Episode Transcript
[00:00:00] S.
[00:00:14] Welcome to Talking Toowoomba, the podcast sharing real stories that matter.
We're proud to partner with Hope Horizons, shining a light on the journeys of locals impacted by cancer and the incredible people who walk beside them every step of the way.
Today's episode is brought to you by Men's Health Physiotherapy Toowoomba helping men across our region take charge of their health and well being.
Whether it's recovery after prostate surgery, pelvic floor rehabilitation, or building strength and confidence again, their experienced team is there to support you every step of the way.
A quick note before we dive in. The content of the Talk on Toowoomba Podcast is provided for general information and community interest only.
It shouldn't be taken as professional, medical, financial or legal advice and must not be relied upon as such.
Please seek independent, qualified advice relevant to your own circumstances before making any decisions.
Now let's get into today's conversation.
[00:01:26] Today we're chatting with Corey Pendlebury from Men's Health Physiotherapy in Toowoomba. And Corey, I understand that you do a lot of work with Hope Horizons.
[00:01:37] To do with prostate cancer.
[00:01:39] What role does physio play?
[00:01:42] Yes, I do a lot of work with prostate cancer and the role that physio plays with with all type of pelvic cancers is a supportive role. So in prostate cancer I see guys before and after treatment and unfortunately, although.
[00:01:58] Those treatments can be very effective at treating the disease, they can have some friendly fireside effects on the body, for example cause issues with muscle systems, the bladder, the bowel and sexual dysfunction.
[00:02:12] So physiotherapy has a large role to.
[00:02:14] Play in in trying to prepare guys for those issues and counteract those problems.
[00:02:22] In addition to the face to face pelvic health consults, I also offer telehealth services.
So we know that pelvic health problems such as for example prostate cancer are over represented in regional and rural areas and although it would be ideal to meet all those guys in person and assess them in the rooms, it can't always happen.
So I do offer telehealth consults for them and the other thing that I try really hard to do is just to get around the community and speak to different community groups.
So whether that be men's sheds or other community groups, places like Hope Horizons and talk to them about men's health, physio and prostate cancer and men's health.
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Today's episode of Talking Toowoomba is brought to you by Men's Health Physiotherapy Toowoomba helping men across our region take charge of their health and wellbeing.
Whether you're recovering after prostate surgery, working on pelvic floor strength, or just want to build confidence and mobility again, their experienced team is there to support you every step of the way. And right now, listeners of talking Toowoomba get 10% off their first consultation.
Just mention the podcast when you book Men's Health Physiotherapy Toowoomba Expert Care close.
[00:04:03] If someone was to have their prostate removed, will they ever gain bladder control again?
[00:04:09] Yeah, their chances of getting bladder control back are very good.
[00:04:12] So when they do a radical prostatectomy, which is full removal of the prostate, which is the surgical technique that they use for prostate cancer, although it's very likely that the guys will have problems.
[00:04:24] With their bladder control to start with.
[00:04:26] Their chances of a full recovery are very good. And in fact, the research tells us.
[00:04:30] That 85 to 90% of blokes that.
[00:04:32] Have that procedure make a full recovery of their bladder control.
Now, the kicker with that research is that it's looking at them 12 months after the surgery. So although we're very optimistic with that patient group that they'll get better, we.
[00:04:47] Do have to be careful in educating them that to start with, they're probably.
[00:04:51] Going to have some problems and that those problems aren't going to get better in a matter of days or weeks. And it generally takes months and it could be several months and it could be up to 12 months.
There are things that the guys who are going through that process can do to help improve their chances of recovery, some of which relate to their lifestyle. So things like staying fit and healthy as possible, losing weight, drinking a healthy fluid intake.
And then the other thing that we know is really helpful, and this is where physio comes in, is pelvic floor exercises.
So pelvic floor exercises, they're not a silver bullet for bladder control after having your prostate removed, but they definitely help reduce the severity of the issues and they help quicken up someone's recovery to normal.
[00:05:42] So as you say, okay, it's not a silver bullet, but should someone who perhaps been diagnosed with prostate cancer and knows that they've got a treatment ahead of them, whether it be surgery, chemo, hormonal or radiation.
Should they perhaps be looking at doing these pelvic floor exercises beforehand? Is that an added way to try and help ease any complications after the treatment?
[00:06:11] Yeah, it's a great question. And the short answer is yes, particularly for radiation treatment and surgical treatment.
Now, the reason I say yes is the research does confirm that guys that get access to the pelvic floor physio before surgical intervention in particular, but also before radiation treatment, they definitely get a better outcome.
[00:06:36] Okay, so what about erectile function, in other words, sexual activity and recovery afterwards after they've had the treatment? Can you tell us about that?
