What is it?
Urinary incontinence is the unwanted leakage of urine and can occur in men as a result of bladder or prostate problems or previous pelvic surgery like a radical prostatectomy.
Why does it occur?
Urinary leakage in men may occur for a number of reasons:
- Overactive bladder: The bladder has developed an inability to hold urine and squeezes or sends a strong signal to empty out the urine before it is actually full.
- Overflow Leakage: This can occur when the bladder muscle no longer has the ability to squeeze effectively or there is a blockage of urine flow from prostate enlargement or scar tissue in the urethra. As a result the bladder never fully empties and men may not even feel the urge to urinate but leak without warning.
- Stress Urinary Incontinence: This is urine leakage, which occurs when coughing, sneezing or straining. While infrequent in men it may occur after surgery to remove the prostate for cancer or radiation for prostate cancer.
Medical conditions like diabetes, stroke, Parkinson’s disease and other neurologic conditions can significantly impact urinary control.
How is it evaluated and why?
Your urologist will discuss your urinary symptoms, fluid intake and medical problems. They will perform a thorough physical exam to evaluate your type and cause of your symptoms and might ask you to fill out a bladder diary. In addition, they may perform urine tests, ultrasound of the bladder or kidneys and if necessary an urodynamics test (bladder testing).
What are my treatment options?
- For treatment options of overactive bladder please follow the link to OAB.
- For treatment options for prostate enlargement follow link to BPH.
- Treatment for Stress Urinary Leakage in Men:
- Behavioral therapy: Limit fluid intake, caffeine, soft drinks, alcohol, acid beverages (fruit juices) and spicy foods.
- Conservative Management:
- Diapers pads
- Penile clamp- Soft padded clamp that is placed around the penis to mechanically prevent leakage. It is removed every 2-3 hours during the daytime to empty the bladder.
- Catheter- May be indicated in debilitated patients if they have developed bed sores or skin breakdown as a result of urine leakage
- Bladder Training/Pelvic Floor Exercises: Commonly known as Kegels, these exercises are performed daily to strengthen weak pelvic floor musculature. If you have had a prostatectomy, you will be instructed when to begin and how to perform these once you have recovered from your operation.
- Medications: There are no well-established medications to help men with stress urinary leakage. If men also have overactive bladder then they may benefit from medications designed to relax the bladder muscle.
- Procedures: Some men’s stress leakage may not be adequately controlled after trials of medication or conservative therapy. In these patients we can offer additional treatment options. If the leakage occurs after prostatectomy it is advised to wait at least one year after the surgery before deciding to move on to one of the following procedures:
- Urethral Sling: A synthetic piece of mesh is placed underneath the urethra through a small 3 inch incision behind the scrotum. The sling acts to support the urethra like a hammock when the man strains or coughs. This surgery is typically performed as an outpatient procedure. On some occasions, you may be sent home with a urinary catheter for 2-3 days post procedure.
- Artificial Urinary Sphincter: This is a mechanical device that utilizes a small donut shaped inflatable cuff that wraps around the urethra. A pump is implanted into the scrotum underneath the skin. With this pump, the patient can manually open and close the cuff thus allowing urine to flow when appropriate and prevent urine leakage. This surgery is typically performed as an outpatient procedure and is performed through a small incision below the scrotum. Your urologist will discuss the details of your procedure and help decide if it is the right one for you.