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
st 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. The involuntary leakage of urine on any effort or activity
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 !!