Urinary
incontinence is the accidental release of urine. It’s not a disease. It’s a
symptom of a problem with a man’s
urinary tract.
Urine is made by the
kidneys and stored in a sac made of muscle, called the
urinary
bladder. A tube called the
urethra leads from the bladder through the prostate
and penis to the outside of the body. Around this tube is a ring of muscles
called the urinary sphincter. As the bladder fills with urine, nerve signals
tell the sphincter to stay squeezed shut while the bladder stays relaxed. The
nerves and muscles work together to prevent urine from leaking out of the
body.
When you have to urinate, the nerve signals tell the muscles
in the walls of the bladder to squeeze. This forces urine out of the bladder
and into the urethra. At the same time the bladder squeezes, the urethra
relaxes. This allows urine to pass through the urethra and out of the body.
Incontinence can happen for many reasons:
If your bladder squeezes at the wrong time,
or if it squeezes too hard, urine may leak out.
If the muscles
around the urethra are damaged or weak, urine can leak out even if you don't
have a problem with your bladder squeezing at the wrong time.
You
can also have incontinence if your bladder doesn't empty when it should. This
leaves too much urine in the bladder. If the bladder gets too full, urine will
leak out when you don't want it to.
If something is blocking your
urethra, urine can build up in the bladder and cause leaking.
Urinary incontinence happens more often in older men than
in young men, but it’s not just a normal part of aging.
What are the different types of urinary incontinence?
Urinary incontinence can be short-term or long-lasting (chronic).
Short-term incontinence is often caused by other health problems or treatments.
This topic is about the different types of chronic urinary incontinence:
Stress incontinence
happens when you sneeze, cough, laugh, lift objects, or do something that puts
stress or strain on your bladder and you leak urine.
Urge incontinence is an urge to urinate that’s so strong that
you can't make it to the toilet in time. It also happens when your bladder
squeezes when it shouldn't. This can happen even when you have only a small
amount of urine in your bladder. Overactive bladder is a kind of urge
incontinence. But not everyone with an overactive bladder leaks urine.
Overflow incontinence happens when your
bladder doesn't empty as it should and then leaks urine later. This happens
when bladder muscles are weak or the urethra gets blocked. These blockages can
be related to an enlarged prostate or a narrow urethra.
Total incontinence happens when you are always leaking urine.
It happens when the sphincter muscle no longer works.
Functional incontinenceis rare. It happens when you can't
make it to the bathroom in time to urinate. This is usually because something
got in your way or you were not able to walk there on your own.
What causes urinary incontinence in men?
Different
types of incontinence have different causes.
Stress incontinence
can happen when the prostate gland is removed. If there has been damage to the
nerves or to the sphincter, the lower part of the bladder may not have enough
support. Keeping urine in the bladder is then up to the sphincter alone. The
sphincter may be too weak to hold back the urine. And any extra pressure from
sneezing, coughing, or straining can cause urine to leak.
Urge incontinence is caused by bladder muscles that squeeze so
hard that the sphincter can't hold back the urine. This causes a very strong
urge to urinate. Doctors don't know why this happens, but sometimes it can be
caused by other urinary problems.
Overflow incontinence can be caused by something blocking the urethra, which
leads to urine building up in the bladder. This is often caused by an enlarged
prostate gland or a narrow urethra. Over time, the bladder gets so full that
pressure builds up and forces the extra urine to move past the blockage and out
of the bladder. Overflow incontinence may also happen because of weak bladder
muscles.
In men, incontinence is often related to prostate
problems or treatments.
Drinking alcohol can make urinary
incontinence worse. Taking prescription or over-the-counter drugs such as
diuretics, antidepressants, sedatives, narcotics, or non-prescription cold and
diet medicines can also affect your symptoms.
What are the symptoms?
The most common sign of
urinary incontinence is leaking urine from the bladder. Other signs will depend
on the type of urinary incontinence you have.
Stress incontinence:
You release a small amount of urine when you cough, strain, lift something, or
change position.
Urge incontinence: The need
to urinate is so strong that you can't reach the toilet in time.
Overflow incontinence: You have the urge to
urinate, but you can only release a small amount. And you can't control the
constant dribbling of urine.
How is urinary incontinence in men diagnosed?
