Today is the first day of Movember! Not only is Movember about growing weird and wonderful mos, it’s about raising awareness and funds for Men’s Health issues. The first in our Movember series is looking at… Prostate Health.
What is the Prostate?
The prostate is a small gland that sits below your bladder and on your pelvic floor muscles (yes, men have pelvic floor muscles too!). It is shaped like a donut and varies in size – normally the size of a walnut – and grows slowly as we age. The main function of the prostate is to produce seminal fluid and some hormones.
Image credit: Continence Foundation of Australia
What can go wrong?
Benign prostatic hyperplasia (enlargement)
This is a non-cancerous enlargement of the prostate that affects your urine stream. Your stream can be weak, or it can be difficult to start and stop urination, and possibly cause incontinence. It can cause infections, bladder stones and reduced kidney function but isn’t thought to lead to prostate cancer. Your GP can diagnose the condition, which normally involves lab tests or imaging. Treatment can include medications and possibly surgery.
This is inflammation of the prostate caused by infection, injury, or an immune system disorder. It causes groin or pelvic pain and makes urinating difficult. Diagnosis can be made by your GP and treatment may involve anti-biotics.
Prostate cancer. The stats…
- the most common cancer diagnosed in men over 50
- 18,000 new cases are diagnosed in Australia each year
- more men die from prostate cancer each year than women from breast cancer
- in their lifetime, a man has a 10% chance of developing prostate cancer and a 2% chance of dying from it
What is Prostate Cancer?
It occurs when abnormal cells develop in the prostate. These cancerous cells can then spread to nearby or distant body parts. It is generally a slow growing disease. Men can live for many years without worsening symptoms or having the cancer spread. Unfortunately for some men with high grade disease, it can spread quickly and be life threatening.
What symptoms should I look out for?
Symptoms aren’t usually seen until the later stages of the cancer development. The following symptoms might not mean you have cancer, but if you have any of these, you should consult your doctor. They might include:
- frequent or sudden urges to urinate
- difficulty starting or stopping urination
- discomfort urinating
- blood in your urine or semen
- pain in your lower back, upper thighs or hips
How is Prostate Cancer diagnosed?
For men aged over 50 (or 40 with a family history of prostate cancer), a DRE (Digital Rectal Examination) and a PSA test (blood test) may be performed as part of an annual check-up with your doctor. The tests can also be performed at any time if you have any of the above symptoms or your doctor suspects a possible cancer diagnosis.
If both tests are positive, a biopsy is taken of the cancer to confirm whether the cells are malignant (cancerous) or benign (not cancerous).
Your doctor or cancer specialist will discuss the different treatment options with you. Options are normally based on the whether the cancer is growing slowly or aggressively. Radiation, hormone therapy, chemotherapy and/or surgery may be treatment options.
Radical prostatectomy (surgical removal of the prostate) is the most common curative therapy. There are different surgical methods of this procedure, and like all surgeries, there are risks and post-operative complications that can occur. Two of the most common side effects include incontinence and erectile dysfunction.
As seen in the picture above, the prostate wraps around your urethra as it leaves your bladder. It’s your urethra that carries urine and semen out of the penis.
At the point the urethra joins the bladder, there is a ring of muscles called the bladder neck sphincter. This sphincter opens and closes to allow and stop the flow of urine through your urethra. Another group of muscles that sit below the prostate are your pelvic floor muscles. They also act like a sphincter and affect the flow of urine from the bladder.
Both muscles are involved in bladder control. If the bladder neck sphincter is damaged during prostate cancer surgery, this can lead to urinary incontinence – and that’s why your pelvic floor muscle’s function is crucial in minimising leakage.
How does Physio help?
Your physio will be able to tailor a strengthening program for your pelvic floor muscles to speed up the recovery process and reduce your leakage. The quicker your muscles regain their strength, the sooner the leakage will stop. They will also be able to provide advice on when to start appropriate forms of general daily exercise like walking, and return to leisure activities like golf, tennis, bowls, and so on.
Matthew has performed further study in Men’s Health and Post Prostatectomy recovery. During a consultation with Matthew, he may use a Real Time Ultrasound machine to help you see and understand how your pelvic floor muscles function in real time – it allows you to see your muscles moving and working with your movements. This is great feedback, as working those muscles is often quite difficult for most men early in the recovery process. That’s why we also recommend for most men to have an appointment with us pre-surgery, to learn how to contract your pelvic floor muscles whilst they are still functioning well. This knowledge becomes beneficial post-surgery, making for a better understanding of pelvic floor muscle activation and quicker recovery process. It’s the groin pain and discomfort following surgery, that makes this process challenging for most men.
The good news is there is a lot that can be done to help your incontinence! With the right management and plan, returning to normal can take anywhere from 3 months to a year. Don’t just ignore your issues; the sooner you see your Physiotherapist and address them, the better!
Need more info?
If you would like to read some more information about prostate cancer, cancer, or men’s health, please visit the links below.