Behavioral therapies such as pelvic-floor-muscle training and bladder-control strategies can reduce incontinence episodes by more than 50 percent in men following prostate-cancer surgery, according to new research from the Center for Aging at the University of Alabama at Birmingham and the Birmingham/Atlanta Veterans Affairs Geriatric Research, Education and Clinical Center. The findings, published in the Journal of the American Medical Association (JAMA) on Jan. 12, 2011, indicate that these therapies can improve bladder control and enhance quality of life.
Incontinence is common in men following prostate-cancer surgery, and while it improves in most men in the months following surgery, up to 65 percent of men may still have some leakage after one year. The UAB researchers followed 208 men ages 51-84 with persistent incontinence. Most subjects were five years post-surgery, with a range of one to 17 years after surgery.
One group of men received eight weeks of behavioral therapy administered during 4 visits. This group saw a 55 percent decrease in incontinence episodes, down from an average 28 episodes a week to 13. A second group, who received the behavioral therapy and additional treatment via biofeedback and electrical stimulation of the pelvic muscles, had a 51 percent decrease.
"Our finding indicate that no matter how long it's been since surgery, behavioral interventions can help men reduce the number of incontinent episodes they experience," said Patricia Goode, M.D., professor in the Division of Gerontology, Geriatrics and Palliative Care and lead author of the study. "There is no guarantee that they'll be completely dry, but behavioral therapy will help reduce incontinence and improve quality of life."
Behavioral therapy, first described in the late 1940s, consists of pelvic-floor-muscle training —learning which muscles to squeeze and strengthen to close the urethra — and bladder-control strategies, which include actively using the muscles to prevent leakage, fluid-management skills and maintaining a bladder diary.
"Behavioral therapy works, but unfortunately many men are not aware that it is an option or don't know where to find the therapy," said Kathryn Burgio, Ph.D., professor of Gerontology, Geriatrics and Palliative Care and a study co-author. "Making this sort of therapy more easily accessible will be even more important as the Baby Boom generation ages and the number of men developing prostate cancer increases."
Goode says some physical therapists offer behavioral therapy, and two organizations maintain a database of practitioners, the National Association for Continence and the Wound, Ostomy and Continence Nurses Society. UAB has a Continence Clinic that offers behavioral therapy.
The study also found that biofeedback and pelvic floor electrical stimulation, which have been used to treat incontinence since the 1980s, also were effective when combined with behavioral techniques, but did not lead to better results than the behavioral therapy alone.
"Biofeedback works for some men," said Burgio, "but our study would suggest that it is not an essential treatment component for all men undergoing behavioral therapy following prostate surgery.
Goode and Burgio say there are surgical options for the treatment of male incontinence, but they are invasive, expensive and not without risk. Behavioral therapy could be a good first treatment for men following prostate-cancer surgery.
"The message is that the there are non-invasive treatments which can mitigate incontinence and improve quality of life," said Goode. "Men, their families and the medical profession need to be more aware of the value and benefit of behavioral therapy."
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