Your
doctor will do a physical exam, ask questions about your symptoms and past
health, and test your urine. Often this is enough to help the doctor find the
cause of the incontinence. You may need other tests if the incontinence is
caused by more than one problem or if the cause is unclear.
How is it treated?
Treatments are different for
each person. They depend on the type of incontinence you have and how much it
affects your life. After your doctor knows what has caused the incontinence,
your treatment may include medicines, simple exercises, or both. A few men need
surgery, but most do not.
There are also some things you can do
at home. In many cases, these lifestyle changes can be enough to control
incontinence.
Cut back on caffeine drinks, such as coffee and
tea. Also cut back on fizzy drinks like soda pop. And don't drink more than one
alcoholic drink a day.
Eat foods high in fiber to help avoid
constipation.
Don't smoke. If you need help quitting, talk to
your doctor about stop-smoking programs and medicines. These can increase your
chances of quitting for good.
Stay at a healthy
weight.
Try simple pelvic-floor exercises like Kegels.
Go to the bathroom at several set times each day, and wear clothes that you can
remove easily. Make your path to the bathroom as clear and quick as you
can.
When you urinate, practice double voiding. This means going
as much as you can, relaxing for a moment, and then going again.
If you have symptoms of urinary incontinence, don't be
embarrassed to tell your doctor. Most people with incontinence can be helped or
cured.
Urinary incontinence occurs when the muscle (sphincter) that holds your
bladder's outlet closed is not strong enough to hold back the urine. This may
happen if the sphincter is too weak, if the
bladder muscles contract too strongly, or if the
bladder is overfull.
A man may have one or more types of
incontinence, and each type may have a different cause.
Urge incontinence is
caused by bladder contractions that are too strong to be stopped by the
sphincter. Often the urge is a response to something that makes you anticipate
urination, such as waiting to use a toilet, unlocking the door when returning
home, or even turning on a faucet. The bladder contractions can be caused by
many conditions, including:
Overactive bladder is a kind of urge incontinence. But not
everyone with overactive bladder leaks urine. For more information, see the
topic
Overactive Bladder.
Overflow incontinence usually is caused by obstruction of the urethra from
BPH or
prostate cancer or when the bladder muscles contract
weakly or don't contract when they should. Other causes include:
Functional incontinence is a rare form of incontinence
caused by physical or mental limitations that restrict a man's ability to reach
the toilet in time.
Urinary incontinence in men is often related to prostate problems. As men age,
the prostate gland grows larger, squeezing the
urethra and pushing the neck of the
bladder out of position. These changes can lead to
incontinence. In most cases, incontinence due to prostate enlargement can be
cured by medicine or prostate surgery.
But prostate surgery is
also a major cause of urinary incontinence in men.
Short-term (acute) incontinence following
prostate surgery may go away with time, especially for younger men. In some
cases, the incontinence may last up to a year.
Stress incontinence is a common complication following
prostate removal (radical prostatectomy) or
radiation treatment for prostate cancer, though it is
becoming less common with improving surgical techniques. For more information,
see the topic
Prostate Cancer.
If your incontinence is not related to prostate surgery and
it appears suddenly, it will usually clear up after you have received treatment
for whatever is causing the incontinence. For example, incontinence related to
a
urinary tract infection,
prostatitis, or constipation will most likely
disappear when the infection or condition is cured. For more information, see
the topics
Urinary Tract Infections and
Prostatitis.
For some men, incontinence
may have more than one cause.
Many factors have been
associated with an increased risk of
urinary incontinence in men. Incontinence may be the
result of various health conditions or medical treatments, or it could be
caused by family history or lifestyle. Sometimes factors from more than one of
the lists below can combine to cause incontinence.
Physical
conditions or lifestyle factors that may make urinary incontinence more likely
include:
Age-related changes, including decreased
bladder capacity and physical frailty.
See your doctor immediately if your
urinary incontinence does not go away or is
accompanied by:
Weakness or numbness in your buttocks, legs,
and feet.
Fever, chills, and abdominal (belly) or side
pain.
Blood in your urine, or burning with urination.
A
change in your bowel habits.
Call your doctor if:
You have a problem with urinary incontinence
that is getting worse.
Uncontrolled loss of urine is enough of a
problem that you need to wear an absorbent pad.
Incontinence
interferes with your life in any way.
