Tackling male incontinence

Male incontinence affects one-in-eight men, significantly affecting quality-of-life, the IOS 2021 Annual Medical Conference heard. However, there are effective treatment strategies and a more proactive approach and increased awareness could help relieve the impact of this condition, Ms Aoife Ni Eochaidh, Chartered Physiotherapist, Clinical Specialist Physiotherapist, Women’s and Men’s Health and Continence, Bon Secours Consultants Clinic, Galway, gave a comprehensive presentation on the risk factors and latest treatment approaches to male incontinence.

Her clinic’s main patient cohort in this area are men who have had a radical or robotic prostatectomy, men with benign prostate enlargement, and men with a history of prostatitis. “Pelvic floor muscle dysfunction and osteoporosis are linked, which you might be surprised to hear, and we have good evidence to support this in women, (I know we are talking about men today). But as osteoporosis unfortunately progress, with spine flexure, the tummy protrudes, the ribs can end up resting on the pelvis, and that pressurises the pelvic floor muscles and the woman or man can have incontinence.

Urge incontinence is of course a falls risk, so just keep that in mind,” she commented. Bladder retraining is the recommended treatment and will cure urinary incontinence in 75 per cent of cases: “You could have the best pelvic muscle floor function, but if you have poor bladder habits the man is still going to have issues.” “Pelvic floor muscle training from the pelvic physio side of things is the gold standard for treatment,” Ms Ni Eochaidh reported, while other male incontinence treatments include electrical stimulation, bulking agents, male slings, artificial sphincters, and other devices.

She stressed the importance of early intervention and “pre-rehab for men undergoing prostate cancer surgery”, praising her urology colleagues in Galway for referring such cases to her before surgery to begin training. Ms Ni Eochaidh also discussed an online pelvic floor muscle training solution her clinic developed during Covid-19, which facilitated the continuation of services, and continues to be particularly useful given that clients are referred from all areas of the country and there is a national shortage of pelvic physiotherapists. In relation to digital rectal examination (DRE), she said it gives GPs a great opportunity to assess pelvic floor muscle function when they are carrying out a prostate check or assessing piles, etc.