Urinary incontinence can turn a man’s life upside down.
The fear of unintentional loss of urine can make you drop out of the summer golf league. It can make you fear going to an outdoor wedding. It can make you think twice about sexual intimacy. Yes, it can be embarrassing.
Incontinence in men can be caused by any injury, disease or condition that damages the nerves involved in urination. This could be the nerves in the brain, bladder or sphincter. If you have diabetes, over time you can develop nerve damage that impairs your bladder control. Other illnesses like Parkinson’s disease, multiple sclerosis or stroke can affect the nerves in the brain that control the bladder, resulting in incontinence problems. Spinal cord injuries can also create incontinence.
An incontinence issue particular to men is problems related to the prostate gland. The prostate gland surrounds the urethra, just below the bladder. Its normal function is to add fluid to semen. As men age, this gland often becomes enlarged. It can put pressure on the urethra and cause urinary problems like urgency and leaking, urinary frequency, and urge incontinence.
Some men become incontinent after radical prostatectomy surgery for prostate cancer. This surgery removes the prostate gland, and sometimes nerves related to urination and erection are damaged during the procedure. Patients with prostate cancer who are treated with radiation can also have temporary or permanent bladder issues as a result of the treatments.
Possible Causes Of Urinary Incontinence
- Bladder muscles that weaken with age.
- A blockage in your urethra.
- An overly full bladder that doesn’t empty properly.
- Enlarged prostate.
- Muscles surrounding urethra don’t function properly.
- Kidney stones or bladder stones.
- Chronic cough.
- Constipation.
- Obesity.
- Nerve damage.
- Diabetes.
- Stroke.
- Alzheimer’s disease.
- Parkinson’s disease.
- Prostate cancer.
Types Of Urinary Incontinence
Male Stress Urinary Incontinence (SUI): Involuntary urine leakage that usually occurs with activity or physical exertion, whether a cough, sneeze or laugh, exercise or heavy lifting. It’s caused by the external force or pressure to the bladder that overcomes a weakened urethral sphincter, allowing urine to be expelled involuntarily.
This type of leakage also develops sometimes after:
- Benign prostatic hyperplasia: a noncancerous enlargement of the gland.
- Transurethral prostatectomy, or TURP: Removal of a portion of the prostate gland through the urethra.
- “Simple” prostatectomy: Removal of only the part of the prostate blocking urine flow.
Urgency Urinary Incontinence (UUI): Urgency Incontinence is the involuntary loss of urine, usually after a strong, sudden need to urinate. This type of incontinence is often associated with other symptoms of overactive bladder, such as urinary frequency (voiding more than eight times per day), urgency (the feeling that you may leak if you don’t void immediately) and nocturia (awakening more than once per night to void).
It is most commonly caused by involuntary contractions or “spasms” of the bladder and may be associated with severe sudden episodes of incontinence with little to no warning or activity.
Mixed Urinary Incontinence: Some men suffer both stress and urgency urinary incontinence. Leaking can be caused by a cough, sneeze or physical exertion. They’ll also experience strong, sudden urges to void and often not make it to the restroom in time.
Climacturia or “Orgasmic” Incontinence: After a radical prostatectomy, which removes the prostate gland and surrounding tissue, you might leak urine when sexually excited and also eject urine from the urethra during orgasm. This commonly occurs along with stress urinary incontinence, frustrating both you and your partner.
How To Avoid Urinary Incontinence
You can control some causes of temporary urinary incontinence.
Limit alcohol, caffeinated beverages or other liquids that cause a loss of bladder control. And talk to your doctor about the possible side effects of muscle relaxants, blood-pressure medications, sedatives and heart medications.
Here’s how to reduce the risk of urinary incontinence:
- Keep fit! And ask your doctor about exercises that will strengthen the muscles controlling your bladder.
- Keep your Body Mass Index score in the normal range (between 18.5 and 25).
- Follow a sensible, good-for-you diet.
- Limit caffeine, alcohol.
- Do not smoke.
What’s The Difference Between Urinary Incontinence And An Overactive Bladder?
It might seem subtle, but urinary incontinence is a symptom (when something causes you to lose control of your bladder) and an overactive bladder is a condition (when the bladder can’t hold urine as it should).
Men are more likely to have an overactive bladder than stress urinary incontinence. If you experience stress urinary incontinence, a likely cause is a side effect of prostate cancer surgery.
Surgery for Male Incontinence
Artificial Sphincter
If your incontinence is caused by weakness or nerve damage affecting the sphincter muscle’s function, an artificial sphincter can be implanted to keep the urethra closed until you are ready to urinate. The artificial sphincter consists of a cuff around the urethra, a small reservoir implanted in the abdomen and a pump in the scrotum. You simply squeeze the pump when it’s time to urinate, which deflates the cuff so the urine can flow normally through the urethra. The cuff then gradually refills automatically, keeping your urethra closed.
Male Sling
For some men, a sling that supports the urethra can help with urinary incontinence. The sling attaches to the pelvic bone and puts pressure on the urethra to prevent leaks.
Urinary Diversion
Patients who have had to have their bladder removed or have lost all bladder function due to nerve damage may want to undergo urinary diversion surgery. Urine is diverted from the bladder to a reservoir created with tissue from the small intestine. A small opening in the abdomen, called a stoma, is created so the urine can be drained. Patients may use a catheter or may have a bag that collects the urine.
Both surgery and radiation can cause urinary incontinence (leaking urine) or impotence (not being able to have an erection). The level of urinary incontinence and how long it lasts and the quality of the erections a man has after treatment will depend on whether the cancer has spread. These also depend on what treatment is used.
Nerves that help a man have an erection are right next to the prostate. Surgery to remove the cancer may damage these nerves. Many times a special form of surgery, called nerve-sparing surgery, can preserve the nerves. But if the cancer has spread to the nerves, they may have to be removed during surgery.
These same nerves can also be damaged by the X-rays that are used in radiation therapy.
Medicines and mechanical aids may help men who are impotent because of treatment. Some men recover part or most of their ability to have an erection several months or even years after surgery.
The Post-Prostatectomy Rehabilitation program at Hartford HealthCare’s Tallwood Urology & Kidney Institute uses the latest diagnostic tools and therapeutic technologies for a prompt diagnosis and treatment plan.
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