Incontinence in Men

Urinary incontinence (UI), the accidental leakage of urine, is a treatable problem. Although women are far more likely than men to experience UI, many men suffer from incontinence. The prevalence of UI increases with age, but UI is not an inevitable part of aging. There are four basic forms of urinary incontinence:

• stress incontinence - the involuntary loss of urine during actions—such as coughing, sneezing, and lifting—that put abdominal pressure on the bladder
• urge incontinence - the involuntary loss of urine following an overwhelming urge to urinate that cannot be stopped
• overflow incontinence - the constant dribbling of urine, usually associated with urinating frequently and in small amounts
• functional incontinence when people with normal bladder control have problems getting to the toilet because of mobility issues

Causes

For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Nerves carry signals from the brain to the bladder and sphincter. Any disease, condition or injury that damages nerves can lead to urination problems. It can occur at any age. Any disease, condition or injury that damages nerves can lead to urination problems may affect bladder emptying by interrupting the nerve signals required for bladder control.

• Men who have had diabetes for many years may develop nerve damage that affects their bladder control.
• Stroke, Parkinson's disease and multiple sclerosis all affect the brain and nervous system, so they can also cause bladder emptying problems.
• Overactive bladder is a condition in which the bladder squeezes at the wrong time. The condition may be caused by nerve problems, or it may occur without any clear cause. A person with overactive bladder may experience urinary frequency—urination eight or more times a day or two or more times at night, urinary urgency—the sudden, strong need to urinate immediately and/or urge incontinence—urine leakage that follows a sudden, strong urge to urinate.

Prostate problems can affect bladder functioning. The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation. The prostate gland commonly becomes enlarged as a man ages, a condition called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra and affect the flow of the urinary stream. Problems with urination do not necessarily signal blockage caused by an enlarged prostate.

Treament for prostate cancer, such as a radical prostatectomy or external beam radiation, may lead to erection problems and either temporary or permanent bladder problems.

Diagnosis

The first step in solving a urinary problem is talking with your healthcare provider. Your family doctor may investigate the problem or refer you to a urologist, a physician specially trained in identifying and treating bladder-related issues, for evaluation.

Medical History. Your general medical history, including any major illnesses or surgeries, and details about your continence problem and when it started, will help your doctor determine the cause. You should discuss how much fluid you drink a day and whether you use alcohol or caffeine. You should also list the medicines you take, both prescription and nonprescription, because they might be part of the problem.

Voiding Diary. You may be asked to keep a voiding diary, which is a record of fluid intake and trips to the bathroom, plus any episodes of leakage. Reviewing the diary will give your doctor a better idea of your problem and help direct additional tests.

Physical Examination. A physical exam will check for prostate enlargement or nerve damage. In a digital rectal exam, the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to it. This exam gives the doctor a general idea of the size and condition of the gland. To check for nerve damage, the doctor may ask about tingling sensations or feelings of numbness and may check for changes in sensation, muscle tone and reflexes.

EEG or EMG. Your doctor might recommend non-invasive, painless tests, such as an electroencephalogram (EEG), where wires are taped to the forehead to sense dysfunction in the brain, or an electromyogram (EMG), where wires are taped to the lower abdomen to measure nerve activity in muscles and muscular activity that may be related to loss of bladder control.

Ultrasound. An ultrasound is a non-invasive, painless test performed by a technician holding a device that sends sound waves into the body and creates a picture of your organs on a monitor. During an abdominal ultrasound, the technician slides the transducer over the surface of your abdomen for images of the bladder and kidneys. In transrectal ultrasound, the technician uses a wand inserted in the rectum for images of the prostate.

Urodynamic Testing. Urodynamic testing focuses on the bladder's ability to store urine and empty steadily and completely and your sphincter control mechanism. It can also show whether the bladder is having abnormal contractions that cause leakage. The testing involves measuring pressure in the bladder as it is filled with fluid through a small catheter. This test can help identify limited bladder capacity, bladder over activity or under activity, weak sphincter muscles and/or urinary obstruction.

Treatment

No single treatment works for everyone. Your treatment will begin with simple treatment options and depend on the type and severity of your problem. Many men regain urinary control by changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. If these behavioral treatments do not work, you may choose to try medicines or surgical treatment. Your doctor will offer guidance about the best treatment option for your condition, your lifestyle and your preferences.

Behavioral Treatments. For some men, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom—a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips.

Biofeedback. Biofeedback uses sensors to make you aware of signals from your body, and it may help you regain control over the muscles in your bladder and urethra. Biofeedback can also be helpful when learning Kegel exercises.

Kegel Exercises. Kegel exercises strengthen the pelvic floor muscles, which help hold urine in the bladder. They are easy to learn and you can do them anywhere. They are most effective when you perform them while sitting or standing. Working against gravity is like adding more weight, and it makes your muscles stronger.

Medicines. Medicines can affect bladder control in different ways. Before prescribing a medicine to treat incontinence, your doctor may consider changing a prescription you already take that may be affecting your bladder control. Otherwise, your doctor may choose from the following types of drugs for incontinence:

• Alpha-blockers are used to treat problems caused by prostate enlargement and bladder outlet obstruction. They act by relaxing the smooth muscle of the prostate and bladder neck, allowing normal urine flow and preventing abnormal bladder contractions that can lead to urge incontinence.
• 5-alpha reductase inhibitors work by inhibiting the production of the male hormone DHT, which is thought to be responsible for prostate enlargement. These 5-alpha reductase inhibitors may help relieve voiding problems by shrinking an enlarged prostate.
• Imipramine relaxes muscles and blocks nerve signals that might cause bladder spasms.
• Antispasmodics work by relaxing the bladder muscle and relieving spasms.

Surgery. Surgical treatment may help men with incontinence caused by a change in the position of the bladder, an enlarged prostate or nerve-damaging events, such as spinal cord injury or radical prostatectomy. Your urologist will determine whether surgical treatment is appropriate for you, and make recommendations accordingly.

Urolift. The Urolift® System is a minimally invasive, non-surgical procedure to relieve the symptoms of Benign Prostatic Hyperplasia (BPH), a common condition where the prostate enlarges as men age. It takes less than 10 minutes, using a very light anesthesia. With UroLift, there is no cutting, heating or removal of the prostate and patients return home with immediate results.

Source: The National Institute of Diabetes and Digestive and Kidney Disease