Behavioral therapies for urinary incontinence in men
Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. Men who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.
Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. A doctor will teach a person about the structure of the lower urinary tract and the causes of incontinence.
A voiding schedule is first established. Then you are trained to resist the first urge to urinate and refrain from urinating until the scheduled time. The intervals between scheduled bathroom visits are increased until you can refrain from urinating for several hours.
Biofeedback is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.
Men with incontinence are taught bladder-sphincter biofeedback methods along with pelvic floor exercises. These techniques record bladder, rectal sphincter, and abdominal pressures as well as electrical activity. As the information is recorded, it is displayed for you. By watching the information, you learn to relax your bladder and abdominal muscles and contract your pelvic floor muscles based on the information displayed.
Learning biofeedback requires practice in a lab or other setting under the guidance of a trained therapist. Home biofeedback units also are available.
Pelvic floor muscle training
Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine and are used to treat urge or stress incontinence. Kegel exercises are done as follows:
- The muscles to be exercised are the pelvic muscles. These can be felt by purposely stopping the flow of urine in midstream and starting again. The muscles that squeeze the urethra and anus are the ones involved.
- Remembering what it felt like to control these muscles during urination, try to contract them when not urinating. If the stomach or buttocks muscles tighten, the muscles are not being exercised correctly.
- Tighten these muscles for 3 seconds and then relax for 3 seconds.
- The exercises should be repeated 10 to 15 times per session. Do at least 3 sessions a day.
Kegel exercises can be done when you are at home or away from home, and at any time during the day. No one will be aware that you are doing the exercises, so you can do them often, no matter where you are.
Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working. To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.
How Well It Works
There hasn't been a lot of research on bladder training for men who have incontinence problems, but bladder training may be able to help. And trying it poses no risks. Most people who use bladder training have fewer symptoms of incontinence. Some people completely eliminate their incontinence.1
Again, there is not a lot of evidence for biofeedback combined with other behavioral therapies in men. More research is needed.
Pelvic floor muscle training
Two reviews of men using pelvic floor muscle training to improve continence after surgery on the prostate gave different results. One review showed that pelvic floor muscle training did help men control leakage of urine after a radical prostatectomy for prostate cancer.2 But another review showed no benefit overall in men trying pelvic floor muscle training after any prostate surgery.3
What To Think About
Behavioral methods require a high level of motivation.
To be successful, prompted voiding requires a committed caregiver.
To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.
- Payne CK (2007). Conservative management of urinary incontinence: Behavioral and pelvic floor therapy, urethral and pelvic devices. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2124–2146. Philadelphia: Saunders Elsevier.
- MacDonald R, et al. (2007). Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness. BJU International, 100(1): 76–81.
- Hunter KF, et al. (2007). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews (2).
Other Works Consulted
- Carlson KV, Nitti VW (2001). Prevention and management of incontinence following radical prostatectomy. Urologic Clinics of North America, 28(3): 595–612.
- Nitti VW, Blaivas JG (2007). Urinary incontinence: Epidemiology, pathophysiology, evaluation, and management overview. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2046–2078. Philadelphia: Saunders Elsevier.
- Ouslander JG (2008). Urinary incontinence. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 125–128. Philadelphia: Saunders Elsevier.
Last Updated: July 21, 2008