Holistic Physiotherapy for Prostate Cancer Survivors
By Sam Hughes, Pelvic PT
In the past few years, there has been a significant increase in the number of prostate cancer survivors seeking physiotherapy services to help treat the side effects of prostate cancer treatment. Perhaps due to increasing evidence of pelvic floor muscle training (PFMT) helping to manage some of the symptoms, more physiotherapists are becoming interested in treating this population. However, it is important to note that there are other areas that will affect this population’s recovery outcome, and that PFMT is only a part of it.
I have been working in this area for over 10 years, and I’ve learned that not everyone will benefit from PFMT. Clinically it makes sense, but we have to look at biology as part of the equation, which is influenced by the central nervous system, people’s expectations and social support.
There are over 23,000 men diagnosed with prostate cancer every year in Canada. Medical advancement and early detection and treatment has resulted in an increasing number of prostate cancer survivors. However the side effects of treatment can greatly impact men’s mental status and quality of life. The most common side effects of treatment are urinary incontinence (UI) and erectile dysfunction (ED). These symptoms, especially in younger men, violates expectations regarding urinary and erectile function age norms and often negatively impacts the psychological well-being of patients. Mental status can also influence UI, ED and healing speed. One in six men with a prostate cancer diagnosis will experience clinically significant depression. These rates are higher than the general population, and depression and anxiety can significantly be associated with worse surgical outcomes and higher risk for UI. To address and screen mental health is probably more important than PFMT when treating this population.
For someone who has been treating the pelvis for over 12 years, I prioritize screening the mental health status of my clients. The pelvis seems to be an area where people tend to guard and respond to emotions, especially stress. There is a strong correlation between anxiety and depression and bladder symptoms. Anxiety and depression is a risk factor for UI and UI is a predictor for the onset of depression and anxiety.
Pelvic PT Treatment for Prostate Cancer Survivors
Pelvic physiotherapists need to have a deeper appreciation of how much prostate cancer affects people’s lives (patients and their family members). A therapy session should start off with compassion and understanding and should be a safe place for collaboration, trustworthiness and empowerment. When addressing UI, it is important for your therapist to look at all the variables that will influence improvement, such as mental/emotional status, surgical outcome, goals and expectations, behaviours and muscle performance. A treatment plan should always take into account how much urinary incontinence is affecting your life, and may not correlate with the amount of leakage or pad usage. There are many effective treatments that can be prescribed by a physiotherapist to help modulate the nervous system. If severe depression is identified, it is the physiotherapist’s job to refer to mental health professionals and programs.
Sam Hughes is a registered physiotherapist, holistic pelvic health practitioner, public speaker and author of The Guide to Optimizing Recovery after Prostate Cancer Surgery.
Depression and prostate cancer: a focused review for the clinician
Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates
The Impact of Anxiety and Depression on Surgical and Functional Outcomes in Patients Who Underwent Radical Prostatectomy
Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer
Anxiety and depression associated with urinary incontinence. A 10-year follow-up study from the Norwegian HUNT study (EPINCONT)