Male incontinence

Incontinence in Males

Male incontinence is an issue that few men feel comfortable talking about, let alone admitting to. The NHS estimates that between three and six million people in the UK suffer from some degree of urinary incontinence. Although women are two times as likely to have incontinence, many men are also affected. Incontinence is not considered a normal consequence of aging, yet many people associate incontinence with the elderly, leading to shame and embarrassment for its sufferers. The following article will discuss the types of incontinence, causes of male incontinence, diagnosis of the condition, and treatment options available.

Types of Incontinence

Stress incontinence occurs when a sudden stress is placed on the bladder, such as when the patient coughs, sneezes, lifts a heavy object, or exercises. These activities raise the pressure in the abdomen, which in turn places pressure on the sphincter muscle surrounding the urethra. The result is an involuntary leakage of urine.
Urge incontinence results when the bladder spasms and causes a sudden, urgent need to urinate. Patients may not be able to make it to the bathroom on time and may leak urine before doing so.

Overflow incontinence occurs when the bladder is stretched beyond its capacity, causing an overflow of urine. This can happen in males if the prostate gland becomes so enlarged that it partially obstructs the ureter.

Causes

Continence of urine involves the complex interplay of the brain, nerves, and organs of the male urinary system. Any disease condition that affects any one of these can lead to problems of incontinence. Diseases such as Multiple Sclerosis and Parkinson’s can affect the nervous system and cause problems with incontinence. Patients who suffer a spinal cord injury may have impairment to nerves that innervate the bladder, leading to problems in emptying the bladder.
By far, the biggest contender as a cause of male incontinence is the prostate gland. Surrounding the urethra just below the bladder is the prostate gland, which is the approximate size and shape of a walnut. Its function is to supply fluid to semen.

Benign Prostatic Hypertrophy (BPH) is a condition in which the prostate gland enlarges. Enlargement of the prostate gland is common as men age. As the prostate enlarges, it may put pressure on the urethra, the tube that carries urine out of the body, and cause problems with the flow of urine. Symptoms are not common before the age of 40; however, it is estimated that more than half of men in their 60’s and 90% of men in their seventies and eighties have some symptoms related to an enlarged prostate gland.

Symptoms that men with an enlarged prostate might experience include:

• a hesitant, interrupted or weak urine stream
• dribbling or leakage of urine
• urinary frequency, especially at night (nocturia)
• urge incontinence

Diagnosis

Men who suffer from male incontinence should first visit their family doctor. A urinalysis will likely be done to check for an infection. During the initial visit, the doctor will ask several questions in order to ascertain the scope and magnitude of the problem. Questions asked may include:

• When did the problem start? (days, weeks, or months)
• How often do you experience incontinence? (rarely, frequently, or constantly)
• Are you able to hold your urine at night? (nocturia)
• Do you consume alcohol? Caffeine?
• What is your daily intake of fluids?
• Are you taking any medications? (antihypertensives, sedatives, narcotics, diuretics)
• Do you have any health problems? (any condition affecting brain or nerves, or urinary tract)
• Have you had any surgeries? (bladder, prostate, or ureters)

It may be helpful for the patient to keep a diary of symptoms for at least a week before the appointment. The diary should include the number of times the patient was incontinent, activities prior to the episode, and 24-hour fluid intake. Such a diary may provide clues as to the cause of the incontinence.

A digital rectal exam will be included in the examination. The physician will insert a gloved finger into the patient’s rectum. The purpose of this is to judge the size and contours of the prostate gland. At the same time the physician can check tone and reflexes of the rectum. An abnormality in tone or reflex may point to a nerve problem as the cause of incontinence.
Men experiencing male incontinence may be sent to a urologist. A urologist specializes in diseases of the urinary tract. The urologist may decide to perform one or more of several tests:

• Ultrasound-an ultrasound of the abdomen will include bladder and kidneys. A transrectal ultrasound provides images of the prostate gland
• Urodynamic Testing-examines the bladder’s ability to store and release urine completely-can also examine sphincter control and whether the bladder is having abnormal spasms
• PSA-a blood test which, when elevated, may point to cancer of the prostate.

Treatment

There are several treatments for male incontinence that may be done at home. A simple remedy that may be of use is for the patient to limit their fluid intake at certain times of the day. For example, if the patient is mainly incontinent at night, limiting fluid intake before going to bed may limit this problem.
Bladder training is a method in which the patient voids in certain time intervals, slowly increasing the time between voids. This can help to strengthen sphincter muscles as well as the bladder. It may take several weeks before improvement is noticed.

Kegel exercises can also be used as a way to strengthen pelvic floor muscles. Extensive studies are inconclusive as to their usefulness, but many physicians are still advocates of these simple exercises that can be done easily anywhere and at any time. Patients are advised to perform Kegels three times a day for five minutes. The exercises involve isolating those muscles that start and stop the flow of urine.

There are many medications on the market specifically for male incontinence.
These include three main classes of drugs:

• Alpha-blockers, which relax smooth muscle of the bladder and prostate (Hytrin, Flomax, Cardura, Uroxatral)
• 5-Alpha reductase inhibitors, which inhibit production of the male hormone DHT thought to be responsible for prostate enlargement (Proscar, Avodart)
• Antispasmodics, which relax the bladder musculature and relieve spasm (Pro-Banthene, Detrol LA, Ditropan XL, Enablex, Sanctura, Vesicare
• In severe cases of male incontinence caused by prostate enlargement, surgery may be recommended. Two common surgeries are TURP and prostatectomy. TURP (transurethral resection of the prostate) involves insertion of an instrument, or resectoscope, through the urethra so that the prostate can be debulked, and obstruction can be relieved. In a prostatectomy, the prostate is removed. Complications of this procedure may include ongoing incontinence and impotence, but may be necessary in some severe cases.

Male incontinence is a common problem, which can cause considerable distress and embarrassment for the patient. Types of incontinence include stress, urgency, and overflow incontinence. Symptoms can consist of a hesitant, weak, or interrupted stream, urgency, intermittent or constant dribbling or leaking of urine, frequency, and nocturia. Diagnosis should begin with a visit to a general practitioner, who may opt to send the patient to a urologist. Tests to diagnose male incontinence and its causes may include a digital rectal examination, urinalysis, blood work, ultrasound, and urodynamic testing. Treatment options include self-help treatment such as fluid restriction, bladder training, and Kegel exercises. Numerous medications are available to treat male incontinence. In the event that other treatments fail, a surgical cure may be offered.

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