Male Stress Incontinence

Although stress incontinence is often thought of as a problem primarily affecting women, men can also suffer from male stress incontinence. However, the causes of stress incontinence in men and women are often very different. Male and female urinary systems are quite different, and are therefore vulnerable to different problems.

Male stress incontinence refers to the involuntary leakage of urine that occurs when pressure is exerted on the bladder. This pressure can result from lifting a heavy object, coughing, sneezing or any other activity that places stress on the structures of the urinary tract such as the bladder and urethra.

In men, stress incontinence is often the result of a problem or a treatment for a problem involving the prostate gland, which is a walnut-sized organ that lies at the base of the bladder and surrounds the urethra. Inflammation or hypertrophy (overgrowth) of the prostate can put pressure on the urethra, making it difficult for the muscles to control the opening and closing of the urinary sphincter, which acts as a one-way valve allowing control of urination. When this one-way valve no longer functions properly, urine can leak out of the bladder under pressure. This leakage may range from a small, occasional trickle to complete loss of bladder control.

Common treatments for prostate disease include TURP (transurethral resection of the prostate), prostatectomy (removal of the prostate) and radiation of the prostate gland. Leakage of urine is quite common following any of these procedures, particularly prostatectomy, and often resolves in the weeks or months following surgery. For a small percentage of men (5 to 20%), prostatectomy results in permanent incontinence.

Treatment of male stress incontinence ranges from self-help remedies, to medications, to surgery, depending upon the severity and length of duration of the problem:

• Self-help remedies – Self-help remedies are treatments that can be tried at home. These may include limiting fluid intake (but not to the point of dehydration), voiding more frequently, avoiding bladder irritants (i.e. alcohol, caffeine, citric juices and foods containing citric acid), stopping smoking (which can cause frequent coughing), and losing weight if necessary. Bladder retraining involves gradually lengthening the time between voiding trips to help to strengthen the muscles involved in controlling urination. Kegel exercises are exercises that target these muscles, and should be performed several times a day. To perform Kegels, it is important to first identify these muscles, which can be done by attempting to stop the flow of urine mid-stream. Once the person becomes aware of how to tighten these muscles, repetitions can be performed, gradually increasing the number of contractions of these muscles, as well as the length of time these contractions are held.

• Medications - Some men require medication for treatment of male stress incontinence. Medications generally target incontinence in one of several ways: by blocking nerve signals that cause the bladder to contract abnormally, by relaxing the bladder, by decreasing the amount of urine produced, or by decreasing prostate size. Medications are not for everyone. Some medications may cause undesirable side effects or do not mix well with medications that are being taken to treat other conditions.

• Surgery - There are several procedures that may be performed for male urinary incontinence. In general, surgery is reserved for severe cases of incontinence after less invasive remedies have been tried. Surgical options include the injection of bulking agents around the urethra, the creation of an artificial urinary sphincter, or the creation of a sling to support the urethra. Choosing surgery as an option to treat male stress incontinence is a decision that should be made only after all the risks and benefits of the procedure have been carefully explained and considered.

Although urinary incontinence is a distressing problem that many men find untenable, there are many incontinence products available that can decrease feelings of embarrassment over this common condition. The creation of male incontinence pads and male incontinence pants that look and feel like regular underwear can greatly increase confidence and security, diminishing feelings of shame and depression that many men who suffer from incontinence feel.

Male stress incontinence is a common condition usually caused by problems stemming from disease of the prostate. There are many treatment options open for men suffering from this condition, ranging from self-help remedies, to medications, to surgical intervention as a last resort. In the meantime, anyone suffering from stress incontinence has available a variety of incontinence products designed specifically to decrease the negative feelings associated with male stress incontinence.

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