Body and soul to recover from the effects of the tumor and its treatment such as urinary incontinence or erectile dysfunction, supported by specific actions and often during a follow-up treatment.
Under rehabilitation refers to the re-qualification of a person to participate in normal social (professional and personal) life after an illness or injury or disability. To this end, his so-called functional health is to be restored as far as possible. Such is when the functions and structures of the body and mind, its activities and its participation in the life "normal" considering all factors (according to the ICF of the WHO in 2001, ICF = International Classification of Functioning, Disability and Health).
This (complex) definition is the basis for all measures in rehabilitation, which is regulated in the Social Code (SGB). After rehabilitation services may be provided by different carriers, for example by health insurance (especially for medical treatment) and the pension system (especially vocational rehabilitation). This is to prevent against possible long-term consequences of illness and treatment (tertiary prevention, see also prevention ) in order to avoid, among other incapacity, disability, dependency or a need for social services.
Rehabilitative measures already in the diagnosis of the disease begin after their therapy inpatient, outpatient, or be carried out and to continue for a long-term outpatient follow-up.Also, the inclusion of the environment of the person concerned (eg, partner, manager) may be useful.
General objectives of the rehabilitation
The rehabilitation is to restore, for example, the physical and mental capabilities of the person concerned, promote its functions and activities, and activate its defenses. But it should also motivate him to cooperate and self-help guide to a health-conscious lifestyle, stabilize emotionally and help his illness management. Overall, this improves the general health and increases the (health-related) quality of life.
To this end, a variety of measures come into question as the physiotherapy with water and thermal treatments, physiotherapy and physical training. The prevention, also against other diseases serves health training. It includes, for example, aerobic exercise, smoking cessation and healthy diet (diet therapy, possibly with the involvement of a partner, for more information see Unconventional methods of treatment for prostate cancer ).
To the psychological and social effects of the cancer itself psycho-oncologists care (psychosocial oncologists): Specially trained in this field doctors or psychologists accompany, advise and treat the victims and their relatives. The offer is supplemented by information on measures (eg on other treatment options), support from the social services (eg power applications) and training aids (eg opinion).
Rehabilitation in prostate cancer
Patients that locally curative treated (locally with healing intent) ( radical prostatectomy ,radiation therapy ), a specialist rehabilitation should be offered, for example in the form of a follow-up treatment (AHB). This is done stationary and is usually organized by the clinician for the period after discharge. Rehabilitation should the participation of urologists, "multi-pronged" treatments carried out at comorbidities of the patient by other specialists and with help. It should be provided to the patients, a psycho-oncological care to support the coping (see previous paragraph).
Objectives of rehabilitation are:
- Treatment of therapy-related disorders, especially after radical prostatectomy urinary incontinence (involuntary loss of urine) and erectile dysfunction (impaired limb stiffening), after radiotherapy, especially dysfunction of bladder and bowel, and also erectile dysfunction
- Restore the physical and mental performance
- Re-qualification to participate in normal social life
- Preservation or restoration of earning capacity, provided that the patient is not yet pensioned
The radical prostatectomy can weaken the inner bladder sphincter so that the outer in the pelvic floor muscles alone for urinary continence (the "water holding") must provide. Often this does not succeed at first, resulting in urinary incontinence (involuntary loss of urine) results. It usually is a stress incontinence, that is a leakage of urine during a more or less strong impact (through coughing, sneezing, laughing, sports). This usually improves during the healing process after surgery.
Urinary incontinence after radical prostatectomy should be "multi-track" treatment. In stress incontinence physiotherapy should focus on: Incontinent patients receive appropriate tools (eg templates) and follow a specific continence training (KT, see also pelvic floor exercises ), supplemented (training with feedback of success) when required with drugs, electrical stimulation or biofeedback . Subsequent surgical procedures such as injections of the urethral mucosa or the insertion of a loop system or an artificial sphincter are rarely required (further details in the magazine under surgery for urinary incontinence after radical prostatectomy ).Other forms of urinary incontinence should be excluded or treated (see also urinary incontinence ).
After radiotherapy urge incontinence may occur, ie a loss of urine during heavy urination, caused by irritation of the bladder with overactivity of the muscles. To a so-called neurogenic urinary incontinence by radiation-induced damage to nerves that supply the bladder, it is very rare. Both forms are treated primarily with medication. A mixed urge incontinence or stress urinary incontinence after radical prostatectomy shape is also possible (for forms, examination and treatment see also urinary incontinence ).
Recovery of sexual function
Especially by impairment of nerves that run to the prostate along, it comes in most patients immediately after a radical prostatectomy to a more or less pronounced erectile dysfunction (ED), a disorder of erection (stiffening member; see also Erectile Dysfunction ) . This also affects many patients during or after radiotherapy , hormone and chemotherapy , the ED can occur with considerable delay. Here and in the operation, other mechanisms may play a role as vascular damage and effects on hormone levels and the psyche.
In an ED, it comes with time to changes in the corpora cavernosa of the penis, which reduce their elasticity and thus complicate the subsequent regaining erectile function. Therefore, an early detailed advice about possible sexual dysfunction and partnership problems should occur, possibly with the inclusion of the partner. It is important at an early stage Schwellkörpertraining that can begin even before or directly after tumor therapy. For this purpose are taking medications and other measures into account (see below and erectile dysfunction ), supported by sports, physiotherapy as well as relaxing and psychotherapeutic methods.
In patients curatively treated (with healing intent) ( radical prostatectomy , radiation therapy ) may be used for the treatment of erectile dysfunction: PDE-5 inhibitors, vacuum erection systems ("pumping"), SKAT (Schwellkörperautoinjektionstherapie) or intraurethral prostaglandin E1 (explanations s to all proceedings Erectile Dysfunction ).
First, a PDE-5 inhibitor should be used. If this does not work sufficiently, the other methods mentioned above should be considered taking into account the patient's desire. That in patients who were operated on with bilateral nerve sparing (see radical prostatectomy ), a regular evening taking a PDE-5 inhibitor advantages compared with an income only when required, has not been established. It is crucial for the success that the patient can try a method until he has mastered it, and not give up when it does not work immediately.
Rehabilitation of additional complaints
Many complaints can make a specific diagnosis and treatment required during rehabilitation.For example, lymphedema caused (accumulation of tissue fluid) through surgical or radiation-induced closure of lymphatic vessels and can be treated with lymphatic drainage. A urinary obstruction can be caused by a swelling of the prostate after radiation therapy or surrounding tissue after radical prostatectomy and a bladder catheter or medication require (see also drugs for BPH treatment ).
Other examples of possible ailments that require special treatment are urethral infections, leakage or later cicatricial narrowing of the new urethra connection after radical prostatectomy (anastomotic leak, the anastomosis ), inflammation of the rectum (proctitis) after radiotherapy, scar pain, hormone deficiencies, fatigue (Fatigue Syndrome) and sleep disorders.
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