April 24, 2024 – The urgent must urinate, a choked flow of urine and the sensation of not having gotten every little thing out. These are symptoms of lower urinary tract problems in men, and greater than 72% of men Experience no less than one among them.
However, European researchers consider they might have found a recent solution to treat these symptoms: a smartphone app that mixes pelvic floor exercises and behavioral changes.
That may sound too good to be true, but a study presented at a serious urology conference in Paris this month showed that digitally accessible behavioral and physical therapy strategies could possibly be as effective as medication for a lot of men with mild to moderate bladder symptoms (LUTS).
“We believe that flexibility in terms of time and location is a high priority for our patients,” said Dr. Christian Gratzke, study leader and urologist on the University Hospital Freiburg. “For this reason, using an app makes sense for many people.”
Gratzke and his colleagues recruited 237 German men with mild to moderate lower urinary tract symptoms, specifically an enlarged prostate or overactive bladder. Participants were divided into two groups and received either their previous treatment regimen plus an app-based therapy that combined pelvic floor exercises plus behavioral/lifestyle interventions and bladder control techniques, or the previous treatment alone.
App users were asked to maintain a urine diary and complete a series of questionnaires about how bothersome their symptoms were and their quality of life.
After 12 weeks, the boys who used the app-guided strategy showed significant and clinically meaningful improvement of their symptoms, in addition to significant improvements in symptom severity and quality of life, all of which were higher than those that received their usual care.
“We were able to show that physiotherapy and lifestyle advice are another pillar in the treatment of male LUTS,” says Gratzke. “What was new was that we used an app that included several modules, such as urge stopping training, mental training, a knowledge section and a physiotherapy section, which was the strongest of all.”
LUTS information
Age and problems with voiding and urination often go hand in hand. These problems are sometimes related to an enlarged prostate that presses against the urethra (the tube through which urine flows) or to a bladder filling and storage disorder, also referred to as an overactive bladder, which will be brought on by either an enlarged prostate or a detrusor muscle within the bladder wall that just isn’t working properly. LUTS is common, affecting about half of all men of their 60s. But these problems often arise much earlier.
“When men are in their late 40s or over 50, they notice that the force of the stream decreases. And the less force there is, the more force and pressure the bladder has to exert to expel the same amount of urine,” said Seth Cohen, MD, MPH, associate professor within the department of urology at NYU Langone Medical Center in New York City and host of the Men's Health Show on Sirius XM 110 Radio. “Some men don't even notice the difference. It's just part of life. For others, it's a big problem. They have to go to the bathroom all the time – the prostate gets bigger and causes blockages. And the bladder is constantly sending signals to the brain: I have to go, you're not emptying completely.”
David Chan, MD, associate director of urology at Northwell Health in New Hyde Park, NY, recalled a former patient who fit Cohen's “gotta go” description perfectly. “He knew where every single bathroom was, wherever he went, and realized it was time to do something about it; that's what made him see a doctor,” Chan said.
Choosing the appropriate management strategy
LUTS should not one size suits all, and neither is treatment. “It's logical that most patients will respond to and prefer the less invasive options when possible,” said Arthur Louis Burnett, MD, director of the Laboratory of Basic Research in Neuro-Urology and professor of urology at Johns Hopkins Medicine in Baltimore. “The choice of options really depends on the patient's preferences,” he said.
Cohen agreed. “At NYU, we first try to encourage behavioral changes, like reducing caffeine consumption and alcohol consumption and other irritants. That can improve urinary urgency and confidence for men who wake up at night to pee, have to pee frequently during the day,” he said. “Often you can get them to 90%.”
Other behavioral and lifestyle changes include limiting fluid intake, physical activity, timed urination (emptying the bladder at timed intervals), and double urination (urinating followed by a second attempt 1–2 minutes later).
Pelvic floor training (referred to by Gratzke as physical therapy) is more common for men in Germany than within the U.S. One misconception is that it’s geared toward women, especially after childbirth or after they develop an overactive bladder or stress incontinence. However, Patrick Wenning, a physical therapist at Restore Motion, a practice in Rockville, MD, said no less than 50% of his practice cases involve pelvic floor exercises and workshops for men referred to him by local urologists and colleagues.
“The workshops are really aimed at men in their 40s and 50s,” said Wenning, who has additional specialized training in pelvic floor issues. “You have this system in your body that you need to be aware of and pay attention to early on. So when things start not working properly, you can tune in and intervene early.”
The pelvic floor is made up of muscles that support the organs (including the bladder and rectum) within the pelvis. Pelvic floor exercises teach you activate, strengthen and isolate these muscles to cut back urinary urgency and incontinence.
“I want men to learn how to relax the pelvic floor muscles, reduce the tone of the pelvic floor muscles, and contract and release the muscles in the right way,” Wenning said. “If the muscles are on the right track, they can support the bladder while you sleep, and the bladder can hold the urine and then send the signal to urinate at the right time.”
Gratzke agreed. “There are certain benefits to strengthening the pelvic floor, but few people do it,” he said. “At the end of the day, I prefer to always prevent the disease, not treat it. You know, people go to the gym because they want to work out; they do muscle training, endurance training, etc. Why not combine that with physical therapy for the pelvic floor?”
Admittedly, the study participants were highly motivated, which can have contributed to their success in controlling their symptoms. It is a limitation that should be considered. For men who shouldn’t have the time or don’t want to incur the expense of physical therapy, medications are an option.
“I tell patients: The best person to take care of you is yourself. Know your body,” Chan said.
These exercises are easy to do if you happen to know which muscles you need to work. One of the simplest ways to locate your muscles is while urinating. Here's do it:
- Try to stop or slow the flow of urine halfway through urination.
- Do not tense your buttocks, leg and abdominal muscles and don’t hold your breath.
- If you possibly can slow or stop the flow of urine, you’ve successfully positioned these muscles.
Some men find these muscles by imagining that they are attempting to stop the passage of gas. Contracting these muscles creates a pulling sensation; these are the appropriate muscles for pelvic exercises. It is significant to not contract some other muscles.
How to do the exercises:
- Tighten these muscles and slowly count to 5.
- Relax your muscles and slowly count to 5.
- Repeat 10 times.
- Do a set of 10 repetitions 3 times every day.