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Patient Information Department of Urology Male Lower Urinary Tract Symptoms:
Lifestyle Advice, Bladder Training and
Pelvic Floor Exercises

Lower urinary tract symptoms (LUTS) include the need to pass water very frequently
(frequency) and without much warning (urgency), associated with leakage of urine (urge incontinence); not being able to start to pass urine immediately (hesitancy), and a decrease in the force of the stream. This may also be associated with having to pass urine more frequently at night. Sometimes after prostate surgery there can be leakage of urine during physical activity or when coughing or sneezing; this is stress incontinence.
Men can also experience leakage of urine after finishing urinating and then on
walking away from the toilet (post-micturition dribble).
What is normal?

The kidneys are continuously filtering blood to produce urine, which is stored in the
bladder. The bladder will hold 400-500mls of urine, and an urge to pass urine is normally felt when the bladder is half full, thus giving time to reach the toilet. For various reasons, this message may become blurred or your bladder may contract to empty without warning, not allowing time to reach the toilet. At the base of the bladder is the prostate gland, which circles the water pipe (urethra). In men over the age of 60, it is quite common for this gland to become enlarged and give rise to the above urinary symptoms. It is important for you to have consulted your GP regarding this so that he/she can examine the prostate gland. Going to the toilet up to 6-8 times in 24 hours, with one of these occurring at night is considered normal. There are several strategies that can be employed to control symptoms of urgency and frequency.
Fluid management
A daily fluid intake of 1.5 – 2 litres is recommended. This is approximately 5-7
Caffeine tends to act as an irritant to the bladder it is recommended that caffeine free products are tried. These are widely available. Substitute caffeinated drinks with water or fruit squashes. Caffeine is found in tea, coffee, chocolate, high-energy drinks like Red Bull and Lucozade, Coca-cola and cocoa. If you drink large quantities of caffeinated drinks you should cut down gradually over a fortnight to reduce withdrawal effects. Large volumes of fluid within a short period of time and fizzy drinks can cause rapid filling of the bladder leading to frequency and urgency. Drinks should be spaced evenly through the day. If you cut down on fluids to try to control frequency, this means urine will become more concentrated and will irritate the bladder more. You will also be more prone to constipation, which will exacerbate bladder symptoms. Ideally urine should be a light straw colour. Very dark and strong smelling urine may mean it is too concentrated, and you should drink a bit more. If urine is very pale with no smell, then you may be drinking too much. During hot weather, air travel, after exercising and during sickness you will need to drink more. The table below indicates some of the fluids and foods which can irritate the bladder. Good Spicy foods Stronger brands of tea and coffee contain Cranberry juice should be limited to 400mls a day, and should be avoided if you have been diagnosed with interstitial cystitis or prescribed Warfarin.
Drug management
A number of medications can be prescribed by your GP to help control urgency and
urge incontinence, and to treat prostate disease. You can discuss these with your
Taking a prescribed diuretic (water tablet) will cause you to go to the toilet more
frequently than normal a few hours after you have taken it. It is important for your health that you continue to take prescribed medications, so if you find it is causing you great difficulty you should consult your GP. A number of common drugs and remedies can also contribute to bladder symptoms. You should seek advice from your Pharmacist, GP or Continence Nurse.
Bad habits
• Going to the toilet ‘just-in-case’ • Straining to empty your bladder or bowel Good tips
• Give your bladder time to empty properly. If you feel you are not emptying completely, make sure you have fully emptied by waiting a few seconds and then try to empty more. • If you are troubled by getting up to empty your bladder during the night, do not drink directly before you go to bed. If you wake up thirsty during the night, have a few sips of water.

Bladder training

This is a process whereby you train your bladder to hold a greater volume of urine.
It is used to treat an overactive or unstable bladder which is responsible for the
symptoms you are experiencing. If you have this condition the bladder contracts before you are ready to go to the toilet, this can happen especially if you get into the habit of going ‘just in case’, as the bladder learns to hold a small amount. Instead of your bladder controlling you, you must learn to control your bladder. When you feel the urge to pass water, tell yourself that you are not going to. Try to distract yourself for five to fifteen minutes from the time you get the first urge (use whatever method best distracts you). If you do this for a week, every time you want to pass water, you should find that by the end of the week the urge to urinate is delayed. During the next week do the same thing and delay passing urine by a further five to fifteen minutes; by doing this your bladder will learn to hold on more, and your symptoms will reduce. Please be persistent and remember that your bladder is like any other muscle in the body and may require a few months training in order to reach its full potential.
Deferment techniques – helping you to hold on

