Male Incontinence

More than 33 million Americans experience some form of urinary incontinence or bladder condition, according to the National Association for Continence. It occurs in men of all ages, though chances increase with age.

There are three basic forms of male incontinence:

• Stress incontinence: Leakage that occurs when physical stress, including sneezing, coughing or athletic activities, puts pressure on the bladder.
• Urge incontinence: A sudden need to urinate because the bladder contracts involuntarily, forcing urine out.
• Overflow incontinence: The bladder doesn’t empty as it should and later leaks urine as a result. This commonly happens when the urethra is blocked by an enlarged prostate.

Different types of incontinence have different causes:

• Stress incontinence: This can result from prostate removal. If the nerves or the sphincter muscle have been damaged, the urethra won’t close enough to keep urine from leaking.
• Urge incontinence: This occurs when the bladder muscles are too strong or squeeze at the wrong times, pushing urine past the sphincter. Causes include bladder stones, infection, inflammation, an injury or disease of the nervous system, such a multiple sclerosis, or neurologic conditions.
• Overflow incontinence: This usually occurs when there is a blockage of the urethra, making it difficult for the bladder to empty completely. Over time, the bladder gets so full that pressure forces urine past the sphincter. The blockage is often the result of an enlarged prostate pressuring the urethra, but weak bladder muscles also may contribute.

The main symptom of incontinence is the accidental release of urine.

• Stress incontinence: Urine leaks when coughing, laughing, exercising or sudden movements.
• Urge incontinence: An immediate need to urinate, even small amounts. Patients urinate frequently and have trouble reaching the toilet in time.
• Overflow incontinence: A constant urge to urinate, but urine just dribbles continuously.

A urologist will perform a detailed history and physical exam, so it is helpful if the patient keeps a bladder diary for a few days beforehand to record times of urination, the amount of urine, leakage, and foods and beverages consumed. The physician may also perform one of several tests:

• Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
• Postvoid residual volume: Measures the amount of urine left in the bladder after urination.
• Urinalysis: Examines the composition of the patient’s urine.
• Bladder scan: An ultrasound examines the kidneys, bladder, and urethra to see if the bladder empties completely.
• Cystoscopy: A slender tube with a tiny camera inserted into the urethra uncovers any abnormalities in the urethra or the bladder.
• Urodynamics: Measures pressure in the bladder and urine flow.

Lifestyle changes, including modifications to the diet and Kegel (pelvic squeezing) exercises, can help manage both stress and urge incontinence. The physician may also recommend the following treatments:

• Further testing: To determine that the bladder is emptying and that there is not a blockage from the prostate (if present) or scar tissue (if prior surgery has been done).
• Medications: Anticholinergics (which block neurotransmitters), beta-3 agonists (mirabegron), or alpha-adrenergic (nerve-stimulating) drugs.
• Surgery:
  • Prostate surgery: Removal of tissue in the prostate gland or maneuvering the prostate itself, to alleviate pressure on the urethra and allow the bladder to empty.
  • Sling: The surgeon inserts support material directly under the urethra and attaches it to the pelvis. This procedure is for patients who have had their prostates removed and is usually outpatient.
  • Artificial urinary sphincter: A device is inserted to encircle and close the urethra, acting as a replacement muscle.

To record urination patterns click here.