Do not be embarrassed to discuss incontinence with your
doctor. Incontinence is not an inevitable result of aging. Most people with
incontinence can be helped or cured.
If you have chronic
urinary incontinence that begins slowly, you may be
able to control the problem yourself. (See the Home Treatment section of this
topic.) If home treatment does not control your problem, or if incontinence
interferes with your lifestyle, ask your doctor to recommend a
treatment.
If you have urinary incontinence that begins suddenly
(acute), call your doctor. Acute incontinence is often caused by urinary tract
problems or medicines and can be easily corrected.
Who To See
Any of the following health professionals can diagnose
and treat
urinary incontinence:
If you need surgery to treat your incontinence, it is
important to find a surgeon who is experienced in the type of surgery you need,
usually a urologist.
The first steps your doctor will take
to learn the cause of your
urinary incontinence are a
medical history and a physical examination. The
physical exam will include examination of the penis, the prostate, and the
nervous system. The history and exam, along with routine diagnostic tests such
as a urinalysis, often provide enough information to determine the cause of the
incontinence and enable your doctor to start treatment.
Your
doctor may ask you to keep a
voiding log, which is a record of the amount of
liquids you drink and how much and how often you urinate.
Tests
that may be done to determine the type and cause of your urinary incontinence
include:
Cough test to check for urine leakage while
coughing.
Urodynamic tests, which could include tests to look
for hesitancy or interruptions of your urine flow, to measure the volume of
urine left in your bladder after urination (post-void residual), and to measure
how much urine in the bladder causes you to have a strong urge to urinate. The
actual tests done vary from person to person. Urodynamic testing may include:
Uroflowmetry.
The uroflowmetry test measures the rate of urine flow during urination. During
the test, a flow curve will be charted to determine the peak flow rate. A low
peak flow rate may be suggestive of an obstruction or a weak bladder causing
the incontinence.
Pressure flow studies, which measure pressures
produced in the bladder as the flow changes. Pressure studies may help
distinguish between urinary symptoms caused by obstruction and those caused by
a problem affecting the bladder muscles or nerves. This test is often used when
the cause of a man's symptoms is uncertain.
Residual urine determination. Your doctor may
measure your post-void residual volume by inserting a thin tube (catheter) into your bladder or by using a bladder
ultrasound scan immediately after you have urinated.
Cystometrogram (CMG). This test evaluates your
bladder's ability to store and release urine.
Electromyogram (EMG), which is used to record the
electrical activity of muscles.
Your doctor may conduct a cystoscopic exam (a test that
allows your doctor to see inside the urinary tract) to rule out other causes of
incontinence.
Further tests may be required if initial treatment
for incontinence has failed. Other tests may also be needed if you have had
previous prostate surgery,
radiation therapy, or frequent
urinary tract infections, or if a
catheter cannot be easily placed into your
bladder.
Tests such as cystourethrogram, an X-ray taken of your
bladder and urethra while you are urinating, are not often used to evaluate
incontinence, but they may be helpful. If your doctor wants to do one of these
tests, ask whether the test is necessary to diagnose your type of
incontinence.
The treatment you and your doctor
choose will depend upon what type of
urinary incontinence you have and how much you are
bothered by your symptoms.
Assuming there is no infection or
cancer or other cause that could only be cured by surgery, treatment for
incontinence proceeds in stages.
Behavioral strategies
are tried first for all types of incontinence. These include reducing the
amount of liquids you drink, eliminating caffeinated and carbonated drinks, and
establishing a schedule for urinating. See the Home Treatment section of this
topic for more information.
Exercise on a
regular basis is important for physical and emotional health. Some men with
urinary incontinence stop exercising because they fear that it will cause
leakage. But regular exercise is important and can help you manage stress and
keep your muscles in tone.
Pelvic floor (Kegel) exercises can reduce symptoms of
urge or stress incontinence.1
Continence products such as absorbent pads or diapers,
incontinence clamps, and pressure cuffs may be used if you are progressing
through a different treatment and are waiting to see whether your incontinence
goes away or if other methods of treatment have failed. But these products
should only be used along with a more specific treatment, since they can hide a
more serious condition that may be curable.
Medicines may be prescribed, depending on the cause of your
incontinence.
Antispasmodics and anticholinergics may be prescribed to
relax the bladder (for
urge incontinence).
