Male Incontinence

Urinary incontinence is the accidental release of urine. This is actually a symptom of an underlying medical condition and not a disease entity itself. Urinary incontinence is an embarrassing and challenging problem for both men and women. However, because of anatomy, it is easier to provide incontinent protection for women than it is for men.

The urinary tract system is made up of four major organs. The first is the kidneys where the urine is produced and stored for a short period of time. The bladder fills as urine travels through the ureters into the bladder where the body stores the urine until it\’s ready to be expelled. At this time a complex orchestration of neurotransmitters and muscular contractions begin so that the urine can travel through the urethra and out of the body.

Urinary incontinence can be triggered at different ages and for different reasons. Men have a much lower risk of developing urinary incontinence but a much higher risk of developing overflow incontinence. In either case it is important to address the underlying medical condition in order to effect a successful treatment protocol.

There are several different types of treatable urinary incontinence. Stress incontinence is the loss of urine during specific actions that increase the pressure on the bladder, such as sneezing, coughing or lifting. Urge incontinence is the loss of urine following an overwhelming urge to urinate that the individual cannot stop. Overflow incontinence, which is most common in men, is constant dribbling of urine that is usually associated with urinating frequently and in small amounts.

The urinary tract system operates as a complex mechanism that is controlled by the brain and in which nerves and muscles must work together. At any point during this process damage can be done that will affect the way in which the urinary tract system works. For instance, nerve damage can affect the peripheral nerves in men who have had diabetes. Individuals who have strokes, Parkinson\’s disease and multiple sclerosis can also experience bladder emptying problems because of the damage done in the brain. A spinal cord injury can also affect the way in which the bladder empties by interrupting the nerve signals which originate in the brain but are lost in the spinal cord.

However, the most common cause for men to have difficulty with the urinary tract system are prostate problems that lead to urine overflow and incontinence. The prostate is about the size of a walnut and surrounds the urethra just below the bladder and in front of the rectum. As the prostate gland enlarges it squeezes on the urethra and causes an inability to completely empty the bladder. Symptoms will vary, but the most common one involves changes or problems with urination, such as hesitancy, interrupted stream or urgency and leaking.

Treatments for benign prostatic hypertrophy or prostate cancer can also affect the way in which a man urinates. For instance, a radical prostatectomy, surgical removal of the entire prostate, may lead to an inability to have an erection and urinary incontinence. External beam radiation can also result in temporary or permanent bladder problems.

Urinary incontinence in a man will be diagnosed using an intensive medical history, extensive physical examination and a voiding diary. This voiding diary is a record of fluid that the man drinks and the number of trips to the bathroom each day, as well as any episodes of urinary incontinence. By studying this diary the primary care physician or urologist has a better idea of the specific symptoms and can help direct additional testing or accurate diagnosis of any underlying problems.

Other diagnostic testing which your physician may recommend includes an EEG to evaluate dysfunction in the brain, EMG to evaluate nerve activity in the muscles, ultrasound to view the actual structures and urodynamic testing that focuses on the ability of the bladder to store and empty urine. The urodynamic testing can also show whether or not the bladder is having abnormal contractions, either before or during or after urination, that can cause leakage.

Treatment for urinary incontinence in men is tied directly to any underlying medical condition. No single treatment will work well for everyone and the recommendations for treatment will depend upon the type and severity of the problem, the individual’s lifestyle and the preferences of the patient. Many men can regain control by changing just a few of their lifestyle habits and doing exercises to strengthen the muscles.

For instance, some men can avoid incontinence by simply limiting the amount of fluids they drink at certain times of the day or planning regular trips to the bathroom. Other treatments can include medications that affect control in different ways. Some medications will block abnormal nerve signals while others slow the production of urine. Some medications can shrink the prostate while others will relax the wall of the bladder and make it less spastic.

Alpha blockers are medications that are used to treat problems caused by prostate enlargement and relax the smooth muscle of the prostate allowing a normal amount of urine flow. 5-alpha reductase inhibitors are medications which inhibit the production of male hormone DHT, thought to be responsible for prostate enlargement. Imipramine is a tricyclic antidepressant that relaxes muscles and blocks nerve signals that can cause bladders spasms. In the final medication classification are anti-spasmodic which work to relax the bladder muscle and relieve spasms.

For some men medication is not an option and they must turn initially to surgical treatments. These treatments can help men who have urinary incontinence as a result of nerve damage. An artificial sphincter is an implanted device that keeps the urethra closed until you\’re ready to urinate. It does not solve incontinence caused by uncontrolled bladder contractions but rather from nerve damage that interferes with sphincter control.

Another surgical option is called the sling. In this procedure the surgeon creates a support for the urethra by wrapping a strip of material around and attaching the ends to the pelvic bone. This keeps constant pressure so that it does not open until the patient consciously releases the urine. The urinary diversion is done if all of the bladder function is lost because of nerve damage or if the bladder itself must be removed. A reservoir is created using a small piece of intestines and a stoma created to the outside where urine can be drained into a catheter or bag.

Many men do not talk to their physicians or anyone else about urinary incontinence and often spend their days only too aware of where the next bathroom is. However, because of advances in technology and diagnostic evaluation many men are able to receive successful treatment protocols and recommendations when they are able to speak directly and honestly with their primary care physician and seek the help that they so richly deserve.

RESOURCES

National Kidney and Urologic Diseases Information Clearinghouse: Urinary Incontinence in Men

The University of Chicago Medical Center: Male Incontinence

Delaware Urologic Associates: Male Stress Urinary Incontinence

National Association for Continence: Male products

Cleveland Clinic: Male Incontinence