The non-surgical treatment options for SUI are pelvic floor physical therapy, incontinence clamps, and tension penile loops.
Pelvic Floor Physical Therapy (PFPT)
PFPT is a branch of physical therapy that focuses on the muscles in the pelvis. This is an excellent first-line option for all patients with SUI. If they have very mild symptoms, this will be the only option. However, patients that have very severe SUI will need surgical treatment.
For patients planning for a prostatectomy (surgery), PFPT can be started before the operation. This helps men control their pelvic floor better to get ready for post-operative SUI. Physical therapists with postgraduate training focused on the pelvic floor provide this therapy.
Every therapist has their own practice style, but some of the cornerstones of this treatment include:
- pelvic floor muscle training (think Kegels on steroids)
- behavioral changes (changing how much liquid you drink and your urinating schedule)
- manual therapy (direct treatment to the pelvic floor)
- biofeedback (monitor to show you what you are doing)
- functional training (including muscle squeezing during daily activities)
PFPT has also been shown to help with urge urinary incontinence, constipation, fecal incontinence, and pelvic pain.
External Devices
These are devices that are placed around the penis to compress the urethra. There are different types depending on the activity they are needed for.
Incontinence Clamp
Incontinence clamps are simple tools used daily to stop urine leakage. A clamp is placed around the outside of the penis shaft to stop urine from leaking. There are different brands on the market, which are very similar, so it is important to choose the one that works best and is the most comfortable for you. Incontinence clamps come in different sizes, so it is essential to pick the correct size to get adequate compression without preventing blood flow to your penis. If using one of these devices, you must follow the instructions to prevent injury, specifically only wearing the clamp when awake and removing it every few hours to urinate. You should also rotate the location you place the clamp on your penis from the base to the midshaft and move it every few hours.
Tension Penile Loop
Another unique subtype of SUI is climacturia. This occurs when you have leakage of urine when you reach climax or orgasm. Many men think that it is ejaculate or semen. However, after the prostate is removed, the patient is unable to ejaculate. The ejaculate volume can also be diminished from radiation therapy. Men can still achieve orgasm without ejaculating. For men experiencing this, a tension penile loop is a non-surgical option. These loops are made of silicone and are very similar to constrictive rings used for erectile dysfunction. They are placed at the base of the penis and cinched down to compress the urethra while not causing problems with blood flow. It is important that you remove the loop as soon as you are done having intercourse.
Precautions for External Compression
When using any external device, you should alert your doctor if you have numbness, pain, swelling, discoloration, or skin irritation of your penis.
Conclusions
The ability to control continence is something that many people may take for granted. Unfortunately, many prostate cancer survivors are dealing with incontinence as a result of the treatment they have received. However, there are many treatment options depending on how bad your incontinence is.
If these non-surgical options are not enough to control your incontinence, then there are surgical options. To explore these options, it is important to find a urologist who is an expert in these procedures. Please refer to the article about surgical options for stress urinary incontinence for more details.