Urinary incontinence in men most often appears after treatment of the prostate - radical prostatectomy, surgery for benign enlargement, radiotherapy. It also occurs independently of those: with an overactive bladder, after pelvic injury, in neurological conditions, and in men who have loaded their pelvic floor for years through heavy work or sport.
The mechanism varies, and it is the mechanism that determines the therapy. After prostatectomy one element of the continence system is missing, so the role of the pelvic floor muscles becomes disproportionately large and they have to be taught to work for two. With an overactive bladder the problem lies in how the bladder behaves, and training without the behavioural part will change little.
Training started before surgery has the best-documented effect - the patient learns a correct contraction while still without a catheter, without pain and without pressure. After the procedure he returns to something he already knows, instead of learning it from scratch at the hardest possible moment. If surgery has already happened, therapy makes just as much sense - it simply starts from a different point.
Therapy
- Detailed history and a bladder diary
- Functional examination of the pelvic floor muscles
- Learning to contract and release the pelvic floor correctly
- Individual training - before surgery and after it
- Learning to brace against exertion, coughing and lifting
- Behavioural therapy and habit retraining
- A home programme
- Biofeedback assessment