Continence Questions and Answers for Men

What bladder and pelvic floor issues do men face?

Men can develop problems with their bladder and bowel or pelvic floor. Bladder leakage or a poor urine stream can indicate pelvic floor or prostate issues. Weak muscles around the anus can cause soiling. Pain in the penis or anus can be from pudendal neuralgia. Many can be assessed by a pelvic floor physiotherapist.

What are common problems men can experience with their bladder, bowel and sexual health?

1 in 8 men have a problem with their pelvic floor or their bladder/bowel. These problems may occur gradually over time, such as a poor stream due to prostate enlargement, or needing to visit the toilet frequently due to poor bladder habits. Other problems occur suddenly. After prostate removal or radiation for prostate cancer, urine leakage or incontinence is common.

Bladders are designed to store urine. They will get smaller in size if the bladder is not stretched regularly by ‘holding on’. Frequent emptying of the bladder or going ‘just-in-case’, will reduce its capacity. Boys and men of all ages can reduce their bladder function, causing frequent urination, urgency, and urgency incontinence.

Prostate enlargement is normal for men over 50, but can cause bladder outlet obstruction or a slow, incomplete emptying.

After prostate surgery for prostate cancer, many men find that they have trouble with incontinence. As the prostate is removed, part of the mechanism that keeps men dry is also removed. The leakage may be very mild, a few drops when exercising or severe, with the bladder not storing any urine at all. In the weeks to months after surgery the leakage should reduce as the pelvic floor strengthens.

Any damage to the muscles, the blood supply or the nerves of the pelvic floor can cause problems with sexual functioning. The penis is also a great indicator of male heart health! If erections are not as strong as they once were, it could indicate that the circulation has been compromised, with for example high cholesterol.

What’s normal and what should I be worried about?

Developing good bladder and bowel habits are important to prevent pelvic floor, continence and erectile issues. Drinking 1.5-2 L of fluid each day, and a diet high in fibre will help bladder and bowel health. Not going ‘just in case’ but teaching your bladder to hang on will reduce bladder frequency. Constipation can be reduced with going when you get the urge rather than waiting till later.

While pain in the pelvic floor after prostate surgery is common, pain that persists or comes on without surgery is not. Persistent pain in the pelvic floor can be caused by ill-fitting bicycle saddles, pelvic trauma or nerve entrapment. Pain can be in the penis, the testicles or in the anus.

After surgery to the prostate, many men feel like there is a golf ball or grapefruit between their legs, behind the testicles. This is a normal effect of the swelling caused by the surgery and should ease over the first 4 weeks.

Prostate infections may cause acute pain and is best treated with antibiotics. However, pain should not persist and ‘chronic prostatitis’ is now called Persistent Pelvic Pain and should be assessed by a pelvic pain specialist. It is more likely that the pelvic floor is involved than the prostate.

How do I know if my condition requires physiotherapy or other medical attention?

Men over 50 who find their urine stream gradually slowing, or who feel they can’t empty their bladder completely, should see their GP for an assessment of their prostate. This is NOT necessarily prostate cancer, but prostate enlargement.

A pelvic floor physiotherapist can assess and manage persistent pelvic pain and pelvic floor dysfunctions such as incontinence. Any sudden onset pain, new incontinence or unusual bowel changes should be checked by a doctor. If there are no obvious medical reasons for the change in symptoms, then come in for an assessment so I can help to find a diagnosis.

Why should I get help?

Bladder and bowel dysfunction can really affect your day to day life. Being worried about where the next toilet is, whether you will make it or if you will have an accident, changes how you live life. If left untreated the leakage of urine or faeces (poo) often gets worse, impacting your social life, work life and relationships.

Bladder and bowel dysfunction also often stop people from exercising as well, causing general health issues such as obesity. Having problems such as incontinence or erectile problems, can also be a leading cause of depression, anxiety and other mental health issues. Poor erections can also cause depression and marital problems.

How can physiotherapy help me get back to normal?

While it may be embarrassing to talk about at first, I will help you to feel at ease and accurately assess your problem. I will ask very personal questions that are designed to tease out the symptoms you have and help to formulate a diagnosis. Based on this diagnosis we will discuss a treatment program.

Poor bladder habits

Education about how the bladder functions will help you to develop bladder habits that encourage your bladder to store urine in appropriate volumes. You may be asked to keep a bladder diary to chart your progress.

Leakage after prostate surgery

After treatment for prostate cancer I will teach you the best way to exercise the pelvic floor muscles in a functional way. Advice on managing your incontinence while on the road to recovery will also be available.

Erectile dysfunction

Specific pelvic floor exercises can also help to improve erections.

Pelvic Pain

Education on chronic pain and how the mind and the body work together to perpetuate the problem is vital to learning to manage persistent pelvic pain. As a part of a multi-disciplinary team, I will help you to manage your chronic pelvic pain.

How effective is physiotherapy for treating men’s health issues?

Pelvic floor exercises are best taught by a pelvic floor physiotherapist. Imagine stopping the flow of urine and holding on without using your stomach muscles or your bottom. Once you can do this, you can try to do it while participating in the activity that causes you to leak (eg while lifting or swinging a golf club).

There is very good high level evidence encouraging men to see a specially-trained physiotherapist before and after surgery for prostate cancer. The combination of education, pelvic floor muscle training and psychological support that is provided has been shown to improve outcomes of continence, quality of life and psychological status [1]. I have spent many years studying the male pelvic floor after prostate surgery and will be able to advise you on the best treatment for your incontinence.

Managing chronic pelvic pain is a multi-disciplinary effort [2]. While the evidence for physiotherapy in the management of persistent pelvic pain is yet in its infancy, the techniques used by Australian pelvic floor physiotherapists are being emulated all over the world. I have been treating pelvic pain for more than 15 years and continue to go to conferences and lectures to ensure your treatment is evidence based and the best available.

The management of continence issues and other LUTS in men has Lots of clinical evidence but less empirical evidence. Conservative management is recommended as a first line treatment strategy in reviews [3] and by the international continence society [4].

Pelvic floor exercises have been shown to improve erectile dysfunction, ejaculatory dysfunction and premature ejaculation as well as improving incontinence [5].

How long until I feel normal again?

This will really depend on what caused the problem. Post Prostatectomy it can be weeks to months. Your pelvic floor physiotherapist will monitor your progress closely.

Bladder and bowel function issues often develop over many years. They can often be reversed in a few months if you work on them diligently.

Chronic pelvic pain doesn’t always get completely resolved. However a specially trained pelvic floor physiotherapist will help you to manage your pain over a few months.

This will give you a new lease on life!


References and Links.

1. Chang, J.I., V. Lam, and M.I. Patel, “Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. European Urology,” 2016. 69(3): p. 460-467. Link

2. Baranowski, A.P., et al.,Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World Journal of Urology,” 2013. 31(4): p. 779-784. Link

3. Newman, D.K., et al.,An evidence-based strategy for the conservative management of the male patient with incontinence. Current Opinion in Urology,” 2014. 24(6): p. 553-559. Link

4. ABRAMS, P., et al., INCONTINENCE. 5 ed. 5th International Consultation on Incontinence. 2013, Paris. No Link Available.

5. Siegel, A.L.,Pelvic Floor Muscle Training in Males: Practical Applications. Urology,” 2014. 84(1): p. 1-7. Link

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