[00:06:46] Yeah. So I think it's fair to say that's a more difficult challenge when it comes to prostate cancer. And when you look at the research, the chances of someone making a full sexual recovery or erectile function recovery compared to, say, for example, bladder recovery after prostate surgery, they're definitely less. But that doesn't mean that it's a foregone conclusion. And there's lots of things that can impact that. For example, the bloke's age, the type of disease they've got, the location of the disease, what their sexual function is like going into the surgery.
If you look at the facts, we know that between 60 to 100% of blokes that have their prostate removed have problems with erections after the surgery. And those facts, that research is quite varied, so in some ways it's not overly helpful. And it probably just highlights the variety in the ways that people respond to the treatment.
Now, even though we say that up to 100% of guys will have problems with erections after they have their prostate removed, there's lots of things that you can do to address that. And they'll work closely with their healthcare team and particularly their urologist to do things like take medication.
Physio's got a role where we will talk to guys about general exercise, pelvic floor exercise. There's a whole world out there and whole industry out there to help guys get their sexual function back.
And it's a topic that we need to be more comfortable talking about.
[00:08:18] Okay, now, you spoke about the pelvic floor exercises.
How do you do a pelvic floor exercise?
I know, unfortunately, we don't have the added advantage of visual here, but can you talk us through it to try and help somebody who perhaps could be listening to this episode start to try and be working on it before they seek some professional help?
[00:08:38] Yeah, sure. And the reason that we can shed a bit of light on that, just using words, is because of some research that's been done and led by a group centred in Brisbane, actually, and they've done some studies where they found a poor group of guys and they stuck some needles into them in some awkward places, and those needles are measuring electrical activity in the muscles and they ask them to use the muscles and they ask them to do it in a variety of ways.
So the way that we know works best for most guys to think about a pelvic floor exercise, particularly for bladder control, is, is to think about shortening the length of their penis or sucking their penis back into their pelvis. The other way that we describe it often, and that works better for some blokes, is if you think about stopping the flow. So if you're halfway through doing a wee and you have to cut the stream off mid stream, then that's the other way to think about it. Now, although I can tell you that's the best way for most guys, I've got no idea if that will work best for you.
[00:09:39] And you could stick 10 blokes in
[00:09:41] A room and tell them to lift their leg up and they're probably going to do it all different ways. Some might lift from their knees, some might lift from their hips.
It's the same with your pelvic floor. Even though I can tell you to do it a certain way.
We're all individuals and we all do things differently, so what we actually need to do is individually assess everybody.
That's the best way to do it anyway, if it's available.
And the best way to assess someone these days, a bloke that is, is to use an ultrasound machine.
And we place the ultrasound probe on the perineum. So that's the area of skin between the scrotum and the anus. And from there, if we look inside, we can see some key pelvic floor muscles and we can see the urine tube. By using that technique, we can be very confident that we can get good information that they're using their pelvic floor.
[00:10:31] Speaker C: Well, and I can attest to that because you've done that for me with the ultrasound. And one thing I noticed, which is interesting, when I first started doing it, I was, I'll explain it from a.
[00:10:46] Layman'S point of view and then you can perhaps tweak it from the professional.
[00:10:50] Side of things, was obviously I was doing it too hard and I was actually working on the bowel. I was basically clamming up Like a clamshell.
[00:11:00] Yeah.
[00:11:00] Whereas it's actually more subtle. Yeah.
[00:11:03] And by doing it subtly and thinking about it as you're doing it, you do it more correctly.
[00:11:09] Is that right?
[00:11:09] Yeah. A lot of blokes, I think, make that mistake. And when we're talking about male pelvic floor and exercises and bladder control, and particularly when we're talking about in the context of prostate cancer, what we're effectively trying to do is get increased closing pressure on the urine tube.
And we want that urine tube closing pressure to be greater than the bladder pressure.
And like you said, Shane, it's very easy to overdo it and start using these other surrounding muscle groups, for example, your abdominals or the muscles around your bottom.
And the problem with those muscle groups is that they actually increase your bladder pressure.
So although you might be taking a step forward by doing a good pelvic floor contraction and getting good closing pressure on the urine tube, if you're also offsetting that by overusing your stomach or your bottom, then you're taking a step backwards at the same time, and you're not manipulating the pressure equation the way that we want. So a lot of people do have to go a little bit softer.
[00:12:10] Okay, so we've talked about that. It's actually a good idea perhaps to do these exercises once you've been diagnosed and before perhaps you go to have any kind of treatment for the cancer itself.
Sometimes when you're diagnosed with prostate cancer, this can be, I'll say, a long period of time, but how long is a piece of string comes to mind here? Sometimes it might be only a month, sometimes it might be two or three months before you actually start your treatment. So you'd be better off if, you know you've got prostate cancer or any kind of cancer in the pelvic area where you are going to have to do some work on your pelvic floor, that you should start sooner rather than later.
