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On April 24th, 2024, the urgent need to urinate, a weak stream of urine, and the feeling of incomplete emptying are all symptoms of lower urinary tract problems in men, with over 72% of men experiencing at least one of these. European researchers believe they may have a new way to address these symptoms: a smartphone app that combines pelvic floor training and behavioral changes. It may sound too good to be true, but research presented this month at a major urology conference in Paris showed that digitally accessible behavioral and physiotherapy strategies could be just as effective as medication for many men with mild to moderate bladder symptoms known as LUTS.
„We believe that offering our patients time and spatial flexibility is a high priority,“ said Dr. Christian Gratzke, lead investigator of the study and urological surgeon at the University Medical Center Freiburg in Germany. „That’s why using an app works well for many people.“
Gratzke and his colleagues recruited 237 German men with mild to moderate lower urinary tract symptoms, particularly due to an enlarged prostate or overactive bladder. Participants were divided into two groups, with one receiving their usual treatment plan plus app-based therapy combining pelvic floor training, behavioral/lifestyle interventions, and bladder control techniques, while the other received just their usual care. App users were asked to keep a urination diary and fill out a series of questionnaires on symptoms and quality of life. After 12 weeks, men using the app-based strategy experienced significant and clinically meaningful improvements in their symptoms as well as significant improvements in symptom severity and quality of life; all of these measures were greater than in men receiving their usual care.
„We were able to show that physiotherapy and lifestyle counseling are an additional pillar in the treatment of male LUTS,“ said Gratzke. „What was new was the fact that we used an app that included multiple modules such as urge control training, mental training, an educational section, and a physiotherapy section, which was the most powerful of all.“
LUTS Tips
Aging and bothersome bladder emptying and storage problems often go hand in hand. These issues are often linked to an enlarged prostate, which presses against the urethra (the tube through which urine flows), or with a dysfunction in bladder filling and storage, also known as overactive bladder, which can be caused by either an enlarged prostate or malfunction of the detrusor muscle in the bladder wall. LUTS is prevalent and affects about half of men in their sixties. However, these problems often occur much earlier. „As men enter their late 40s and then into their 50s, they realize that the strength of the stream is decreasing, and as it decreases, the bladder needs to exert more force and pressure to expel the same amount of urine,“ said Seth Cohen, MD, MPH, Associate Professor in 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 a part of life. For others, it’s a big issue; they need to constantly go to the bathroom – the prostate enlarges and obstructs, and the bladder constantly sends signals to the brain – I need to go, you haven’t fully emptied.“ David Chan, MD, Associate System Chief of Urology at Northwell Health in New Hyde Park, NY, recalled a former patient who perfectly fit Cohen’s description of the „need to go.“ „He knew where every single bathroom was wherever he went and realized it was time to do something about it; that’s why he sought medical attention,“ Chan said.
Choosing the Right Management Strategy
LUTS are not a uniform disorder, nor is the treatment. „It’s obvious that most patients, whenever possible, would respond to the less invasive options and tend to gravitate towards those,“ said Arthur Louis Burnett, MD, Director of the Basic Science Laboratory 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 try to promote behavioral changes first, such as reducing caffeine and alcohol and other irritants. „This can be crucial for men who wake up at night to urinate, pee frequently during the day, experience urgency and urge incontinence,“ he said. „With a lot of time, you can get them to 90%.“
Other behavioral and lifestyle changes include limiting fluid intake, physical activity, timed voiding (emptying the bladder based on time intervals), and double voiding (urinating, followed by a second attempt 1-2 minutes later). Pelvic floor training (referred to by Gratzke as physiotherapy) is more common in men in Germany than in the US. There is a misconception that it is targeted towards women, especially after childbirth or developing overactive bladder or stress incontinence. However, Patrick Wenning, a physiotherapist at Restore Motion, a practice based in Rockville, MD, said that at least 50% of his practice cases involve pelvic floor training and workshops for men recommended to him by local urologists and colleagues. „The workshops are mainly for men in their forties and fifties,“ says Wenning, who has additional specialized training in pelvic floor issues. „They have this system in their body that they need to be aware of early and pay attention to. So when something isn’t working right, they can intervene and act early.“
The pelvic floor consists of muscles that support organs (including the bladder and rectum) in the pelvis. Pelvic floor training involves learning how to activate, strengthen, and isolate these muscles, which can help reduce urinary urgency and leakage. „I want men to learn how to relax the pelvic floor muscles, decrease the tone of the pelvic floor muscles, and properly contract and release the muscles,“ said Wenning. „When the muscles are on the right track, they can support the bladder during sleep, and the bladder can hold urine and then send the signal to urinate at the right time.“ Gratzke agreed. „Strengthening the pelvic floor has certain benefits, but few do it,“ he said. „It’s about my preference to always prevent the disease, not to 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 pelvic floor physiotherapy?“
Admittedly, the study participants were highly motivated, which may have contributed to their success in alleviating their symptoms. This is a limitation to consider. For men who don’t have time or don’t want to bear the cost of physiotherapy, medications are an option. „I tell patients: The best person taking care of you is yourself. Know your body,“ said Chan.
These exercises are easy to do once you know which muscles to train. One of the simplest ways to locate your muscles is while urinating. Here’s how:
– Try to stop or slow down the urine flow halfway through.
– Do not tighten the buttocks, leg, or abdominal muscles and do not hold your breath.
– If you can slow down or stop the urine flow, you have successfully located these muscles. Some men find these muscles by imagining trying to stop the passage of gas. Contracting these muscles produces a pulling sensation; these are the correct muscles for pelvic exercises. It’s important not to tighten other muscles.
To perform the exercises:
– Slowly contract these muscles and count to five.
– Relax the muscles and count to five.
– Repeat 10 times.
– Do three sets of 10 repetitions each day.