Antibiotics may be prescribed for
incontinence caused by infection.
You may need to avoid medicines
that can cause incontinence, such as diet, cold, and allergy medicines.
Self-catheterization may
be tried if you have
overflow incontinence from a weak bladder or blockage
or if surgery is not the best option for you.
Surgery is usually considered when it is the only treatment
that can cure the incontinence, such as when the condition is caused by a
bladder obstruction.
Urinary incontinence can be a problem following treatment for
prostate cancer, including radiation therapy and
removal of the prostate. For more information, see the topic
Prostate Cancer.
Treatment will be
different for men who have total incontinence or who cannot comply with or
tolerate specific treatments because of a serious illness or disease.
The following
changes to diet and lifestyle may help reduce incontinence:
Reduce or eliminate caffeinated and carbonated
drinks—such as coffee, tea, and soda pop—from your diet.
Do not
drink more than one alcohol drink a day.
Try to identify any foods that might irritate your
bladder—including citrus fruits, chocolate, tomatoes, vinegars, spicy foods,
dairy products, and aspartame—and eat less of those foods.
If you
smoke, quit. For more information, see the topic
Quitting Smoking.
If constipation is a
problem, increase the amount of fiber in your diet. You can do this easily by
adding a small amount of wheat bran, even a spoonful, to dishes you normally
eat. See your doctor if your constipation continues. For more information, see
the Home Treatment section of the topic
Constipation, Age 12 and Older.
If you are
overweight, try to lose some weight. Remember that effective weight-loss
programs depend on a combination of diet and exercise. For more information,
see the topics
Weight Management and
Fitness.
The following changes to urinary habits may help reduce
incontinence:
Establish a schedule of urinating every 3 to 4
hours, regardless of whether you feel the need.
Practice “double
voiding” by urinating as much as possible, relaxing for a few moments, and then
urinating again.
If you have trouble reaching the bathroom before
you urinate, consider making a clearer, quicker path to the bathroom and
wearing clothes that are easily removed (such as those with elastic waistbands
or Velcro closures), or keep a urinal close to your bed or chair.
Talk with your doctor about all medicines you take,
including nonprescription medicines, to see whether any of them may be making
your incontinence worse.
Medicines that may cause urinary incontinence in men
include certain antidepressants, sedatives, and even some allergy and cold
medicines.
If your
urinary incontinence is caused by
prostatitis, a painful inflammation of the prostate
gland, your doctor will prescribe
antibiotics. When the infection is cured, your
incontinence should be cured as well.
Although some
types of long-term (chronic) incontinence may be treated with medicine, the
likelihood that medicines will improve your incontinence depends on the
severity and cause of the problem. Some medicines that are used to treat
incontinence may actually make the condition worse in men whose incontinence is
caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consultation with a urologist is an important
part of incontinence care.
Imipramine is a
tricyclic antidepressant, which is usually used to treat
depression but may also be used to treat urge
incontinence. Imipramine causes the bladder muscle to relax while causing the
muscles at the bladder neck to contract.
Duloxetine is a kind
of antidepressant called a selective serotonin and norepinephrine reuptake
inhibitor (SNRI). It changes how the brain uses certain brain chemicals. How it
helps with bladder control is not yet known.
Anticholinergic and tricyclic medicines may also be used
to treat
stress incontinence, especially if you have both
stress and urge incontinence.
If your
urinary incontinence has not improved after trying
behavioral methods and medicine and your doctor thinks
surgery will be an effective treatment, you may choose to have surgery rather
than live with your symptoms. In some cases, such as when a bladder outlet
obstruction is affecting kidney function, surgery may be the only way to treat
the problem that is causing the incontinence.
Stress incontinence caused by removal of the prostate gland because of
prostate cancer or an
enlarged prostate may also be treated with surgery, if
the incontinence isn't cured after a period of watchful waiting.
Surgery Choices
If overflow incontinence is caused by benign prostatic
hyperplasia (BPH), prostate surgery may relieve the incontinence. For more
information about surgery options and treatment for BPH, see the topic
Benign Prostatic Hyperplasia (BPH).
Surgery for severe stress incontinence that does not improve with
behavioral methods includes:
Artificial sphincter, which is a device
made of silicone rubber that fits around the urethra (the tube that carries
urine from your bladder to the outside of your body) and can be inflated or
deflated to control urination.
