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Male Urinary Incontinence
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Definition and Incidence
Male urinary incontinence is an oftentimes overlooked and underdiagnosed problem.
Recent reports have shown that as many as 9-13% of American men suffer from urinary
incontinence.
Urinary incontinence is not a disease or a normal consequence of aging, therefore, most
cases can be cured or improved. It is a symptom with many causes and is the medical term
used to describe the condition of not being able to control the flow of urine from your body. It
usually happens because the bladder sphincter is damaged or scarred and cannot squeeze
or close off the urethra. This means urine can leak or flow freely from the bladder.
Recent reports have shown that as many as 9-13% of American men suffer from urinary
incontinence.
Urinary incontinence is not a disease or a normal consequence of aging, therefore, most
cases can be cured or improved. It is a symptom with many causes and is the medical term
used to describe the condition of not being able to control the flow of urine from your body. It
usually happens because the bladder sphincter is damaged or scarred and cannot squeeze
or close off the urethra. This means urine can leak or flow freely from the bladder.
Physiology
There are two sphincters that control the flow of urine from the bladder. 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. 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.
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. 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 of Male Incontinence
Male urinary incontinence can be classified into 4 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. This type of incontinence is 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.
- Stress Incontinence
- Urge Incontinence
- Mixed Incontinence
- Overflow Incontinence
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. This type of incontinence is 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 Male Urinary Incontinence
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.
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.
Treatment Options for Male Urinary Incontinence
Behavioral techniques – Scheduled toileting is one technique that puts a man 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 – Depending on symptoms, medications 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 surgery¹
Biofeedback/Electrical Stimulation – 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 – Surgical procedures are available to treat male urinary stress incontinence.
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 – Depending on symptoms, medications 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 surgery¹
Biofeedback/Electrical Stimulation – 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 – Surgical procedures 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 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.