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Prostate Pelvic Floor Physiotherapy

Prostate Pelvic Floor Physiotherapy

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Prostate Pelvic Floor Physiotherapy

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  1. Prostate Pelvic Floor Physiotherapy Karen Edwards Clinical Specialist Physiotherapist WGH

  2. Who am I • Clinical specialist PT at WGH for since 2006 • Background- General PT experience, women’s health continence at St John’s and in NZ, Scientific committee of ICS • Current post- set up for joint consultant female clinic and the male post was a creeping development, with no money attached • New prostate pre op service !!!!!!!!

  3. What is my role with male patients • Fully assess pelvic floor function Internal examination essential part of treatment • Teach correct facilitation of pelvic floor • Provide an individual tailored programme to improve PF, awareness, strength, endurance and functionality • To provide monthly follow up and progress treatment plan as able • To provide motivation and aid with compliance techniques • To liaise with consultant and nursing colleagues re progress • To refer on to Nursing or consultant colleagues if no progress made in 6- 8 months

  4. Myths of the pelvic Floor • First mentioned in 400 BC- believed that air caused the male pelvic floor to contract and that blood flow alone was responsible for an erection. • 1930- first time pelvic floor exercises were mentioned, male • 1996- 1st recognized tool for recording method of assessment • Recent ICS papers 2011

  5. What is the pelvic floor • The floor of the pelvis is made up of layers of muscles. These layers stretch like a hammock from the pubic bone to the base of the spine at the back • Dynamic mobile structure with the ability to improve its function • Maintain continence, bowel and bladder as it supports the urethra and back passage through the pelvic floor muscles.

  6. Pelvic floor hammock

  7. Laproscopic radical prostatectomy

  8. Sphincters

  9. Sphincters cont’d

  10. Sphincter function

  11. Stress incontinence The involuntary leakage of urine on any effort or activity - (varies in volume and activity)

  12. Stress Incontinence

  13. Lets exercise them ! • Positions- Sitting on a hard surface, separate legs and bottom cheeks, standing • Find the max number without losing quality, repeat. • Endurance- hold without losing quality • Static- progress to functional activities • Indicators- scrotal rise, penis indrawing • Eliminate the buttocks • HOW OFTEN ???????????????

  14. WHY do them • Internal urethral sphincter even with nerve sparing, and laproscopic surgery had potential to be effected. • Continence will therefore depend on a competent external urethral sphincter reinforced with the pelvic floor. • Studies have shown benefit of pre and post op correct facilitation of pelvic floor in the first year after surgery. Get started early !!