Urinary Incontinence - Male

Definition

Urinary incontinence is a problem with the control of urine as it flows out of the body. A person may have minor leaks or more severe wetting. There are different types of urinary incontinence, such as:

• Stress incontinence—urine (pee) leaks out during activity and when coughing, sneezing, or laughing
• Urge incontinence (overactive bladder)—the muscle of the bladder squeezes when it should not and lets urine leak out
• Overflow incontinence—the bladder does not empty the right way, so urine builds up inside it and overflows
• Functional incontinence—the bladder is normal, but it is hard to reach the toilet in time

Causes

Many things can cause incontinence. In some people, the cause may not be clear. Causes can also vary by type of incontinence.

Stress incontinence may be caused by:

• Weakening of the muscles that hold the bladder in place
• Weakening of the muscles that control the flow of urine
• Damage to the muscles that control urine flow after prostate surgery
• Obesity
• Chronic cough due to smoking or health problems like chronic obstructive pulmonary disease

Urge incontinence may be caused by:

• Urinary tract infection
• Diabetes type 1 and type 2
• Bladder irritation, such as a kidney stone or tumor
• Drugs, such as hypnotics or diuretics
• Caffeine
• Alcohol
• Nerve damage due to:
  • Spinal cord injury
  • Stroke
  • Multiple sclerosis
  • Parkinson disease
• Constipation

Overflow incontinence may be caused by:

• An enlarged prostate
• A bladder that is blocked, such as by a scar in the tube (urethra) that carries urine from the bladder to the outside of the body
• Fecal impaction that puts pressure on the urethra
• Taking certain medicines, such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, and calcium channel blockers
• Vitamin B12 deficiency
• Weak bladder muscles
• Nerve damage

Functional incontinence may be caused by:

• Health problems that make it hard to move, such as severe arthritis
• Medicines that cause confusion or sedation

Risk Factors

Things that may raise the risk of incontinence are:

• A 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 disease
• Diabetes
• Stroke
• Multiple sclerosis
• Spinal cord injury or disease

Other things that may raise the risk are:

• Caffeine
• Alcohol
• Beta-blockers
• Alpha-agonists
• Cholinergic agents
• Cyclophosphamide

Symptoms

Incontinence is any loss of bladder control. It can result it:

• Leaking when laughing, sneezing, lifting a heavy object, or any other activity that puts pressure on bladder (stress incontinence)
• Leaking plus a strong urge to pass urine (urge incontinence)
• Problems holding urine long enough to make it to bathroom

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. A prostate exam may also be done. A doctor who treats urinary problems will be needed.

Tests to help find the cause of the incontinence may include:

• Blood tests
• Urine tests
• Ultrasound—to view the bladder
• Cystoscopy —to view the lining of the bladder and the urethra
• Urodynamic tests—to measure the flow of urine and the pressure in the bladder

Treatment

Underlying causes will need to be treated. This may help to reduce or stop the incontinence. People who are not helped by these methods may need to manage leakage. Options are:

Healthy Habits

Some healthy habits can help manage leakage, such as:

• Bladder training—to empty the bladder on a regular schedule
• Avoiding incontinence triggers, such as caffeine and alcohol
• Reaching or maintaining a healthy weight

Muscle Strengthening

Strengthening the muscles involved in passing urine can help some people. Options are:

• Kegel exercises —to strengthen the muscles that hold the bladder in place and control the flow of urine
• Painless electrical stimulation to muscles—to increase muscle strength faster than exercises alone

Medicine

Medicines that cause incontinence may be stopped or changed. Other medicines may be given to relax bladder muscles. Botulinum toxin injections may also be given.

Tools to Manage Leaks

Some tools can help absorb or collect urine that leaks, such as:

• Absorbent diapers or briefs
• A tube that collects urine from the penis or urethra and stores it in a bag
• A penile clamp to put light pressure on penis to help stop leaking

Condom Catheter

Copyright © Nucleus Medical Media, Inc.

Surgery

People who are not helped by these methods may need surgery. The surgery that is done will depend on the cause.

Prevention

To lower the risk of incontinence:

• Reach or maintain a healthy weight.
• Avoid food or drinks that can irritate the bladder, such as caffeine, alcohol, or spicy foods.
• Eat plenty of fruits and vegetables to lower the risk of constipation.

References

• Bladder control problems (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems?dkrd=/health-information/urologic-diseases/bladder-control-problems-men.
• Treatment of incontinence. Continence Foundation website. Available at: http://www.continence-foundation.org.uk.
• Urinary incontinence. Urology Care Foundation website. Available at: https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence.
• Urinary incontinence in men. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/urinary-incontinence-in-men-25.