The second chapter on men's pelvic stories is a more specific look at how men (and those who love them) can work through pelvic challenges, focusing on prostate cancer, surgery and treatment. The first chapter talked about the pelvic problems that a man may face. The good news is that with pelvic physiotherapy and a solid commitment to follow through with the work at home both before and after surgery and treatment, complete resolution of both leakage and impotence is possible. Each man will have varying severity and duration of these physical side effects and they can lead to a much reduced quality of life. You can rewrite your story with help.
The protocol that is described here leans heavily on the brilliant work of Jo Milios in Australia, a pelvic physio devoted to men's pelvic health and aided by over 3000 men who have had radical prostatectomies. Men who followed this protocol had much less leakage, much reduced duration of leakage and a much improved quality of life throughout their recovery time. Even more convincing is the statistic that 1 in 6 men had no leakage whatsoever! For 4 - 6 weeks prior to surgery and resuming immediately after surgery, men are taught the following protocol: six times daily, in a standing position, two exercises are performed. The first is 10 fast twitch (or speed 'ems) maximal (full on!) contractions and releases. These are followed by 10 slow twitch (endurance building or hold 'ems) contractions, holding each for 10 seconds with a 10 second relaxation time between each contraction. It's important to find "the right muscles". Try this: squeeze the front passage as if you're stopping the flow of urine, then lift your testes and retract the penis. Doing these exercises in standing is important as this is the position in which most men leak. With your pelvic physio, you'll learn awareness of which muscles activate correctly, then how to release fully and more! The importance of "pre-hab" or beginning training prior to surgery can't be reinforced enough. The time between biopsy/diagnosis and surgery is a time to begin learning about your pelvic function, strengthening and releasing. Bladder control (voiding with control and fully 6 - 8 x daily or learning to do so) and a happy bowel really make a difference as you head into the choppy waters of surgery and treatment. Jo's research has shown that men respond very well to the improved physical control of their waterworks and sexual function with this help, but additionally they are emotionally and relationally so much stronger! Her goal is to improve the quality of life for all undergoing prostate cancer diagnosis, surgery and treatment. Let's get specific....one appointment for assessment/training is sufficient to help you begin. Palpation can be done externally in most cases. Your important three muscles that control your urine, the trio that you need to learn to turn on and off and strengthen are called the external urethral sphincter + bulbocavernosus + puborectalis. Sometimes that pesky external anal sphincter gets dominant and you need to learn to teach it to quiet down. Once you've found these muscles, you'll move onto working in synergies, becoming powerful (for coughing and sneezing), strong (for sit to stand and lifting), having endurance (for standing and walking), improving the quality of contraction/lifting of the pelvic floor as well as improving release/relaxation in order to support the next contraction. The toughest bit? Fatigue. Standing upright will fatigue the system and that fatigue may worsen as the day progresses, causing leakage to occur. Many men will have overactive muscles that need to learn to release and NOT exercise at first (called pelvic downtraining), some men will vary
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