Urinary Incontinence in Men

Cause

Urinary incontinence occurs when the bladder's sphincter muscle is not strong enough to hold back the urine. This may happen when:

• The sphincter is too weak.
• The bladder muscles contract too strongly.
• The bladder is too full.

Prostate treatment is a major cause of urinary incontinence in men.

• Short-term incontinence after prostate surgery can go away with time, especially for younger men. In some cases, it lasts up to a year.
• Stress incontinence is a common problem after prostate removal (radical prostatectomy) or radiation treatment for prostate cancer. It is becoming less common with better surgical techniques.
• Some treatments for an enlarged prostate (benign prostatic hyperplasia, or BPH) can also cause incontinence. But this isn't common.

The bladder contractions that cause urge incontinence can be caused by many conditions, including:

• Urinary tract infection.
• Bowel problems, such as constipation.
• Prostatitis. This is a painful infection of the prostate gland.
• Certain conditions that affect nerve signals from the brain, such as Parkinson's disease or stroke.
• Kidney or bladder stones.
• Blockage from prostate cancer or benign prostatic hyperplasia (BPH).

Overflow incontinence is usually caused by blockage of the urethra from BPH or prostate cancer. Other causes include:

• Narrowing of the urethra (stricture).
• Medicines, such as antihistamines and decongestants.
• Nerve conditions, such as diabetes or multiple sclerosis.

You can have one or more types of incontinence. Each type may have a different cause.

Symptoms

Your symptoms depend on the type of urinary incontinence you have.

The main symptom of stress incontinence is the leaking of urine when you cough, laugh, lift, strain, or change posture.

Symptoms of urge incontinence may include:

• A sudden, urgent need to urinate.
• Sudden leakage of a large amount of urine.
• The need to urinate frequently, often at night.

Symptoms of overflow incontinence may include:

• A urine stream that starts and stops when you urinate.
• Leakage of a small amount of urine.
• A weak urine stream.
• A need to strain while urinating and a sense that the bladder is not empty.
• An urgent need to urinate, often at night.
• Leaking urine while asleep.

What Happens

Urinary incontinence is often related to prostate problems. As men age, the prostate gland grows larger. It can squeeze the urethra and push the neck of the bladder out of position. These changes can lead to incontinence.

• Stress incontinence happens when the muscle (sphincter) surrounding the urethra opens at the wrong time. This can be when you laugh, sneeze, cough, lift something, or change posture.
• Urge incontinence happens when bladder contractions are too strong to be stopped by the sphincter. Often the urge is a response to something that makes you expect to urinate. It can happen when you wait to use a toilet, unlock the door when you come home, or even turn on a faucet. 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 blockage of the urethra from BPH or prostate cancer. It also happens when the bladder muscles contract weakly or don't contract when they should.
• Functional incontinence can happen when there are physical or mental limitations that restrict a man's ability to reach the toilet in time.

In most cases, incontinence caused by an enlarged prostate can be cured by medicine or prostate surgery.

If your incontinence is not related to prostate surgery and it appears suddenly, it will usually clear up after you get treatment for whatever is causing it. For example, incontinence related to a urinary tract infection, prostatitis, or constipation will most likely disappear when the infection or condition is cured.

What Increases Your Risk

Many things have been linked to an increased risk of urinary incontinence in men.

Physical conditions or lifestyle

• Age-related changes, including decreased bladder capacity and physical frailty
• Smoking tobacco
• Injury to the bladder or urethra, such as from radiation therapy or prostate surgery
• Bladder infection or prostatitis
• Obesity
• Structural abnormalities of the urinary tract

Medicines and foods

• Caffeinated and carbonated drinks, such as coffee, tea, and soda pop
• Alcohol
• Prescription medicines that increase urine production, such as diuretics, or relax the bladder, such as anticholinergics and antidepressants
• Other prescription medicines, such as sedatives, opioids, and calcium channel blockers
• Nonprescription medicines, such as diet, allergy, and cold medicines

Diseases and health conditions

• Neurological conditions such as Alzheimer's disease, Parkinson's disease, stroke, diabetes, spinal injury, and multiple sclerosis
• Bladder cancer
• Chronic bronchitis
• Interstitial cystitis
• Anxiety and depression

When To Call

Call your doctor now if your urinary incontinence does not go away or you also have:

• Weakness or numbness in your buttocks, legs, and feet.
• Fever, chills, and belly or flank pain.
• Blood in your urine or burning with urination.
• A change in your bowel habits.

