Urinary Incontinence—Male
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. 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:
- Weakening of the muscles that suspend the bladder
- Weakening of the muscles that control urine flow
- Damage to the muscles that control urine flow following prostate surgery
- Obesity
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:
- Urinary tract infection
- Diabetes type 1 and 2
- Bladder irritation (eg, kidney stone, tumor)
- Drugs (eg, hypnotics, diuretics)
- Caffeine
- Alcohol
- Nerve damage due to:
- Spinal cord injury
- Stroke
- Multiple sclerosis
- Parkinson's disease
- Constipation
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:
- Prostate enlargement
- Bladder that is blocked, such as by a scar in the urethra (stricture)
- Fecal impaction putting pressure on the urethra
- Drugs (eg, antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
- Vitamin B12 deficiency
- Weak bladder muscles
- Nerve damage
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 which cause confusion or sedation can also cause functional incontinence.
Risk Factors
These risk factors increase your chance of developing urinary incontinence:
- Age: older than 65
- History of prostate surgery
- Prostate enlargement due to benign prostatic hyperplasia (BPH), infection, or prostate cancer
- Urinary tract infection
- Obesity
- Chronic lung disease
- Urethritis
- Depression
- Dementia (including Alzheimer’s disease)
- Diabetes
- Stroke
- Multiple sclerosis
- Spinal cord injury or disease
- Use of certain substances or medications:
- Caffeine
- Alcohol
- Beta-blockers
- Alpha-agonists
- Cholinergic agents
- Cyclophosphamide
Symptoms
Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
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:
- Stress test—You relax, then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.
- Urine tests
- Tests to determine problems with your prostate (eg, prostate exam, blood tests)
- Blood tests to detect diabetes
- Ultrasound—This test uses sound waves to examine structures inside the body to determine if any urine remains in your bladder after urinating.
- Cystoscopy—A thin tube with a tiny camera is inserted into the urethra to view the urethra and bladder.
- 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
- This strengthens the muscles that hold the bladder in place and control urine flow.
- Painless electrical stimulation is sometimes used. It can strengthen the muscles more quickly. It is helpful for stress incontinence.
- Bladder training: A regular schedule is set to empty your bladder. You will also be asked to drink 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 by your doctor. These medicines help to relax the bladder muscles.
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.
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.
Condom Catheter
Prevention
Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:
- Reduce your intake of substances which lead to incontinence. These include caffeine, alcohol, and certain drugs.
- Lose weight.
- Avoid and treat constipation.
Resources:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Kidney Foundation
UrologyHealth.org
Canadian Resources:
Canadian Nurse Continence Advisors
Health Canada
References:
American Foundation for Urologic Disease. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/. Accessed September 14, 2009.
Controlling urinary incontinence. FDA Consumer Magazine, United States Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/505_incontinence.html. Published September-October 2005. Accessed July 19, 2008.
Corcos J, Gajewski J, Heritz D, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol. 2006;13:3127-3138.
Prevention of incontinence. Continence Foundation website. Available at: http://www.continence-foundation.org.uk/in-depth/prevention-...incontinence.php. Published June 1997. Accessed September 10, 2009.
Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.
Urinary incontinence in men. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/. Published June 2007. Accessed September 10, 2009.
Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.
Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175:S5-10.
Yang C, Schwartz S, Anderson D, et al. A new, simple device to manage male urinary incontinence. International Continence Society website. Available at: http://www.icsoffice.org/publications/2005/pdf/0464.pdf. Accessed September 10, 2009.
Last reviewed September 2009 by Adrienne Carmack, MD
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.