More than 12 million Americans suffer from urinary incontinence. The condition affects all ages and people of every social and economic level, though urinary incontinence occurs more often in older men than in young men.
There are three basic forms of male incontinence:
- Stress incontinence: occurs when sneezing, coughing or during other activities that put pressure on your bladder
- Urge incontinence: a sudden and urgent need to urinate due to involuntary bladder contraction
- Overflow incontinence: develops when your bladder doesn’t empty as it should and then leaks urine later. This commonly happens when the urethra is blocked by an enlarged prostate.
Different types of incontinence have different causes:
- Stress incontinence can occur when the prostate is removed. If there has been damage to the nerves or to the sphincter, the urethra won’t close enough to keep urine from leaking.
- Urge incontinence is caused by bladder muscles that are too strong or that squeeze at the wrong time, pushing urine out past the sphincter. This often leads to a strong urge to urinate. Urge incontinence can be the result of long-standing blockage of the bladder, neurologic conditions or idiopathic (unknown) reasons.
- Overflow incontinence is usually caused by blockage of the urethra, making it difficult for the bladder to empty completely. Over time, the bladder gets so full that pressure builds up and forces urine out past the sphincter. The blockage is usually the result of an enlarged prostate, but this can also happen because of weak bladder muscles.
The main symptom of incontinence is the accidental release of urine.
- If you have stress incontinence, you may leak urine when you cough, laugh, exercise or move suddenly.
- If you have urge incontinence, you may leak when you get the urge to urinate. You will often urinate frequently and have trouble reaching the toilet in time.
- If you have overflow incontinence you may have the constant urge to urinate, but often just dribble urine continuously.
A urologist will perform a detailed history and physical exam to categorize the incontinence. It is helpful if the patient keeps a diary for a few days before examination to record times of urination, how much urine is passed, leakage and the 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: A test that measures the amount of urine left in the bladder after urination.
- Urinalysis: An examination of the composition of the patient’s urine.
- Bladder scan: An ultrasound of the kidneys, bladder and urethra, to see if the bladder empties completely.
- Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
- Urodynamics: A special technique that measures pressure in the bladder and urine flow.
Both stress and urge incontinence may be managed by lifestyle changes, including modifications to the diet and Kegel exercises. The physician may also recommend the following treatments:
- Medications: Anticholinergics, tricyclic antidepressants or alpha-adrenergic drugs.
- Prostate surgery: If the patient is unable to empty completely, the blockage from the prostate can be removed or opened up to allow the bladder to empty.
- Sling: This procedure places support material directly under the urethra and attaches to the pelvis. It is usually an outpatient procedure. This is used in patients that leak after their prostate is removed for cancer.
- Artificial sphincter: The insertion of a pump, a balloon reservoir and a cuff that encircles and closes the urethra.
For more information on Male Incontinence visit WebMD's Incontinence & Overactive Bladder Health Center.
To record your urination patterns click here.