Call your doctor if:

• Your incontinence gets worse.
• Leaking urine is enough of a problem that you need to wear a pad to absorb it.
• Incontinence interferes with your life in any way.
• You have incontinence that begins suddenly (acute). Acute incontinence is often caused by urinary tract problems or medicines. It can be easily corrected.
• You have a sudden change in your ability to urinate and you aren't sure if it's related to your urinary incontinence.

Watchful waiting

If you have chronic urinary incontinence that begins slowly, you may be able to control the problem yourself. If home treatment doesn't control your problem, or if incontinence bothers you, ask your doctor about treatment.

Exams and Tests

To learn the cause of your urinary incontinence, your doctor will first review your medical history and give you a physical exam. Along with routine testing, such as a urinalysis, this may be all your doctor needs to diagnose the cause and start treatment.

Your doctor may ask you to keep a voiding log. This is a record of the amount of liquids you drink and how much and how often you urinate.

Incontinence testing

Tests that may be done to find the type and cause of your urinary incontinence include:

• Urinalysis and urine culture. These tests show whether you have a urinary tract infection (UTI) or prostatitis, or blood or sugar in your urine.
• Cough test. It checks for urine leakage while you cough.
• Urodynamic tests, which may include:
  • Uroflowmetry. This test measures your rate of urine flow. A low peak flow rate can be a sign of a blockage or a weak bladder.
  • Pressure flow studies. This testing measures pressure changes in the bladder as the flow changes. It is often used when the cause of a man's symptoms is uncertain. It can help show if the cause may be a blockage or a problem with the bladder muscles or nerves.
  • Post-void residual volume. This test measures the amount of urine left after you empty your bladder.
• Cystometrogram (CMG). This test measures how well your bladder can store and release urine.

• Electromyogram (EMG). This test records the electrical activity of muscles.

Your doctor may do a cystoscopic exam. This is a test that allows your doctor to see inside the urinary tract.

Other tests

You may need more tests if:

• The first treatment for incontinence has failed.
• You have had previous prostate surgery, radiation therapy, or frequent urinary tract infections.
• A catheter cannot be easily placed into your bladder.

Some tests aren't often used for incontinence, but they may be helpful. One example is cystourethrogram. It's an X-ray of your bladder and urethra while you are urinating.

If your doctor wants to do more tests, ask how the test can help your doctor treat your incontinence.

Treatment Overview

The treatment you and your doctor choose depends on your type of urinary incontinence and how bad your symptoms are.

If there is no infection or cancer or other cause that could only be cured by surgery, treatment is done in stages.

• Behavioral strategies may be enough to control your symptoms. These include simple changes to your diet, lifestyle, and urinary habits. See Home Treatment for more information.
• Medicines that treat infection or bladder muscle spasm may help.
• Self-catheterization may help you manage overflow incontinence from a weak bladder or blockage. It may also be used if surgery is not the best option for you. When you need to drain your bladder, you insert a thin, hollow tube through your urethra into the bladder. To learn more, see Other Treatment.
• 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 blockage.

Many men who have urge incontinence or overflow incontinence also have an enlarged prostate gland (benign prostatic hyperplasia, or BPH). For more information, see the topic Benign Prostatic Hyperplasia (BPH).

What to think about

Exercise is important for your physical and emotional health. Even if being active causes some leakage, get regular exercise. It can help you manage stress and keep your muscles in tone.

Continence products absorb urine or apply pressure to keep urine from leaking. To learn more, see Other Treatment.

Prevention

You may reduce your chances of developing urinary incontinence by:

• Limiting caffeine and alcohol.
• Getting to and staying at a healthy weight.
• Quitting smoking.
• Avoiding constipation by eating a healthy, high-fiber diet.
• Doing Kegel exercises to strengthen the muscles that control the flow of urine.

Self-Care

You can use behavioral strategies to help control urinary incontinence. These include simple changes to your diet, lifestyle, and urinary habits.

Diet and lifestyle strategies

• Reduce or stop drinking caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
• Limit alcohol to no more than 1 drink a day.
• Eat less of any food that might irritate your bladder. Then look for changes in your bladder habits. Such foods include citrus fruit, chocolate, tomatoes, vinegars, spicy foods, dairy products, and aspartame.
• If you smoke, quit.
• Avoid constipation:
  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
  • Drink enough fluids. Don't avoid drinking fluid because you are worried about leaking urine.
  • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
  • Take a fiber supplement with psyllium (such as Metamucil) or methylcellulose (such as Citrucel) each day. Read and follow all instructions on the label.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and don't strain.
• If you are overweight, try to lose some weight. Be more active, and make small, healthy changes to what and how much you eat. You will notice good results over time.
• Try pelvic floor (Kegel) exercises to strengthen your pelvic muscles.

