For decades, therapy to strengthen pelvic muscles has been the standard treatment for men dealing with urinary incontinence after prostate surgery.
But in a new study, researchers suggest that may not be the best approach. They found individualized physical therapy could work better.
The research was conducted by a team from UT Southwestern.
The study examined records from post-prostatectomy patients with stress urinary incontinence—meaning loss of bladder control while sneezing, bending over, etc—who received physical therapy between 2009 and 2014.
The researchers found most had some muscle “overactivity”—muscle tightness or spasms—rather than just muscle weakness.
Using exercise in an attempt to strengthen a tight or spasming muscle can be counterproductive, making the muscle tighter instead of stronger.
Among the 136 therapy patients whose records were reviewed for this study, the team found 25 had only weak, or “underactive,” pelvic floor muscles, 13 had overactive or tight muscles, and 98 had evidence of both.
The team says tense muscles can be a protective mechanism after an injury from surgery.
Part or all of the prostate surrounding the urethra is removed in a prostatectomy, usually because of cancer.
But the study’s findings are counter to the prevailing idea, which is that these men must have very weak muscles.
Almost every patient has incontinence immediately after a prostatectomy, but that percentage drops to about 5 to 20 percent within two years after surgery.
Those who haven’t seen improvement within two to six months should seek physical therapy.
Standard treatment has focused on strengthening exercises, sometimes using so-called Kegel exercises that involve repetitions of contracting, then releasing, muscles.
Recently, doctors and therapists have begun evaluating patients to determine the right therapy rather than assuming the problem was muscle weakness.
However, there have been few studies looking at the effectiveness of this targeted approach.
In the current study, after a therapist’s evaluation, the men received therapy to either relax or strengthen their pelvic muscles.
In 87%, incontinence improved, with 58% achieving what is considered the optimal improvement of needing two or fewer protective pads per day, according to the study.
The pain was also a problem for 27% of the patients. The number with pain dropped to 14% by the end of therapy, which averaged slightly more than four sessions.
In those who still had some pain, the reported level was reduced.
The team hopes these findings could encourage others to launch studies to test individualized physical therapy.
The lead author of the study is Kelly M. Scott, M.D., an associate professor in the Department of Physical Medicine.
The study is published in International Urology and Nephrology.
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