Leaking urine isn’t a female-only problem, as millions of American men know, though they are likely not forthright in talking about it with their buddies, or their urologist.
I frequently see men with incontinence or bladder control problems who are not aware of the many options to stop the plumbing problems keeping them from the activities they love. Colorado is an active state, and I would like to keep men hiking, biking, fishing, playing with kids or grandkids, camping, throwing around the football or whatever activity they like best. I am here to share some options for male incontinence so you can get back to your favorite activity.
According to the Urology Care Foundation, women are about three times more likely than men to experience urinary incontinence, but about 25 percent of men have it, too. Understanding the problem and taking steps to relieve it, either on one’s own or with my urologic care, can help men overcome this bothersome obstacle that often carries emotional worries as well.
For instance, the psychological aspect can affect social life, preventing men from pursuing their normal activities. They might pass on going fishing or playing golf because they know they can’t be that far away from a bathroom for that long. Not many men want to go to a Rockies game with their friends if they know they might have to make a run (literally) for the bathroom when the bases are loaded with two outs.
Men can experience three general kinds of urinary incontinence.
Overflow incontinence is dribbling urine regularly. This is due to the bladder not emptying all the way when urinating.
Stress urinary incontinence (SUI) is when a cough, sneeze, lifting a heavy object or other activity causes the man to leak urine.
Overactive bladder (OAB) is the sudden, often strong urge to urinate. In this case, men can leak urine before making it to the bathroom in time.
Men may also experience OAB and SUI together. In addition, a man can have total incontinence, which means he leaks urine all the time due to failure of the sphincter muscle.
These kinds of issues can often be efficiently addressed. And most men’s urinary incontinence can be reduced significantly or cured altogether.
Interestingly, men are quicker than women to seek care once they start having bladder control problems. On average, women wait 6.5 years before seeing a healthcare provider; men wait 4.2 years. Perhaps women are much more used to hearing about or experiencing leakages, which causes them to wait longer to go to the doctor. I wish both would seek help sooner, but it is, of course, a touchy subject for anyone.
The mechanics of male incontinence
Each type of bladder control issue is caused by different factors. Bladder control problems can be short-term or long-term. Most cases of short-term male incontinence result from a specific health issue or recent treatment. For example, taking certain medications, such as those for colds, depression, sedatives, narcotics and diuretics, can cause short-term bladder control problems.
Chronic male incontinence is a long-term condition, and thus of greater concern to the man who has it and to his urologist as well. Chronic male incontinence issues are often related to prostate problems or treatments for them.
A lot of men I see think urinary incontinence is another of those things that always happens with age. While it is more prevalent at older ages – and more than 10 percent of men over 65 have bladder control problems – it is not a normal condition.
Let’s address why each type of chronic bladder control issue is likely to occur.
Cause of overflow incontinence. Two things can happen: you make more urine than the bladder can hold or the bladder can’t empty when it is full. Maybe the bladder muscle can’t contract as it should to squeeze the bladder, or there could be something blocking the flow. The result is urine dribbling (a constant drip) or only urinating a small amount, but having to do so frequently. An enlarged prostate gland or benign prostate hyperplasia (BPH) can cause overflow, as can a urethra that is too narrow.
Cause of SUI. This happens when the pelvic floor muscles have been stretched, causing them to weaken. That results in reduced support for the lower part of the bladder, leaving all the work of retaining urine in the bladder to the sphincter muscle. And when physical activity (or a sneeze or cough) pressures the bladder, urine leaks out. SUI is more common in women, but that does not put men in the clear. Heavy lifting can increase the chance for SUI, which is an activity many men participate in whether for their job or while working out.
Cause of OAB. The brain signals your bladder to empty, even though it may not be full, and the bladder muscles contract, squeezing out urine. This can also be caused by malfunctioning bladder muscles that contract on their own, squeezing out urine when the bladder isn’t full. These both result in a sudden, often strong need to urinate. One of the more common causes of male OAB symptoms is the prostate getting larger. This can be caused by aging or prostate cancer.
What can we do about it?
First off, go see a urologist. I’ll do a physical exam, talk to you about your symptoms and how long they’ve been going on, and run a test on your urine. If these don’t give us a solid diagnosis of the problem, we may do other tests.
How we treat male incontinence is based on what we find out as the cause, and also on how much the control problems are affecting your life. At Urology Associates, we generally like to start with what you can do on your own and go from there.
If lifestyle changes (listed below) don’t solve your problems, we may move to medications. Some cases may require surgery, but not that many do.
Deciding factors on pursuing surgery include severity of symptoms, recurring blood in the urine, recurring urinary tract infections and the need to remove blockages that may harm kidney functions. Sometimes surgery has to be done to correct ongoing incontinence after the prostate gland has been previously removed. We can perform the following surgical procedures for male incontinence.
- Nerve stimulation for OAB. Also called neuromodulation therapy, this involves implanting a small device under the skin near the tailbone that sends electrical impulses to the nerves going to the bladder. It acts like a heart pacemaker by controlling bladder contractions. Other neuromodulation therapies may also help.
- Sling surgery for severe urinary incontinence. A bulbourethal sling goes under the bulb part of the urethra and is secured to bone or muscle. This lifts up and compresses the urethra, helping it resist pressure from the abdomen.
- Urethral bulking. To prevent urine leakage, we close a hole in the urethra or thicken its wall by adding material to it.
- Adding an artificial sphincter. This is an inflatable silicone device we place around the urethra that acts like the sphincter muscle.
In persistent cases of male incontinence in which treatment options above aren’t sufficient or desired, you may need to consider wearable absorbent products. Another management option is surgical insertion of an indwelling catheter that drains urine into a holding bag.
What you can do about it
Hopefully, your bladder control issue can be taken care of primarily by your own actions. Here are things you can do.
- To strengthen your pelvic floor muscles, do exercises like Kegels, the ones women do that are essentially tightening your muscles like you’re trying to hold back urine.
- Maintain a healthy weight, as carrying too many pounds means more pressure on the bladder.
- Reduce caffeine consumption because it’s a diuretic that increases urination.
- Don’t have more than one alcoholic drink a day.
- Also limit carbonated beverages.
- Avoid constipation, which adds stress to the bladder, by eating a high-fiber diet.
- Don’t smoke (you’d be surprised at all the urologic trouble smoking can cause).
- Practice the double void: urinate as much as you can, relax, urinate again.
- Try to modify your bladder’s behavior by scheduling bathroom trips at set times during the day.
Those tips on lifestyle can often be very effective. If they don’t work, you really should see me or another urologist – at Urology Associates, of course.
Do yourself a favor. Don’t be the average guy with male incontinence and wait 4.2 years to make an appointment. Start taking control of that bladder today.