Overview

Treating Incontinence in Men

Treating Incontinence in Men

Incontinence (involuntary loss of urine) may be a devastating problem, resulting in embarrassment, loss of intimacy, and even social isolation. We describe it to our patients as a “social cancer”. For a consultation you can contact our reconstructive urology clinic to schedule an appointment.

Types of Incontinence

Incontinence comes in several varieties but the most common are the following:

Stress Incontinence

This is defined as leakage associated with activity. This type of incontinence, or involuntary loss of urine, in men usually occurs after prostate surgery for cancer but occasionally may occur after other events such as injury, transurethral resection of the prostate (TURP), etc. Typically there has been injury to the urinary sphincter muscle. Leakage then occurs when the patient uses their abdominal muscles, for example sneezing, coughing, laughing, bending over, athletic activities, etc.

If a man is diagnosed with stress incontinence, various successful treatments are available.

Urge Incontinence

Also known as overactive bladder, this is when the man gets an irrepressible urgency to urinate and cannot get to a bathroom in time. Men can also get urgency without incontinence, which is the feeling of urinary urgency but the man is able to suppress it (sometimes barely!). These are very common problems, with a wide variety of causes. Causes include: infection, medications, prostate growth, over activity or sensitivity of the bladder muscles, sensitivity to certain foods or substances, neurologic injury or diseases and others. Occasionally, urgency or urge incontinence can be the sign of a more serious underlying condition such as bladder cancer.

Urgency and urge incontinence are NOT normal and need to be evaluated. Evaluation includes a patient’s history and examination, an analysis of the urine, and often additional testing such as cystoscopy (looking into the bladder with a very small camera; it is not a painful procedure) and/or urodynamics (an outpatient “functional” test of the bladder muscles done in clinic).

Treatment depends on the cause and the individual and may include behavioral therapy, medications and/or neuromodulation.

Overflow Incontinence

This is typically a constant leakage that occurs when a patient is unable to efficiently empty their bladder. Urine builds up and “spills” out, like a reservoir spilling over a dam. This can be due to obstruction (such as prostate or scarring in the urethra) and/or loss of bladder function or sensation. It can be dangerous and requires investigation to make sure no other problems are occurring. Treatments generally include catheters and/or surgery.

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Treating Stress Urinary Incontinence

Products That Absorb Urine

These products include diapers and pads. Although they are very helpful, many men are dissatisfied with the smell and inconvenience.

Medications

Currently there are no approved medications for male SUI

Behavioral Changes

Many men discover that there are strategies they come up with on their own to minimize leakage. These include purposeful dehydration, keeping the bladder relatively empty by urinating frequently, and avoiding foods and other products that cause bladder stimulation. A short and incomplete list of products to avoid includes:

  • Tobacco,
  • Alcohol,
  • Caffeine (coffee, tea, soda pop, chocolate),
  • Spicy foods (jalapeno and other peppers),
  • Citric acid foods (grapefruit, and the like), and
  • Tomato-based foods (pasta sauce, and the like).

External Devices

These include clamps that squeeze”the penis and avoid leakage and condom catheters. In the latter, the patient uses a device similar to a condom that goes over the penis, and the patient urinates into it, then it drains to a bag. Although these devices are fairly easy to use and may be satisfying for some men, they have certain risks and most men find them very awkward to use.

Internal catheters

These are catheters that go inside the bladder. They work very well but have a very high rate of infection and many men find them uncomfortable.

Bulking Products

These are various materials (collagen, carbon beads, coaptite) that are injected into the urethra to push the tissue together and so cause some obstruction that may help the incontinence. Although they are generally safe, they rarely cure the problem and usually have to be repeated periodically to maintain continence.

Surgery

Surgery for SUI mainly falls into two categories: slings and sphincter.

Slings

Advanced implant for incontinenceSlings are appropriate for men with mild-moderate incontinence (less than three pads per day). They boost up the urethra, restoring support to the urethra that may be lost after prostatectomy. It is performed with an incision in the perineum (the area between the scrotum and anus) and two tiny incisions in the groin.

Benefits: no moving parts, continence is restored immediately

Risks/downsides: temporary urinary retention (requiring use of a catheter) is common; not as reliable as artificial urinary sphincter for more severe incontinence; does not work as well in certain situations (after radiation, immobile urethra)