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What is incontinence in men?

Male incontinence is the involuntary loss of urine in men. It can be sudden, in small or large amounts, or it can dribble out more slowly. There are multiple causes and generally, more than one factor plays a role in the type and degree of urinary leakage.

Is urinary incontinence serious?

It depends on the cause. It may be a sign of a more serious condition such as multiple sclerosis or a stroke.

Types of Male Incontinence

  • Stress incontinence is the loss of urine due to an increase in abdominal pressure such as a cough, sneeze, or laughing.
  • Urge incontinence is due to a sense of pressure or urgency from an unstable bladder muscle
  • Mixed is a combination of stress and urge types of incontinence
  • Functional is due to outside causes such as a urinary tract infection, delirium, medications, or impaired mobility.

How is incontinence different in males vs. females?

Women do not have prostates which when enlarged can cause slow urinary flow which can back up if men ‘hold their urine’ for prolonged periods of time. However, women can have pelvic organ prolapse that is so severe it obstructs the flow of urine by kinking the urethra. 

Are women more prone to urinary incontinence?

Yes, women are more prone to incontinence due to obstetrical trauma and low estrogen after menopause. Incontinence increases with age in both men and women. A Swedish study found that the rate of urinary incontinence was 9.7% in younger women with a normal body mass index BMI less than 25kg/m2 and increased to 48.4% in those with higher BMIs and advancing age. The rate in men is approximately 22.6% [1,2,3].

What are the main causes of urinary incontinence in men?

Urinary incontinence may have multiple causes:

  • Structural and functional disorders involving the bladder, urethra, ureters, and surrounding tissue 
  • Spinal cord or central nervous system (CNS) disorders from disc disease or strokes. 
  • Medical problems such as diabetes, multiple sclerosis
  • Drug-induced
  • Intrinsic Sphincter Deficiency from prostate surgery or radiation, pelvic fracture
  • Impaired mobility and cognition
  • Obesity
  • Chronic lifting or coughing (smoking)
  • Overactive bladder muscle

Do prostate drugs cause incontinence?

  • Drugs like antipsychotics and antidepressants can cause urinary retention and overflow incontinence
  • Alpha-antagonist – Urethral relaxation- these are used to treat prostate problems
  • Diuretics ‘water pills’ can overwhelm bladder capacity especially in elderly persons
  • Calcium channel blockers cause decreased muscle contractility in the bladder, causing urinary retention with overflow incontinence
  • Sedative-hypnotics causes sedation leading to functional incontinence
  • Angiotensin-converting enzyme (ACE) inhibitors – Diuretic effect and by causing a cough
  • Anti-parkinson medications  cause urinary urgency and constipation

Symptoms of Urinary Loss

  • Loss of urine with coughing, laughing, sneezing, dancing
  • Sudden urge to urinate followed by urine loss
  • Odor
  • Dampness in underwear
  • Neurologic symptoms such as numbness, tingling

What is the treatment for urinary incontinence?

Medications, surgeries, exercises, and physical therapy are the mainstay of treatment. Treat the underlying cause such as diabetes. In the case of overflow incontinence, keeping the bladder drained at regular intervals with catheters is the primary management tool.

Pelvic Floor Exercises

How does a man perform kegel exercises (pelvic floor exercises)?

Yes, they also benefit men who develop urinary incontinence following prostate surgery [4]. Kegel exercises improve the strength and tone of the muscles of the pelvic floor called the levator ani and the pubococcygeus. 

During periods of increased intra-abdominal pressure such as coughing, tensing these muscles tightens the surrounding tissue that supports the urethra. This helps compress the urethra during times of increased pressure which limits leakage.. 

Male incontinence products include the following:

  • Male incontinence pouch/sheath – this is a super absorbent sheath that covers the penis like a glove and collects the urine. It is for single use.
  • Male incontinence clamp/clips are placed around the penis to block the flow of urine. It is  used to control when men urinate. To urinate, men release the clip/clamp pressure around the penis, allowing the flow of urine to the toilet or urinal.
  • Male incontinence pads/male incontinence guards are similar to sheaths except they are not occlusive and fit more loosely around the penis
  • Male incontinence underwear is underwear that has an absorbant material that wicks moisture away until it can be changed
  • Drip collectors for mild male incontinence are disposable or reusable material that is designed to attach to underwear or slip over and around the penis. It may have adhesive backing or specially designed brief to hold in place

How can catheters help?

  1. Intermittent catheters are used periodically throughout the day and night to keep the urine drained
  2. Condom catheters for male incontinence for those who can void on their own but who may have mobility problems

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