Causes of Bladder Control Problems in Men

Urinary incontinence is simply the accidental leakage of urine. Problems with urinary function affect men of all ages. As with women, the incidence of bladder problems increases with age but bladder problems are not an inevitable consequence of aging.

Good urinary function depends upon nerves and muscles working together. Nerve problems that may cause bladder control problems in men may include:

• Diabetes related nerve damage
• Stroke, Parkinson's disease, multiple sclerosis
• Some cases of overactive bladder
• Spinal cord injury
• Birth defects like spina bifida¹

In men, bladder control problems are often symptoms of some type of medical condition related to the function of the prostate gland. The prostate surrounds the urethra just below the bladder (Figure 1). The prostate commonly becomes enlarged as men age (benign prostatic hypertrophy or BPH) and may squeeze the urethra resulting in more frequent urination.

Treatment of prostate cancer with either radiation or surgery is known to be related to an increased risk of bladder control problems. During the first month following prostate surgery, nearly 90% of men may experience urinary leakage which generally improves over the next 6 to 12 months.² Other factors that can influence the incidence of bladder problems are age, the size of the prostate and surgical technique.³ Both surgery and radiation treatments by seed implantation (brachytherapy) or by external beam therapy may affect the nerves and the sphincter muscles that control the release of urine from the bladder.⁴

Treatment of Urinary Incontinence in Men

There are many effective treatment options available for the management of urinary incontinence. You and your healthcare profession can decide what treatment is best for you. Simple behavioral changes-limiting fluid consumption, reducing caffeine, adjusting some medications, and timing your bathroom activities often prove helpful.

Extensive studies have not been conducted to definitively show that the Kegel exercises used to strengthen the pelvic muscles are effective in reducing incontinence in men, but according to the National Institute of Diabetes and Digestive and Kidney Diseases, many clinicians find the exercises to be an important part of the therapy for men.¹

Use of evadri Bladder Control System in Men

For men who are unable to effectively perform the Kegel exercises on their own, a complete training program of pelvic muscle rehabilitation, including the type of treatment provided by the evadri Bladder Control System, may have a positive impact on the early recovery of bladder control following prostate cancer surgery.

At an office based session, as small sensor is inserted into the anus to record muscle activity. Small patch electrodes are placed to monitor the activity of accessory muscles. A monitor is connected to the sensor so that the patient and healthcare professionals can see if the correct muscles are being employed. Like using a video to review your golf swing, this process, called biofeedback, takes the guess work out of doing the exercises correctly for good bladder control.

In addition, mild electrical signals can be sent to the weakened pelvic muscles, helping to awaken them and causing them to contract effectively.

The key to success is in learning how to identify, isolate and strengthen the pelvic muscles.

Studies

In a small study using the type of treatment provided by the evadri Bladder Control System and complete training that included a home exercise program, 74 percent of the men who had radical prostatectomies (total removal of the prostate gland and surrounding seminal vesicles that produce semen) demonstrated improved bladder control. Of the 27 patients who completed the program, 48% had complete success, meaning they no longer required any incontinence devices like pads. Fourteen of the 27 patients continued to show improvement one year after starting the treatments.⁵

In this study the patients who benefited from a successful biofeedback program also demonstrated improved self image and self-worth.

A much larger review of clinical trials with a total of over 1000 men who had urinary incontinence after radical prostatectomy indicated that pelvic floor muscle therapy helped men recover bladder control more quickly than those who did not perform these Kegel exercises. ^3,6 In one of the studies of 300 men, those receiving biofeedback-enhanced pelvic floor muscle therapy were more likely to have no leakage after 1, 3, and 6 months than those with no muscle training. The conclusion was that after radical prostatectomy surgery an early supportive rehabilitation program, such as the pelvic floor muscle therapy with the evadri bladder control system, significantly reduces the time to rediscover bladder control. When comparing all clinical trials, there was significant variation in the technique used to provide the biofeedback directed pelvic floor therapy.⁷

To reduce some of the variables, a study was conducted of 60 consecutive patients who underwent radical prostatectomy performed by the same surgeon. Mariotti and others evaluated the type of care available with the evadri Bladder Control System. Pelvic floor electrical stimulation plus biofeedback was begun 7 days after catheter removal and provided twice a week for six weeks. This safe and effective therapy resulted in a significant positive impact on the early recovery of bladder control following radical prostatectomy. The authors found that within four weeks following surgery, there were significant benefits in the early recovery of bladder control and reduction of urine leakage.⁸

When to start pelvic muscle therapy?

The best time to do proper Kegel exercises probably varies; however, researchers from the Kaiser Permanente Medical Center in Los Angeles, California, found that men who were taught how to perform pelvic floor exercises before and after surgery were more likely to have regained bladder control within three months of the surgery.⁹

Bladder control is a life long concern. Learning to perform these pelvic floor exercises correctly may be one way for men to take control of their own healthcare. Leading urologists, such as Dr. Judd Moul, encourage men that regardless of the treatment option that is chosen to deal with prostate cancer, men should continue to perform pelvic muscle exercises as a means of getting the most from their bladder control therapy and for the improved sexual performance and vitality that is associated with good pelvic floor muscle tone.¹⁰

Summary:

The loss of bladder control may be a devastating complication of treating prostate conditions. The increasing number of treatment options and the positive results seen with programs using such tools as the evadri Bladder Control System are seen by many as signs of hope. Rediscovering bladder control can help restore dignity and improve quality of life for many men.

1. Urinary Incontinence in Men, NIH Publication NO. 04-5280, March 2004.
2. Jonler M, et al Urology 1996; 48 (3): 433-440.
   Eastham JA, et al J Urol 1996; 156:1707.
3. Hunter KF, et al Cochrane Database Syst Rev 2007;2:CD001843.
4. Stothers L., Thom D, Calhoun E. J Urol 2005 Apr;173(4):1302-8.
5. Jackson J, et al. Urol Nursing 1996;16:50-54.
6. MacDonald R, et al BJU Int 2007 July;100 (1) :76-81. Epub 2007 Apr 13.
7. Filocamo MT, et al. Eur Urol 2005;48: 734
8. Mariotti G, et al J Urol 2009; 181, 1788-1793.
9. Parekh AR, et al. J Urol 2003;170:130-3.
10. Male Stress Incontinence. (Consumer Education Brochure) Editor: Judd Moul MD. National Association For Continence. 2009; www.nafc.org

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