Urethral bulking, which involves injecting material around the urethra to control
urination by either closing a hole in the urethra or building up the thickness
of the wall of the urethra.
Bulbourethral sling, which is being
studied as a treatment for urinary incontinence that results from prostate
surgery. In this procedure, a sling is placed beneath the
urethra to support it and is attached to either muscle
tissue or the pubic bone. The sling compresses and elevates the urethra, giving
the urethra greater resistance to pressure from the abdomen.
What To Think About
Surgery is usually not considered
for urinary incontinence unless it is the only reasonable way to cure it or
after attempts to treat the problem with conservative measures or other
treatment have failed. The decision to have surgery must always be based on an
accurate diagnosis and realistic expectations for the surgery.
Most surgical failures are due to incorrect diagnoses. Other reasons for
failure include healing problems, additional causes of incontinence that aren't
apparent before the surgery, and a lack of experience or skill on the part of
the surgeon performing the procedure.
Factors that increase the
chances that surgical treatment will fail to correct incontinence include
obesity, long-term (chronic) cough,
radiation therapy, age, poor nutrition, and strenuous
physical activity.
Treatment other than surgery or
medicine may be used to treat
urinary incontinence.
For stress incontinence
Biofeedback, a
technique that helps you learn to control a specific body function, may be an
option for some men who have stress incontinence or urge incontinence.
For urge incontinence
Behavioral
therapies such as biofeedback and bladder training can be used to treat urge
incontinence.
For overflow incontinence
Some men may require intermittent
self-catheterization. During this procedure, a catheter is inserted into the
bladder, usually 3 to 4 times a day.
Other Treatment Choices
Catheterization may be used to treat
severe incontinence that cannot be managed with medicines or surgery. Catheters
do not cure incontinence but rather allow you or a caregiver to manage
incontinence.
Condom or Texas catheter uses a special condom
that can be attached to a tube for short-term use. The condom, placed over the
penis, keeps the tube in place. The tube allows the urine to drain out.
Continence products such as
absorbent pads or diapers, incontinence clamps, or
pressure cuffs may be used to manage any form of incontinence. Some of these
products absorb leaked urine and some put pressure on the urethra to help
prevent urine from leaking.
What To Think About
Men often use absorbent products,
such as pads or diapers, when other methods of treating incontinence have
failed or cannot be used. Some men may prefer to use absorbent products rather
than taking medicines or having surgery. They may also use absorbent products
after surgery for prostate cancer, while they are waiting to see if their
incontinence goes away. This method does not treat the incontinence but manages
the problem instead. In general, absorbent products should only be used along
with a more specific treatment, because use of absorbent products can hide a
more serious condition that may be curable.
NAFC is a nonprofit national organization with a mission
of consumer advocacy, education of the public, and information dissemination
through collaboration and networking for the benefit of those with urinary
incontinence. NAFC's booklet "Your Personal Guide to Bladder Health" can be
ordered on the NAFC Web site.
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1-800-891-5390
Fax:
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E-mail:
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Web Address:
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The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC), a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
Human Services. The clearinghouse provides information about diseases of the
kidneys and urologic system to people with kidney and urologic disorders and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient organizations and government agencies to
coordinate resources about kidney and urologic diseases.
UrologyHealth.org, American Urological
Association
UrologyHealth.org is a Web site written by urologists
for patients. Visitors can find specific topics by using the "search"
option.
The Web site provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology Resource Center to find materials about urologic problems.
Nitti VW, Blaivas JG (2007). Urinary incontinence:
Epidemiology, pathophysiology, evaluation, and management overview. In AJ Wein
et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3,
pp. 2046–2078. Philadelphia: Saunders Elsevier.
Other Works Consulted
Appell RA, Winters JC (2007). Injection therapy for
urinary incontinence. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2272–2287. Philadelphia: Saunders
Elsevier.
Carlson KV, Nitti VW (2001). Prevention and management
of incontinence following radical prostatectomy. Urologic Clinics of North America, 28(3): 595–612.
Shekarriz B, et al. (2001). Intraoperative,
perioperative, and long-term complications of radical prostatectomy.
Urologic Clinics of North America, 28(3):
639–653.
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