• Marcus Drake
  • Kate Lough
  • Professor Mandy Fader
Marcus Drake, North Bristol NHS Trust and ICS Standardisation Steering Committee Chair

What are the main focuses in your field in the area of incontinence?

Options for treatment are wide, and depend on how the patient feels about the severity of their symptoms. After an assessment of their condition I generally suggest they see a continence advisor and/or a physiotherapist, as pelvic floor exercises can be helpful.

Medications available mainly focus on a condition called overactive bladder. This is where a person feels an overwhelming urgency to go to the loo — or actually wet themselves. There are various drugs available to help treat this condition in two main classes. The more long-standing drug class tries to reduce the stimulation of the bladder; these are called antimuscarinics. A more recent introduction aims to relax the bladder; this is a beta-3 agonist.

If those treatments are unsuccessful, we are talking about intervention. Surgical options for people with an urgency to urinate might include injections in the bladder with Botox; or a stimulator implant into the back for the bladder nerves. Or, indeed, larger operations are sometimes required.

 

What are the main focuses in your field in the area of prostate problems?

The prostate is a fleshy gland that sits around the exit to the bladder. Once a male reaches puberty, male hormones cause the prostate to grow. This growth is typically outwards. If it grows inwards, the force of the bladder is restricted, and so your stream becomes weaker. You take longer to urinate, you are slow to start, slow to finish.

Drugs are available to help: an alpha-blocker to relax the urethra, for example, and 5-alpha reductase inhibitors which are designed to counteract prostate growth by targeting the specific male hormones, and therefore slightly reversing lifelong prostate enlargement.

Many men aren't too troubled by later-life urinary symptoms, depending on their severity — and providing they are reassured that it doesn't represent anything such as a cancer. However, if they are bothered, they may think about an operation to remove the part of the prostate causing the blockage. This is usually done through a telescope, either doing a conventional operation called a “TURP”, or using a laser to create a better channel.

Kate Lough, Specialist Physiotherapist in Pelvic Floor Dysfunction

What are the main focuses in your field in the area of incontinence?

My main area of work is any form of incontinence in men and women. The most common cause of incontinence in men is prostate-related surgery.

It's important to establish when the urinary leakage occurs, what provokes it. Is it stress urinary incontinence related to a physical activity, or an increase in abdominal pressure or urinary leakage associated with urgency?

A full history including a rectal examination to assess the pelvic floor muscles will determine what management will help to improve the symptoms. Bladder control is related to pelvic floor muscle function. An intensive, supervised pelvic floor muscle retraining programme over a three to six month period aims to regain strength, endurance and function.

Physiotherapists also provide education and information about practical measures to minimise symptoms such as post void urethral clearance, bending and lifting techniques and containment products. They might also refer on to specialist nurses for information about other containment devices.

 

What are the main focuses in your field in the area of prostate problems?

Men with symptoms of urinary or bowel leakage post prostatectomy need help to understand the mechanism for the incontinence. Clear explanations and visual aids help the men understand how the bladder and bowel work and why the prostate removal has led to post op problems.

Understanding the role of the pelvic floor muscles can help the men play a role in their post op management. It’s not clear when these patients should be referred to see a specialist physio — and the evidence for pelvic floor muscle exercises for post-operative prostate management is not strong. 

In my experience men who are given the opportunity to see a specialist physiotherapist pre op or post op gain understanding about their symptoms and can be taught how to correctly tighten and relax their pelvic floor muscles. This seems to provide reassurance and support, and knowledge of where to come for help. 

Professor Mandy Fader, Professor of Continence Technology, Faculty of Health Sciences, Southampton General Hospital

What are the main focuses in your field in the area of incontinence?

I specialise in managing incontinence with products so that people can lead as normal life as possible. It's vital that continence products are reliable and effective so that people have the confidence to go out and take part in things they like to do. For women, choices are limited mainly to absorbent pads; but for men there are several other options. These include wearing a sheath that drains urine into a bag. This can be very useful when incontinence is quite severe or for times when pads are difficult to change. A body-worn urinal works in a similar way. A penile compression device can be useful to keep urine in the bladder, particularly after surgery if the sphincter isn't working properly, but these can only be kept on for an hour or two at a time. 

For both men and women who have problems with urine retention — or who have very severe incontinence, a catheter — by which urine drains out of the bladder through a tube and into a bag — might be an option. These can get infected and blocked so tend to be used only if other products don’t work well. 

What are the main focuses in your field in the area of prostate problems?

It is very common for men who have an operation on their prostate to have bladder leakage afterwards. This may only be for a few days but sometimes this can last for months — or in some cases be permanent, particularly after major surgery for prostate cancer.  Its important for men to be prepared for some incontinence after surgery and have plenty of pads available. Sometimes after prostate surgery men have to go to the loo very frequently and in a hurry. Bottles, similar to those used in hospital can be helpful and you can also buy disposable flat-packed ones which are good for travelling.

People who have a sudden frequent and urgent need to go to the loo can learn various coping strategies. For instance, there are ways to train the bladder to know that it doesn't have to empty so frequently. This is often used in conjunction with medication to relax the bladder, give it a larger capacity and give the patient a more normal bladder pattern. There is a temptation to rush off to the loo when the urge to urinate comes; but that can only serve to stimulate the bladder. One technique is to sit down and try to distract the mind and suppress the feeling of urgency until the contraction goes away.