Urinary habits

Try one or more of these tips. They may help you gain some control over your symptoms:

• Set a schedule for urinating every 2 to 4 hours. Go whether or not you feel the need.
• Practice "double voiding." This means 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. Wear clothes that are easy to take off (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 the medicines you take, including nonprescription medicines, to see if 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.

Medicines

Medicine can help with some types of urinary incontinence.

Medicine choices

• For overflow incontinence: If incontinence is caused by an enlarged prostate, medicines to treat benign prostatic hyperplasia may be prescribed. But these medicines don't always improve incontinence. For more information, see the topic Benign Prostatic Hyperplasia (BPH).
• For urge incontinence:
  • Anticholinergic and antispasmodic medicines, such as oxybutynin and tolterodine, calm the nerves that control bladder muscles and increase bladder capacity.
  • Alpha-blocker medicines, such as alfuzosin and tamsulosin, relax the muscles in the prostate and bladder.
  • The antidepressant medicine duloxetine may help with bladder control.
  • Botox (botulinum toxin) may be an option when other medicines don't work. A Botox shot helps relax the bladder muscles.
• For stress incontinence: The antidepressant medicine duloxetine may help with bladder control.

What to think about

Some medicines that are used to treat incontinence may actually make it worse in men whose incontinence is caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consulting with a urologist is an important part of incontinence care.

Surgery

Surgery may be an option for men who:

• Have ongoing (chronic) incontinence.
• Have severe symptoms and total incontinence.
• Are extremely bothered by their symptoms.
• Have problems with urinary retention.
• Have moderate to severe blood in the urine (hematuria) that keeps coming back.
• Have urinary tract infections that keep coming back.
• Have a medical problem that can only be treated with surgery. One example is a bladder outlet blockage that is affecting kidney function.

Surgery choices

Overflow incontinence caused by an enlarged prostate (benign prostatic hyperplasia, or BPH) is the form of incontinence most often treated with surgery. For more information about surgery options and treatment for BPH, see the topic Benign Prostatic Hyperplasia (BPH).

Stress incontinence caused by removal of the prostate gland may also be treated with surgery if the incontinence isn't cured after a period of watchful waiting.

Surgery for severe stress incontinence that does not improve with behavioral methods includes:

• Artificial sphincter. A silicone rubber device is fitted around the urethra (the tube that carries urine from your bladder to the outside of your body). It can be inflated or deflated to control urination.
• Urethral bulking. Material is injected around the urethra. This serves to control urination by either closing a hole in the urethra or building up the thickness of the wall of the urethra.
• Bulbourethral sling. A sling is placed beneath the urethra. It is attached to either muscle tissue or the pubic bone. The sling compresses and raises the urethra. This gives the urethra greater resistance to pressure from the belly. Sling surgery may be considered as a treatment for severe urinary incontinence from prostate surgery.
• Sacral nerve stimulation (SNS). An electrical stimulator under your skin sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.

Severe urge incontinence may be treated with surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

What to think about

Surgery works for some people and not others. It is most likely to improve incontinence when:

• The diagnosis is right.
• The cause of your symptoms is something that can be fixed by surgery.
• Your surgeon is very experienced and skilled with the surgery you're having.

Things that can lead to disappointing results include:

• Unrealistic expectations. Surgery won't always cure the symptoms, but it will usually improve them.
• Physical factors such as obesity, long-term cough, radiation therapy, poor nutrition, age, and heavy physical activity.

Other Treatment

Treatment other than surgery or medicine may be used to treat urinary incontinence.

• For stress incontinence, biofeedback can help you learn to read your body's signals. This helps you improve control.
• For urge incontinence, behavioral therapies such as biofeedback and bladder training can help you control the bladder muscles.
• For overflow incontinence, using a catheter tube to drain your bladder can help you keep your bladder from getting too full.

Catheters

• Catheterization may be used to treat severe incontinence that cannot be managed with medicines or surgery. Catheters don't cure incontinence. But they do allow you or a caregiver to manage it.
  • Intermittent self-catheterization is done with a thin, flexible, hollow tube (catheter) that is inserted through the urethra into the bladder. This allows the urine to drain out.
  • Indwelling catheterization uses a catheter that remains in place at all times. For more information, see the topic Care for an Indwelling Urinary Catheter.
  • 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.

Behavioral therapy

Behavioral therapies, including biofeedback and pelvic muscle exercises, are used to treat urge and stress incontinence.

Continence products

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. Others put pressure on the urethra to help prevent urine from leaking.