bladder emptying functions become manual. Essentially, you have to learn how to use your pelvic floor muscles to control your flow of urine and avoid leakage.
Prior to surgery urology nurses with the aid of ultrasound, teach you how to identify the pelvic floor muscles and how to use them to control urinary incontinence. They were simply marvellous; professional and supportive.
It was pretty confronting. I assumed it would be easy, but it isn’t. Blokes don’t know how to contract their pelvic floor muscles! Your pelvic floor is not normally discussed in polite circles, and never amongst us blokes. Learning how to engage your pelvic floor muscles is a steep learning curve and takes dedication and practise. It really is like teaching someone how to walk again.
Once you’ve got it, pelvic floor exercises aren’t hard, it just takes discipline and over time, things slowly improve. A number of men become disheartened, as they don’t believe anything is happening, but you need to be patient. For a while you don’t notice any change, eventually improvement is measureable, and you get your confidence back.
After radical prostatectomy most men are relatively well two years out and have regained continence. Being consistent with your pelvic floor exercises however substantially accelerates your control, and it is much faster with the help of urology nurses.
Early on, I set a deal with my surgeon. I wanted to travel to Chicago for a conference - and I wanted to travel with my continence. At the time, I couldn’t even walk down a curb without leaking, so I was motivated to complete my three sets of pelvic floor exercises daily and even climbed stairs to strengthen my ability to control.
I have fully regained my continence, and today can run 10 kilometres in about an hour or ride 100 kilometres, which is not bad for a bloke in his early sixties! Most of the time I don’t think about continence anymore but I respect its influence on daily life.
This World Continence Week, the Continence Foundation of Australia is encouraging Australians to invest time in 5 healthy habits to prevent incontinence. These habits include a healthy diet and staying hydrated, 30 minutes of exercise every day and good toilet practice.
I’m sharing my story in the hope that it will help other men seek help to improve their health. If you’re a bloke, have the confidence to see your GP, monitor your health and discuss any continence issues - it will help you make your life better.
For further information, advice and support you can contact the National Continence Helpline on 1800 33 00 66. The National Continence Helpline is a confidential service that operates Monday - Friday, 8am - 8pm (AEST).
Professor Rob Ramsay is joint-head of the Gastrointestinal Cancer Program and head of the Differentiation and Transcription Laboratory at the Peter MacCallum Cancer Centre.
He has expertise in genetics and biochemistry, and has three decades of research experience in cancer biology.