Kirk Center for Healthy Living
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Post-prostatectomy
Urinary Urgency and Frequency
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Pelvic Health Table

Post-prostatectomy: Men
1. What are some of the common symptoms?
2. What are some of the common causes?
3. What can I expect my first day of therapy?
4. What can I expect my ongoing therapy to be like?
5. How long can I expect my therapy to last before I begin to see improvement?
6. How long can I expect my therapy to last before I am healed/cured/fixed?
7. What are the credentials of my uro-gynecological physical therapist?


1. What are some of the common symptoms?

Some symptoms after a prostatectomy may include loss of urine when getting out of a chair, loss of urine with coughing or sneezing, constant dripping of urine all day long, loss of urine while sleeping, pelvic pain or difficulty with erections and sexual activity.


2. What are some of the common causes?

The urethra (tube from the bladder to outside of your body) runs through the center of the prostate and this part is called the prostatic urethra. The prostate tends to provide pressure on the urethra to help prevent urine loss. Once the prostate is removed the compression or pressure on the urethra comes from the pelvic muscles. These muscles are usually weak in this situation and they canít stop the loss of urine. Scar tissue from the surgery can cause pain or loss of urine with positional changes. Erectile difficulties are complicated, but they may arise from irritation of the nerves, swelling, inflammation or the inability to provide compression at the base of the penis to keep it erect.


3. What can I expect my first day of therapy?

It helps to write down all of the questions that you have about your condition and therapy. If we do not answer your questions during our evaluation process, you will be prompted by your list to ask your questions at the end of your first session.
Once in the treatment room, your therapists will ask you numerous questions pertaining to your condition. Then they will analyze your posture, balance, back and hip motion, pelvic alignment and scar integrity. They will explain the anatomy of the pelvis using an anatomical model. Then your therapist will give your privacy and ask you to get undressed from the waist down. A sheet will be provided for you to cover yourself, as you lie back on the treatment table. Your therapist will exam the perineum (the area covered by your underwear), and possibly perform a vaginal and/or rectal exam. This is only done with your consent, but can provide very important information used by your therapist to create your Plan of Care. Your therapist will use non-latex gloves and lubrication during this part of the exam, which will make the exam more comfortable. Once this part of the exam is finished, your therapist will give you privacy to dress. Your therapist will then explain their findings and what your Plan of Care should be, as well as answer any questions that you still have.
Please arrive 30 minutes early for your first day of therapy. There will be paperwork for you to fill out and we do not want to eat into your hour of evaluation time with your therapist. Also please bring a list of medications, a list of your past surgeries and list of your conditions. If you downloaded the forms and filled them out in advance of your appointment, you can arrive 15 minutes early, as there are still a few forms to handle in the office. Please bring a photo ID and your insurance card.


4. What can I expect my ongoing therapy to be like?

Depending on your symptoms, therapy may focus on strengthening exercises of the muscles around and inside your pelvis. These include your pelvic muscles, deep abdominal muscles deep back muscles and deep hip muscles. We will also provide education on techniques to prevent/protect your surgical site from increased pressure, especially with coughing/sneezing/lifting and positional changes. Scar manipulation around the surgical site will be helpful. We will provide education about devices that may help with erectile dysfunction. Manual therapy when appropriate may consist of visceral manipulation, connective tissue manipulation, myofascial release and nerve mobilizations (see techniques page for details on manual therapy techniques).


5. How long can I expect my therapy to last before I begin to see improvement?

Since every patient is unique, itís hard to answer this question. We have seen some patients acknowledge improvement in just two visits, while others, although rare, may need months of therapy before seeing improvements. Usually some improvement is seen within 4-6 visits. Your participation in your own healthcare can also have a big impact. This means that you have to take some responsibility for your own health and do what your therapist asks you to do outside your treatment sessions. You are your therapist are a team. Improvement rates also depend on the severity of your condition and how long you have been suffering from it. The longer youíve had your problem, and the more severe it is, will increase the time needed for treatment before you see improvements.


6. How long can I expect my therapy to last before I am healed/cured/fixed?

Again, each patient is unique, so this time frame can vary greatly. Research shows that it takes at least three months of treatment to create a permanent change in the body. We most often request a frequency of once a week for 12 total visits. That is why our office staff will ask you to schedule all 12 of your sessions before starting therapy. If you need more than 12 sessions, your therapist will discuss this with you after you have completed 12 visits and you will decide together whether continuing with therapy would benefit you or not. If so, your therapist will reevaluate you and send a progress note to your physician requesting an extension.


7. What are the credentials of my uro-gynecological physical therapist?

At Kirk Center for Healthy Living we are very selective in our hiring process. We take great care in selecting the most skilled therapists we can find. We also require that they attend multiple post-graduate continuing education courses every year, predominantly with the Herman & Wallace Pelvic Rehabilitation Institute and the Barral Institute, in addition to receiving one hour of one-on-one training with the owner of Kirk Center, Brandi Kirk, PT, BCB-PMB.
All licensed physical therapists have had to apply and be selected to attend Physical Therapy school. It is a very competitive process and only those will the highest grades and best potential are selected. Physical therapists have invested a minimum of 5 years into their undergraduate and graduate training at universities. Once they graduate, they have to sit for a State Board Exam and pass to receive their license to practice. In order to keep their license active, they must dedicate a certain number of hours to continuing education each year.
Uro-gynecological physical therapists have done everything listed above, but have also become a specialist in the field of pelvic health. As a specialist, all continuing education is focused on the conditions that we treat at Kirk Center. Some physical therapists have multiple letters after their names, indicating a license and/or certification in an area of study. Uro-gynecological physical therapists have been trained in internal vaginal and rectal evaluation and treatment techniques and by our state license we are legally allowed and qualified to perform these procedures.
   
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