Male Urinary Incontinence
This broad medical term describes the condition of being unable to control the flow of urine from your body. It is a symptom of other disorders, usually occurring because the bladder sphincter is scarred and can’t squeeze or close off the urethra. Though usually overlooked and underdiagnosed, this problem affects as many as 9 – 13% of American men.
Male continence is maintained by two sphincters: internal and external. The internal sphincter is part of the bladder neck and is under involuntary or reflex control by higher centers of urination in the brain. The external sphincter, which is part of the pelvic floor muscles, is a voluntary sphincter and is actively relaxed at the time of urination. Oftentimes, the internal sphincter is removed or damaged as is the case during radical prostatectomy or bladder neck surgery such as TURP. In these situations the man must rely entirely on the external sphincter to maintain continence. Unfortunately, the external sphincter may be damaged as well during these same types of surgeries rendering the patient incontinent.
Classification and Causes
Male urinary incontinence can be classified into four different categories:
- Stress Incontinence – Occurs when you leak urine during physical activity such as exercise, walking, lifting, coughing and sneezing
- Urge Incontinence – Occurs when you have an overwhelming need to urinate and are not able to hold urine long enough to reach the toilet
- Mixed Incontinence – A combination of stress and urge incontinence, where you have symptoms of both conditions
- Overflow Incontinence – When your bladder never completely empties, which causes urine to leak; found in men with prostate enlargement, scars/strictures of the urethra or bladder neck and can also be due to dysfunctional bladder function, as seen in diabetic patients
Diagnosis of the specific type of incontinence in men can be more complex than in women. The typical evaluation includes a detailed medical history and physical examination. Sometimes your physician will request a voiding diary or pad weight log to determine the nature and degree of incontinence. It is important to rule out simple causes of male urinary incontinence such as urinary tract infection with a formal urine culture, non-invasive flow rate and residual urine measurement. Additional testing should include complex urodynamics and cystoscopy.
- Behavioral Techniques such as scheduled toileting can put you on a regular voiding regimen, and is typically recommended for the frail and elderly. Bladder retraining is a way men can go to the bathroom at specific times in the day where times can gradually be extended to longer intervals. This type of therapy is effective is treating urge and mixed incontinence.
- Pharmacological therapy is medication that can be given to help men with incontinence. Anticholinergic agents can be used as first-line treatments for urge incontinence because they inhibit detrusor contraction, and may help increase bladder capacity. Stress incontinence is typically treated with surgery.
- Biofeedback/Electrical stimulation is practiced to help people gain awareness and control of their urinary tract muscles. The principle of biofeedback is simple: A variety of instruments are used to record small electrical signals that are given off when specific muscles are squeezed to urinate. These muscle squeezings are then converted into audio (hearing) and/or visual (seeing) signs that patients can recognize and learn in order to control muscular activity. With biofeedback, weak muscles can be better activated on demand, overly tense muscles can be relaxed and overall muscle activity can be coordinated.
Surgical Options are available to treat male urinary stress incontinence
- Injections of bulk-producing agents, such as collagen, into the urinary sphincter.
- Implanting a “male sling,” a device designed to support the muscles around the urethra. The AMS AdVance™ Male Sling System is a highly effective, minimally invasive procedure to correct mild to moderate stress urinary incontinence.
- Implanting an artificial urinary sphincter, which mimics the function of a normal, healthy urinary sphincter. Currently the only artificial urinary sphincter available, the AMS 800™ Urinary Control System is an effective solution for moderate to severe stress urinary incontinence following prostate surgery.