Tag Archive | "incontinence"

Post Prostate Surgery Pelvic Floor Exercises Ineffective in Improving Male Incontinence

According to a two randomized trials reported in The Lancet one-to-one pelvic floor exercise therapy for urinary incontinence after prostate surgery is no more effective than standard care.

Cathryn Glazener, PhD, from the University of Aberdeen, United Kingdom, and colleagues, reported that urinary incontinence is common immediately after prostate surgery.  As a result men are often advised to do pelvic floor exercises, but evidence to support this had been inconclusive.  The study sought to establish if formal one-to-one pelvic floor muscle training reduces incontinence.  It was supported by the National Institute of Health and Health Technology Assessment Programme.

The first trial enrolled men in the United Kingdom who had incontinence six weeks after radical prostatectomy, and the second trial enrolled men in the United Kingdom who had incontinence six weeks after transurethral resection of the prostate (TURP).  These trials compared the effect of four one-to-one therapy sessions during a three-month period to standard are and lifestyle advice only.

In trial 1, the rate of urinary incontinence at 12 months in the intervention group was not significantly different from that in the control group. Findings were similar in trial 2. These findings were unchanged by adjustment for minimization factors or by treatment-received analyses.  There were no adverse effects reported in either trial.

The authors conclude that one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be physically effective or cost effective.

Limitations of this study include incomplete blinding and lack of objective measures of incontinence.

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Post Prostate Surgery Incontinence

Incontinence is a known risk of prostate removal surgery (prostatectomy). As many as 65% of men will still have some degree of incontinence up to five years after the surgery. This can be a heavy burden for men who experience it.

Surgical intervention is available for postprostatectomy incontinence and is quite effective but is usually reserved for moderate to severe incontinence and many men are reluctant to undergo another surgery. Medications can be helpful for urge incontinence, but they have side effects.

For men that appreciate treatment that doesn’t mean surgery or medication, there might be another solution. According to a study published in The Journal of the American Medical Association, behavioral training can cut the number of incontinence episodes by more than half, no matter how long ago the men had their surgeries.

Researchers worked with 208 men, aged 51 to 84, who had persistent incontinence for an average of five years after surgery. The men were divided into three groups: One got eight weeks of behavioral therapy alone, and another had behavioral therapy together with biofeedback and electrical stimulation of the pelvic muscles, a combination that’s known to improve continence but is more costly than behavioral therapy. The third group was a control group. Results were similar in both groups who received treatment. The first had a 55 percent decrease in incontinence episodes, from 28 a week on average to 13. The second group had a 51 percent decrease.

Behavioral training includes pelvic floor muscle strengthening to help close the urethra, actively using those muscles to prevent leakage and bladder control strategies such as keeping a diary and fluid management.

Most of the men in the study continued to experience a significant amount of leakage post-therapy, but reported that the therapy still made a difference in their quality of life.

Patients can find local health professionals trained in behavioral therapy for incontinence by going to the National Association for Continence and the Wound, Ostomy and Continence Nurses Society.

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