Andrew Siegel MD 3/28/2020
Behavioral managements are simple and conservative modification strategies that target lifestyle, fluid consumption and voiding habits with the goal of improving urinary symptoms, particularly bladder control issues. These measures, although not curative, can reduce symptoms and improve quality of life. Since urinary control is a process that gradually and incrementally improves after prostate cancer treatment, conservative options are sensible means of management that should be considered before more invasive options. The recommendations that follow are useful not only for men with bladder control issues following prostate surgery, but also any person of either gender with bladder control problems. Pelvic floor muscle training is such an important part of the conservative approach that it will be addressed in a separate entry.
Image above taken by Angela Fornstrom Melbihess
Behavioral Managements
- Healthy lifestyle
The burden of excess pounds often worsens urinary control issues. Therefore, maintaining a healthy weight via nutritious eating, portion control and exercise are beneficial strategies. A healthy diet consists of real and wholesome natural foods, the avoidance of over-refined and over-processed nutritionally-empty choices and the consumption of animal products in moderation. “Eat food, not too much, mostly plants“–the famous seven words of Michael Pollen summarizing the approach.
Physical activities help maintain fitness with low impact exercises, e.g., yoga, Pilates, cycling, swimming, etc., capable of boosting core muscle (of which the pelvic floor muscles form the floor) strength, tone and endurance.
Tobacco cessation can help improve bladder control since the chemical constituents of tobacco negatively affect bladder and sphincter function by constricting blood vessels and impairing blood flow, decreasing tissue oxygenation, promoting inflammation and contributing to coughing.
- Moderation of fluid, caffeine and alcohol
Urinary incontinence will often not occur until a “critical” bladder volume is reached. By sensibly moderating fluid intake (but avoiding dehydration), it will take a longer time to achieve this threshold volume. Both caffeine (present in tea, coffee, cola, chocolate and many energy drinks) and alcohol increase urinary output and can act as urinary irritants, so moderation is recommended. Many foods—particularly fruits and vegetables—have significant hidden water content, so some restraint applies here as well (although vegetables and fruits are up there with the healthiest of real and wholesome natural foods).
- Avoidance of bladder irritants
Urinary irritants may worsen urinary symptoms. Consider eliminating or reducing one or more of the following irritants and then assessing whether symptoms improve:
- Tobacco
- Alcoholic beverages
- Caffeinated beverages: coffee, tea, colas and other sodas and certain sport and energy drinks
- Chocolate
- Carbonated beverages
- Tomatoes and tomato products
- Citrus and citrus products: lemons, limes, oranges, grapefruits, citrus drinks
- Spicy foods
- Sugar and artificial sweeteners
- Vinegar
- Acidic fruits: cantaloupe, cranberries, grapes, guava, peaches, pineapple, plums, strawberries
- Dairy products
- Medication assessment
Diuretic medications (water pills) can substantially contribute to urinary incontinence. If on a diuretic it may be worthwhile to check in with your medical doctor regarding the feasibility of switching to an alternative, non-diuretic medication. This will not always be possible, but if a change to a different class of medication is made, there may be substantial symptomatic improvement.
- Timed voiding (defensive voiding)
Urinating on a regular basis (“by the clock”) before a sense of urgency occurs will keep the bladder as empty as possible. By emptying the bladder before a critical volume is reached, the incontinence can be better controlled. Such “preemptive” or “defensive” voiding is a useful technique since purposeful and “voluntary” urinary frequency is more desirable than “involuntary” incontinence.
- Bowel matters
Avoidance of constipation is an important means of helping control urinary incontinence and other lower urinary tract symptoms. Because of the proximity of the rectum and bladder, a rectum full of solid waste can put pressure on the bladder, resulting in worsening of urinary symptoms, particularly urgency. The presence of gas in the colon can have the same effect, with the distended rectum internally squeezing the bladder, causing the same urgency effect as if you compressed your lower abdomen with your fingers. Since gas production is related to the intake of certain foods, the urinary urgency and incontinence can be improved by tailoring your diet accordingly.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.
The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 