What Does Neobladder Recovery Look Like?
Hi friends! May is bladder cancer awareness month. Bladder cancer is the 4th most common urological malignancy in men and the ninth most common in women (Herdiman, 2013).
Many times, to treat bladder cancer a procedure called a radical cystectomy is performed (Herdiman, 2013). In this procedure the bladder is removed to get rid of the cancerous cells. Our bladders are very important in the functioning of our bodies so there must be some way to replace its function once it is removed. There are a few different ways that surgeons achieve this, and they will make decide which is best with each patient.
One of these methods is creating a neobladder. A neobladder is constructed by taking part of the intestines and shaping it to resemble the bladder (Ong, 2013). While this serves as a replacement for the bladder, it is not simply a ”new bladder” and does not function the same. The neobladder only as a reservoir to store urine (Herdiman, 2013). The neobladder does not contract to empty as a normal bladder would (Ong, 2013).
Because the neobladder doesn’t work the same as a natural bladder, the recovery will include processes to stretch the bladder and regain continence. After surgery, the neobladder has a capacity of about 200 mL (Ong, 2013). A technique called timed voiding is used to help to slowly stretch the bladder over time to its final capacity of about 400-500 mL (Ong, 2013). Timed voiding is a common technique used to treat other conditions like overactive bladder.
With a neobladder, you will also need to relearn the signals and sensations when it is full (Ong, 2013). This will allow you to ensure you empty your bladder and avoid urinary retention. It is also important to learn how to control the pelvic floor muscles to ensure you are relaxing the sphincter when attempting to urinate (Heriman, 2013). It is often recommended to pee while sitting because this promotes relaxation of the pelvic floor muscles (Herdiman, 2013).
On the other hand, the neobladder relies on the pelvic floor muscles to be strong in order to maintain continence. The pelvic floor muscles must be strong and coordinated (doing the right thing at the right time) to avoid urinary leakage. A pelvic floor physical therapist can ensure you are engaging these muscles properly and guide exercises to keep them strong. Pelvic muscle exercise will promote both earlier return of continence and better overall continence after surgery (Ong, 2013). Pelvic floor muscle exercises are encouraged for the first year after surgery and most individuals benefit from performing exercises over their lifetime (Ong, 2013).
Since part of the intestines are used to construct the neobladder, there will be some recovery time for your bowels. Normal bowel habits after a bowel resection will take some time to return (Ong, 2013). Avoiding constipation and straining with bowel movements is important because they can affect the neobladder’s function and increase the risk of urinary leakage (Heriman, 2013). The good news? Pelvic floor therapists are specially trained to help with constipation by educating on diet, exercise, toileting postures, and proper relaxation of the pelvic floor muscles to allow for the easy exit of stool.
Your physician will likely recommend 6-12 weeks without sexual activity following surgery. After that time up to 50% of individuals find themselves dealing with erectile dysfunction in men and pain with sex for women (Ong, 2013). Pelvic floor therapists are specially trained to address these issues.
While any cancer diagnosis can be scary, outcomes are improving for patients every day. Survival rates are rising but there are often big life changes that accompany that. Pelvic floor therapists can be a great addition to your healthcare team if you have been diagnosed with bladder cancer and are planning to or have had surgery for a neobladder. Ask your provider for a referral to a therapist near you, or find one at www.mypfm.com/find-a-pt.
To learn more about the pelvic floor muscles, check out these great resources:
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The Hip and Urinary Incontinence: A look beyond the pelvic floor at what keeps us dry with Lauren Trosch, PT, DPT, OCS
Overcoming Erectile Dysfunction with Susie Gronski, PT, DPT
Female Sexual Function, Dysfunction, and Pain with Dr. Heather Jeffcoat, PT, DPT
Written by Emily Reul, PT, DPT
Herdiman O, Ong K, Johnson L, Lawrentschuk N. Orthotopic bladder substitution (neobladder) part II: postoperative complications, management and long-term follow-up. J Wound Ostomy Continence Nurs. 2013;40(2):171-180.
Ong K, Herdiman O, Johnson L, Lawrentschuk N. Orthotopic bladder substitution (neobladder) part I: indications, patient select, preoperative education, and counseling. J Wound Ostomy Continence Nurs. 2013;40(1):73-82.