Physiotherapist Bill Landry (BScPT, BScH, MCPA, CAFCI) has a special interest in male urinary incontinence. He has developed a program based on the latest evidenced-based research. Working with urologists in London, he continues to develop and improve his program. Research in this field continues to grow and this is incorporated into the program.
Urinary incontinence often occurs in men under various situations, particularly after radical prostatectomy. While programs do exist in Europe, there have been very few programs in Canada. In fact, we were unable to find an equivalent program addressing men’s issues here in South Western Ontario.
Based on the type of urinary incontinence identified at assessment, different types of treatment are indicated. Urge urinary incontinence, stress urinary incontinence and mixed incontinence can all be treated within this program.
Treatment will usually consist of:
- Functional Exercises based on anatomy, physiology and motor control mechanisms.
- Confirm patients are performing the exercises correctly using biofeedback tools such as transabdominal Real time ultrasound, palpation, and in severe cases rectal probe EMG
- Outcome measures incorporated into the program – 24 hour pad test
Bill Landry has 10 years of experience working with men with urinary incontinence issues. He has done post graduate courses in Europe and at the University of Western Ontario. He has worked closely with urologists in London, Ontario to continually improve the program.
Biofeedback is the visual and/or auditory response of a machine programmed to measure changes in the human body’s physiological activity. Biofeedback is primarily used to teach people new physical responses which were previously considered automatic and not within the person’s conscious control.
Biofeedback techniques have been used in connection with Pelvic floor exercises to treat men with urinary stress incontinence, particularly after prostate surgery. “Stress” in this context does not refer to psychological stress (such as anxiety or worrying), but rather to the rise in intra-abdominal pressure brought on by such activities as coughing, sneezing, jogging or lifting. That is, your are stressing the sphincter or valve muscles of the bladder by causing a rapid rise in the pressure within the bladder.
Biofeedback-based continence training has also proven effective with urge incontinence (the urgent need to pass urine and the inability to get to the toilet in time) and overflow incontinence (the spilling over of small amounts of urine when the bladder is full).
When we educate men on performing pelvic floor exercises, a lot of men are confused about how to do these exercises properly. A primarily issue is that they cannot locate and exercise the correct muscles. The three mistakes most often made when learning pelvic floor exercises are the irrelevant contractions of the gluteal (buttock) muscles, the tensing of the abdominal wall muscles, and the contraction of the inner muscles of the legs. In fact, the contracting of the abdominal wall muscles actually increases bladder pressure and thus increases the likelihood of incontinence. The leg and buttock muscles do little to help incontinence. Biofeedback can eliminate these mistakes by helping the person locate the correct muscles to exercise.
We also teach patients how to perform submaximal pelvic floor contractions. Biofeedback is one of the best ways to visually identify submaximal contraction of the pelvic floor muscles.
You can call and book an appointment with Bill Landry. Your assessment will be booked at a time of your choice. Ideally you will want to drink a glass of water 1 hour before the appointment and not goto the washroom. You will spend 45 minutes to 1 hour with Bill going through an assessment and will have the opportunity to visualize your pelvic floor using realtime ultrasound. You will learn a proper Kegel contraction and specific exercises based on your condition.
If you are unable to drive to our facility, you can book a phone consultation. You will be able to spend 45 minutes with our physiotherapist. Mr. Landry can discuss any issues, identify concerns and start a individual program over the phone. You will be educated on the physiology, anatomy and neurodynamic pathways in urinary continence. We will discuss neuroplasticity, endurance, tone, and the strengthening that is required to regain urinary continence. We will send an individual program with articles via email and you will be able to view video’s showing you how you know you are contracting your pelvic floor muscles.
Post Radical Prostatectomy Urinary Incontinence Program
Bill Landry has been working closely with urologist Dr. Stephen Pautler developing a Urinary Continence program for men post-radical prostatectomy. This program is based on the latest research and evidence-based information. After removal of the catheter, a 45 minute assessment is performed. An individualized exercise program is developed and patients are educated about the proper contraction of the pelvic floor using various techniques including realtime ultrasound imaging. Our program includes, motor control patterning techniques, endurance and strengthening of the external urethral sphincter (anterior pelvic floor). Follow-up occurs 2-4 weeks after the initial assessment, and the exercises are progressed to maximize pelvic floor strength, control and urinary continence.
Dr. Stephen Pautler in London approached us to develop a pelvic floor rehab program for urinary incontinence after radical prostatectomy. Over the last two years, we have seen positive results. To quote Dr. Pautler, “My patients have provided very positive feedback about this rehab program. Not only do patients find the multidisciplinary program helpful, it saves me time in clinic.”
“This program really works! Before, I had been greatly discouraged, but was encouraged greatly after my first appointment at Family Physiotherapy Centre. It took four weeks of deducated and disciplined exercises before significant results were noted….” David Mann
David Mann wrote a summary of the program and the issues he dealt with after his radical prostatectomy. With his permission we have put his experiences on our website in a PDF format….Reflections upon Bill’s Exercise Program, By David Mann –
How is this program covered?
This program is covered by health care plans that cover physiotherapy. You do NOT require a physicians referral to book an appointment, however some health care plans require a physicians referral for coverage. Call your health care plan provider for more information. You may be covered under the acute OHIP program.
If your physician would like to refer you to our program, you can print out a referral form and have your physician fax it to 519-439-2111. Alternatively, you can call at 519-439-6111 and ask to book an appointment for the Male Urinary Incontinence Rehabilitation Program. You may also email us at ReceptionCentral@fpclondon.com .
- Post Radical Prostatectomy Rehab Brochure –
- Pelvic Floor Exercise Program Example –
- 24 Hour Pad Test –
- International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) –
- International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) –
- FPCLondon Referral pad-