[00:13:00] Yeah, I think that's a safe general rule.
The research that we do know, looking at prostate cancer and preparation in particular for prostate surgery, basically gives us an ideal time frame of between four to six weeks.
Now, that doesn't mean that six to eight weeks or more is no better. It's just that we don't have any research to support that at the moment.
But certainly from my point of view, if we can get someone into clinic a month or two before treatment, be that surgery or be it radiation, then that's ideal. And look, there are times where we just don't have that. There are times when we just have to move a bit quicker and surgery dates are brought forward, and if that happens, then we work with what we've got.
[00:13:42] What are your tips, your top tips.
[00:13:45] For the best recovery from prostate cancer.
[00:13:48] And prostate cancer treatment?
[00:13:52]My first tip relates to the decision making process. So prostate cancer is complicated and the treatments are complicated and decisions regret is a really big part of prostate cancer.
And I think my advice would be to any guy who has to start making decisions about that would be do your due diligence the way that suits you.
So for some people that might be a bit of independent research.
I think for almost everyone it should include getting opinions from specialists. So be that their general practitioner who knows them well and their situation well, that would be their urologist, that might be their radiation oncologist or their medical oncologist. Because if you get different opinions from different people and the experts, then you know you're at least collecting good information and then you can weigh that up with your own situation and make a decision that you know is best for yourself.
My second tip would be to lean in on those specialists and the healthcare team, the medical professions, the specialists that I just talked about, the urologist and the radiation oncologist, etcetera, they're very good at the medical side of it, obviously, and they're absolutely critical for this and we need them and they get fantastic results.
But they're not the only part of the team that we should be offering people access to. So we also have to think about the allied health team. So that includes, for example, dietitians, psychologists, counsellors, physiotherapists, exercise physiologists, because they'll help people work through those kind of broader issues and the impacts of the treatment.
And then the other key one that every bloke who gets diagnosed with prostate cancer should be accessing is the prostate cancer specialist, specialist nurse. And we've got a couple of fantastic local specialist nurses in Toowoomba and the Darling Downs. And there's also the national program that's available via the telephone as well.
[00:15:51] I found this chat quite interesting, even though we've chatted before and you've imparted some knowledge on me. But I've enjoyed today's chat because we've actually sort of stepped back from when we had looked at, at it all as overall, as a total picture for prostate cancer. And I think it's. You've hit the nail on the head. You said it's very important to do due diligence, do a bit of research, ask questions And I suppose it's a case of the first thing you've got to get over is that point of talking about it.
Us blokes tend to keep things to ourselves more than we probably should.
[00:16:35] Yeah.
[00:16:36] And it's important to talk about it.
Is there anything else that you've experienced in your practice in dealing with men and their prostate cancer that's perhaps stuck out to you and you've gone now, I hadn't thought of that before from your patient's point of view, and gone, okay, I need to focus a bit more on that. Is there anything like that you've discovered over the years that has tweaked you to fine tune how you deal with your patients?
[00:17:07] Yeah.
[00:17:08] I think what we all need to.
[00:17:10] Keep in mind when we're talking about prostates and pelvis.
Pelvis in general, and problems with simple bodily functions that a lot of us take for granted that when they're not there become a big deal. And they don't just impact the person from a physical point of view, they impact that person from a psychological point of view, an emotional point of view and a social point of view. And not only that, they don't just impact that person. Right. A lot of these people who are struggling with these issues have got a significant other who's walking beside them through this as well. So I think that's probably something that stands out for me, is that we need to make sure we're treating people holistically, not just looking after the cancer, not just looking after the physical side of things, but wrapping things up to make sure we're supporting people socially and emotionally as well.
[00:18:02] Alright, I think we'll leave it there.
[00:18:04] Thanks, Corey.
[00:18:05] That was a great chat. Thanks for your time.
[00:18:06] Thank you.
[00:18:07] You're very welcome. Thanks for having me.
[00:18:15] Thanks for joining us on Talking Toowoomba. If today's episode inspired you, please share it to help spread hope and connection right across our community.
A special thanks to our sponsor, Men's Health Physiotherapy Toowoomba, for supporting this episode and the important work of Men's Health in our region.
And as always, a big thank you to Hope Horizons for their incredible contribution to local families living with cancer.
The content of Talking Toowoomba podcast is provided for general information and community interest only.
It should not be taken as professional, medical, financial or legal advice and must not be relied upon as such.
Please seek qualified advice relevant to your own circumstances before making any decisions.
Until next time, keep Talking Toowoomba.
[00:19:20] Music.
