• Urinary Incontinence—Male

    (Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)

    Definition

    Urinary incontinence is the loss of voluntary bladder control that can lead to urine leakage. Incontinence can be temporary or long-lasting. It is a symptom, not a condition.

    Causes

    The causes may vary with the type of incontinence.

    Stress Incontinence

    The leakage may be caused by:
    • Weakening of the muscles that suspend the bladder
    • Weakening of the muscles that control urine flow
    • Damage to the muscles that control urine flow following prostate surgery
    • Obesity

    Urge Incontinence

    This is also known as overactive bladder. It may be caused by:

    Overflow Incontinence

    This occurs when the bladder will not empty. The urine builds up and overflows. This leads to leaking of urine. It may be caused by:
    • Prostate enlargement
    • Bladder that is blocked, such as by a scar in the urethra (stricture)
    • Fecal impaction putting pressure on the urethra
    • Drugs (such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
    • Vitamin B12 deficiency
    • Weak bladder muscles
    • Nerve damage

    Functional Incontinence

    This is when you have normal bladder control, but you are unable to reach the toilet in time. It may be a result of a condition like severe arthritis. Drugs that cause confusion or sedation can also lead to functional incontinence.
    There may be several different causes for incontinence. In some cases, the cause may also be unclear.

    Risk Factors

    Factors that may increase your risk of incontinence include:

    Symptoms

    Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
    With stress incontinence, leakage may happen when there is extra pressure on your bladder. This can happen when you laugh, sneeze, lift heavy objects, or exercise.
    With urge incontinence, you may have a loss of bladder control following a strong urge to urinate. You may not be able to hold urine long enough to make it to a toilet.

    When Should I Call My Doctor?

    Call your doctor if you have a loss of urine control. Your doctor can help you determine the underlying cause.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. You will be asked about your urine leakage and how often you empty your bladder. A physical exam will be done to look for any physical causes. These include blockages or nerve problems. Your doctor may ask you to keep a diary of your urinary habits.
    You may be referred to a specialist. Urologists are doctors who focus on urinary issues.
    Tests to help find the cause of the incontinence may include:
    • Stress test—you relax, and then cough as your doctor watches for loss of urine (this will confirm if you have stress incontinence)
    • Urine tests
    • Tests to explore problems with your prostate (such as a prostate exam or blood tests)
    • Blood tests to detect diabetes
    • Ultrasound—uses sound waves to examine structures inside the body to determine if any urine remains in your bladder after urinating
    • Cystoscopy—a thin tube with a tiny camera is inserted into the urethra to view the urethra and bladder
    • Urodynamic tests—used to measure the flow of urine and the pressure in the bladder

    Treatment

    Treatments may include:

    Behavioral Therapy

    Behavioral therapy includes:
      Making muscles stronger by doing Kegel exercises
      • These strengthen the muscles that hold the bladder in place and control urine flow.
      • Painless electrical stimulation is sometimes used. It can strengthen the muscles more quickly. It is helpful for stress incontinence.
    • Creating a regular schedule to empty your bladder (called bladder training). This training may also involve drinking fewer liquids

    Weight Loss

    Losing weight may help reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.

    Medication

    Medicines may be prescribed to relax the bladder muscles. These types of medicines are called anticholinergics. They are often used in treating urge incontinence. Examples include:
    • Oxybutynin (Ditropan)
    • Tolterodine (Detrol)
    • Darifenacin (Enablex)
    • Solifenacin (Vesicare)
    • Fesoterodine (Toviaz)

    Devices

    Absorbent diapers are often used by men with incontinence.
    Catheters are sometimes used to treat more severe cases. External (condom) or internal (Foley) catheters may be used.
    Another option is a penile clamp. These clamps are padded and have a sleeve to absorb leakage.
    Condom Catheter
    condom catheter
    Copyright © Nucleus Medical Media, Inc.

    Home Care

    • Take care of your skin by gently cleaning yourself after an episode of incontinence. Let the skin air dry.
    • Make it easier to get to the bathroom. For example, rearrange furniture and remove throw rugs. Add night-lights in the hallway and in the bathroom.
    • If needed, keep a bedpan or urine canister handy in your bedroom.

    Nerve Stimulation

    Devices like Urgent PC and Inter-Stim may be used to stimulate the nerves. This may involve implanting a thin lead wire with a small electrode tip. This electronic stimulation therapy can be done as a series of treatments in your doctor's office.

    Surgery

    In men, surgery may be done to relieve a physical blockage due to an enlarged prostate.
    Other procedures involve surgical repair or implants into the bladder sphincter. The sphincter is the gate that allows the urine to flow through.

    Prevention

    Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:
    • Reduce your intake of substances that lead to incontinence. These include caffeine, alcohol, and certain drugs.
    • Lose weight.
    • Avoid and treat constipation.

    RESOURCES

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

    Urology Care Foundation http://www.urologyhealth.org

    CANADIAN RESOURCES

    Canadian Nurse Continence Advisors http://www.cnca.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Corcos J, Gajewski J, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol. 2006;13:3127-3138.

    Incontinence. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=143. Updated January 2011. Accessed September 14, 2012.

    Occhino J, Siegel S. Sacral nerve modulation in overactive bladder. Curr Urol Rep. 2010;11(5):348-352.

    Prevention of incontinence. Continence Foundation website. Available at: http://www.continence-foundation.org.uk. Accessed September 14, 2012.

    Subak L, Wing R, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.

    Urinary incontinence in men. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 29, 2012. Accessed September 14, 2012.

    Urinary incontinence in men. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/#treated. Published June 29, 2012. Accessed September 14, 2012.

    Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

    Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175:S5-10.

    Yang C, Schwartz S, et al. A new, simple device to manage male urinary incontinence. International Continence Society website. Available at: http://www.icsoffice.org/publications/2005/pdf/0464.pdf. Accessed September 14, 2012.

    12/3/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK. Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.

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