Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Urinary Incontinence—Male

(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)
by Brian Randall, MD
Definition

Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or long-lasting. Incontinence is a symptom, not a condition in and of itself.

Causes

The causes may vary with the type of incontinence. There may be several different causes. In some cases, the cause may also be unclear.

Stress Incontinence

Leakage may happen when you laugh, sneeze, lift heavy objects, or exercise. Activities like these can increase pressure on the bladder. The leakage may be caused by:

  • Damage to the muscles that control urine flow following prostate surgery
  • Obesity
  • Weakening of the muscles that control urine flow
  • Weakening of the muscles that suspend the bladder
Urge Incontinence

This is also known as overactive bladder. It is a loss of bladder control following a strong urge to urinate. You may not be able to hold urine long enough to make it to a toilet. It may be caused by:

Overflow Incontinence

This occurs when the bladder will not empty. As a result, the urine builds up. This will cause an overflow and leaking of urine. It may be caused by:

  • Bladder that is blocked, such as by a scar in the urethra (stricture)
  • Drugs (eg, antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
  • Fecal impaction putting pressure on the urethra
  • Nerve damage
  • Prostate enlargement
  • Vitamin B12 deficiency
  • Weak bladder muscles
Functional Incontinence

There is normal bladder control, but you are unable to reach the toilet in time. It may be a result of a condition like severe arthritis. Drugs that cause confusion or sedation can also lead to functional incontinence.

Risk Factors

Risk factors include:

Symptoms

Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

When Should I Call My Doctor?

Call your doctor if you experience a loss of urine control. Your doctor can help you determine the underlying cause.

Diagnosis

Your doctor will ask about your symptoms and medical history. You will be asked about your urine leakage and how often you empty your bladder. A physical exam will be done to look for any physical causes, such as blockages or nerve problems. You will keep a diary of your bladder habits. You may be referred to a specialist. A urologist is a doctor who focuses on urinary issues.

Tests may include:

  • Blood tests to detect diabetes
  • Cystoscopy —A thin tube with a tiny camera is inserted into the urethra to view the urethra and bladder.
  • Stress test—You relax, then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.
  • Tests to determine problems with your prostate (eg, prostate exam, blood tests)
  • Ultrasound—This test uses sound waves to examine structures inside the body to determine if any urine remains in your bladder after urinating.
  • Urine tests
  • Urodynamic tests—These tests are used to measure the flow of urine and the pressure in the bladder.
Treatment

Treatments may include:

Behavioral Therapy

Behavioral therapy includes:

  • Making muscles stronger by doing Kegel exercises
    • Painless electrical stimulation is sometimes used. It can strengthen the muscles more quickly. It is helpful for stress incontinence.
    • This strengthens the muscles that hold the bladder in place and control urine flow.
  • Creating a regular schedule to empty your bladder (called bladder training), which also may involve drinking fewer liquids
Weight Loss

Losing weight may help to reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.

Medication

Medicines may be prescribed to relax the bladder muscles. These types of medicines, called anticholinergics, are often used in treating urge incontinence. Examples include:

  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)
  • Oxybutynin (Ditropan)
  • Solifenacin (Vesicare)
  • Tolterodine (Detrol)
Devices

Absorbent diapers are often used by men with incontinence. Catheters are sometimes used to treat more severe cases. External (condom) or internal (Foley) catheters may also be used. Another option is a penile clamp. These clamps are padded and have a sleeve to absorb leakage.

Home Care
  • If needed, keep a bedpan handy in your bedroom.
  • Make it easier for you to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night lights in the hallway and in the bathroom.
  • Take care of your skin by gently cleaning yourself after an episode of incontinence. Let the skin air dry.
Nerve Stimulation

To stimulate the nerves, there are devices like Urgent PC and Inter-Stim. The procedure may involve implanting a thin lead wire with a small electrode tip. In some cases, the tibial nerve, which extends down to the ankle, is stimulated. This electronic stimulation therapy can be done as a series of treatments in the doctor's office.

Surgery

In men, surgery may be done to relieve a physical blockage due to an enlarged prostate. Other procedures involve surgical repair or implants into the bladder sphincter. The sphincter is the gate that allows the urine to flow through.

Prevention

Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:

  • Avoid and treat constipation.
  • Lose weight.
  • Reduce your intake of substances which lead to incontinence. These include caffeine, alcohol, and certain drugs.

Last reviewed: September 2011 by Adrienne Carmack, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
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