Rushing to the toilet will not help.
You can tighten your pelvic floor muscles to help calm your bladder when the feeling
of urgency develops, this will enable you to hold on for longer. Sitting or standing still
when you get this urge will help you to concentrate on tightening your pelvic floor

Pelvic floor exercises
Your pelvic floor muscles
The pelvic floor muscles form a hammock underneath your pelvis to provide support
and control the bladder and bowel. The muscles attach to the pubic bone at the front,
then span backwards to the coccyx (tailbone) behind. The openings to your bladder and your bowel both pass through the pelvic floor muscle.

What does the pelvic floor do?

• It supports your pelvic organs and abdominal contents, especially when • It supports the bladder to help stop leaking. The muscles need to work gently at all times and be able to work harder when you cough and sneeze to avoid leaking. When muscles are not working effectively you may suffer from urinary incontinence. • It is used to control wind and for ‘holding on’ with your bowels.
Why should I exercise my pelvic floor muscles?

The sphincter (closing) muscles around the bladder neck may be damaged by
prostate surgery, so the pelvic floor muscles become an important way of regaining
continence. You can also contract your pelvic floor muscles after emptying your
bladder to prevent post-micturition dribble.
To do this pelvic floor muscles need to be exercised. The exercise programme will
help to maintain and /or improve their strength.

The exercise programme
A pelvic floor contraction is performed by closing and drawing up you front and back
passages. Imagine you are trying to stop yourself from passing wind and at the same time try to stop the flow of urine. The feeling is one of ‘squeeze and lift’. You can do this lying, sitting or standing. You can see if you are contracting the correct muscles by standing in front of a mirror and if you are contracting the correct muscle you will see the penis and testicles lift. Start gently and stop if it hurts. DON’T • Pull in your tummy muscles excessively
You should aim to perform at least 10 contractions of the muscles, up to 6
times during the day, everyday.

Muscles only develop when you challenge them to work harder than normal. This will
be different for everyone. There are many other ways of exercising the pelvic floor
Develop a habit of bracing your pelvic floor muscles gently during everyday activities
(lifting, carrying and during strenuous exercise) and particularly during any task
which might challenge the bladder or put pressure through the pelvis.
Do not exercise using the pelvic floor muscles to stop and start the flow of urine as it
may interfere with normal bladder emptying.

Tips for a healthy pelvic floor

To relieve the load on your pelvic floor, aim for an acceptable weight for your height
and build. Being overweight [a Body Mass Index over 29] has been proven to have a
negative impact on symptoms of stress incontinence. There are many ways of losing
weight; your GP should be able to guide you as to the most suitable method for you.
Lifting puts extra strain on the pelvic floor. If you do need to lift a heavy object
remember to tighten your pelvic floor before you lift, and hold it tight until you have
lowered the load.
Smoking - research suggests that smokers are more likely to experience urinary
incontinence and this is due to the excessive strain that repetitive coughing puts on
the pelvic floor. If you do smoke and would like support to stop smoking contact:
CAMQUIT – Cambridgeshire Stopping Smoking Service – 0800 018 4304
Or visit NHS Smoking helpline 0800 169 0169

Avoiding Constipation
Many people find symptoms are worse if they are constipated. As the bladder and
bowel are next to each other, a full bowel will affect bladder function. • To keep a healthy bowel, eat a balanced diet, which includes both soluble fibre (oats, barley, berries and fruit) and insoluble fibre (wheat-based foods, cereal, vegetables and nuts). • You should go to the toilet to empty your bowel when you feel the need, as • Adequate fluid intake of 1.5-2 litres will also help. For further advice and information contact: Local Continence Advisory Service 01353 652145 or 01480

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Document history
Nikesh Thiruchelvam (on behalf of the Continence Sustainable Healthcare Partnership). Minor modification from the Cambridgeshire Community Services NHS Trust leaflet: Male Bladder Health Department Department of Urology, Box No 43 Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust Hills Road Cambridge, CB2 2QQ number Fax number 01223 216069 Dept website First published Review date April 2013 File name Male Lower Urinary Tract Symptoms: Lifestyle Advice, Bladder Training and Pelvic Floor Exercises


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