Male Bladder Dysfunction

Explanation of common symptoms/ problems

Bladder symptoms in men are relatively common, with some published evidence showing an incidence of lower urinary tract symptoms in more than 30% of men over the age of 65 (NICE, updated 2015) and other sources finding symptoms of voiding dysfunction in 60% of men over the age of 40 (Glasser et al. 2007). There is also some suggestion that there may be underreporting of symptoms amongst men due to embarrassment, fear of invasive tests or simply not knowing that there is treatment available.

There are a variety of possible causes for bladder symptoms including infection, inflammation, age-related changes, muscle dysfunction or changes in the prostate and a wide range of treatments available. If you have had a diagnosis or treatment for prostate changes, please see some more information here. If you also have noticed some changes in your sexual function, please see some further information here.

Bladder symptoms you may notice might include:

• Frequency
• Urgency
• Nocturia
• Urinary Incontinence
• Dysuria.
• Incomplete emptying – which may include straining to start or finish

Self help / Advice

It is important that you are individually assessed to find out what is causing your symptoms, but the following tips may be useful in some cases:

• Try to avoid going to the toilet 'just in case’ too often.
• It may also be useful to make sure that you don’t always wait until the ‘last minute’ before going to the toilet. Try to leave no more than 4 hours between trips to empty your bladder.
• Do not restrict your fluid intake as this may irritate the bladder further. Drink enough! Adults should drink approximately 1.5 – 2 litres of fluids each day, the majority of which should be water. Try to sip small amounts spread throughout the day.
• Avoid alcohol, caffeine and fizzy drinks, which are known bladder irritants. Eliminate tea, coffee, green tea, energy drinks and soft drinks. Drink decaffeinated tea and coffee if you must!  Reducing juices and artificial sweeteners can also help.
• Reduce fluid intake 3-4 hours before bed, just having a few sips of water if you are thirsty. If you are getting up a lot at night, it can also be useful to avoid too much salty foods or processed foods that can be high in added salt and sugar.
• Watch your weight, aim for a BMI of 19 – 25 ideally. Being overweight or obese has been shown to have a negative impact on bladder symptoms and put extra strain on the pelvic floor muscles.
• Some men find that they feel they can also empty their bladder more effectively in sitting rather than standing. Perhaps give this a try and see if it helps you.  Take your time, relax and do not strain to empty.
• Tighten your pelvic floor muscles before and during any activity that makes you leak (e.g. coughing, sneezing, lifting or rising from sitting), so that this becomes an automatic habit. This is called ‘The Knack’ and can be very useful to reduce leaking with any of these activities.
• To reduce the ‘after-dribble’ you may find it useful to ‘double void’ or double check that you have finished by shaking the penis several times or rub forward with your fingertips from the back passage towards the base of the penis a few times and then try to empty your bladder again. You should then squeeze your pelvic floor muscles strongly to finish.
• Healthy bowels
• Regular physical activity can also keep the bowels moving regularly and optimise bladder and bowel function overall. Adults are advised to take 30 minutes of exercise at least 5 days each week. Walking, jogging, cycling or swimming are simple ways to get out and exercise and can also help with stress management and general health.

Where to go to next

If your bladder symptoms continue to be bothersome refer yourself, or ask to be referred, to a specialist pelvic health

physiotherapist.

Find a Physiotherapist

You should also discuss your symptoms with your GP, if you have not already, as they will have a lot of information to offer and be in a position to refer you for any follow-up that may be required. You may benefit from medications, require some tests or they may refer you to see a specialist doctor (urologist).

You might find some more information through some of these sources:

• POGP booklet: Pelvic Floor Muscle Exercises (for men)
• https://www.bbuk.org.uk/adults/adults-resources/
• https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/
• https://www.ageuk.org.uk/globalassets/age-uk/documents/information-guides/ageukig15_bladder_bowel.inf.pdf
• https://www.continence.org.au/pages/men.html
• https://www.nafc.org/mens-conditions

What to expect from physiotherapy

The specialist pelvic health physiotherapist will ask in detail about your symptoms, and what treatments or strategies you may have tried already.

They may ask you to fill in a bladder diary to look at what you are drinking, how often you go the toilet and how much urine you pass, usually over a three-day period. This will allow them to prescribe individualized bladder training strategies to help you to improve your symptoms.

You may be asked if you are happy to be examined, so that the physiotherapist can assess your pelvic floor muscles and check their strength, coordination and function. This is useful as not everybody will benefit from the same exercise programme. You may be taught specific exercises to improve your pelvic floor muscle function if required.

This is the link to the POGP booklet to learn some more about pelvic floor muscle exercises and what they might entail: POGP booklet Pelvic Floor Muscle Exercises (for men)