Urinary Incontinence in Men

What follows is the second in a 3-part series on urinary incontinence. Part 1 focused on the condition in women, and part 3 will look at bedwetting—a type of bladder problem that affects children.

Urinary incontinence is the involuntary leaking of urine. The condition can be embarrassing and distressing. As men aren’t always quick to seek medical care, they may tend to ignore incontinence and hope it will simply go away on its own.

But there's a different way to look at it, says Dr. Richard Lee, an Associate Attending Urologist and Associate Professor of Urology. “There are myriad options for treating and managing incontinence, ranging from behavioral modification to medication and surgery. For more than a decade, we’ve seen a wave of innovative treatments for the condition. With so many effective approaches, there’s simply no reason to avoid seeing a urologist.”

What causes urinary incontinence?

The urinary system is composed of the kidneys, ureters, bladder and urethra. Urinary incontinence is usually traceable to the bladder—a hollow organ located in the lower abdomen. When the muscles in and around the bladder don’t work the way they should, your urine may leak

What are the main reasons for urinary incontinence in men?

The most common reason for incontinence in men is benign prostatic hyperplasia (BPH). That’s the medical term for an enlarged prostate, a fairly common condition in men as they age. Other, less common causes include:

• Surgery for prostate cancer or bladder cancer
• Neurological diseases such as stroke or Parkinson’s disease
• Diabetes

What are the main types of urinary incontinence?

• Stress incontinence occurs when bending, lifting, sneezing or coughing puts pressure on the bladder, resulting in leakage.
• Urge incontinence happens when the bladder contracts when it shouldn’t, triggering an urgent need to urinate.
• Mixed incontinence is a combination of stress and urge incontinence.
• Overflow incontinence occurs when urine fills the bladder and flows over.

How is incontinence treated and managed?

Behavioral modification is the least aggressive way to treat urinary incontinence. Try reducing coffee and alcohol, as these are both diuretics and will aggravate the need to urinate. You can also try restricting your total fluid intake—but take care not to become dehydrated in the process, Dr. Lee advises.

If the problem persists, medications are available to relax or shrink the prostate and calm the bladder. “We can mix and match these medications, depending on the nature of the problem,” Dr. Lee says, adding that sometimes, Cialis—a drug typically prescribed for erectile dysfunction—can also help men urinate better.

Then, there’s surgery for BPH, which is much less aggressive than it sounds. “Many of the most striking advancements we’ve seen have been in the area of surgery to reduce the size of the prostate,” he says. “We originally had transurethral resection of the prostate (TURP). Now, we have several alternatives,” including:

• A “stapler” for the prostate (Urolift)
• Laser technology (laser TURP)
• High-pressure water jet (Aquablation)
• Steam (a high-tech procedure called Rezum)

Another innovative procedure makes use of a temporary implanted device called iTind, which widens the caliber of the prostate.

What about surgical removal of the prostate as a cause of incontinence?

Fewer such surgeries are performed nowadays than in the past, but a prostatectomy can be a life-saving measure for men with advanced prostate cancer.

However, removing the entire prostate can result in damage to the urethral sphincter that controls urinary flow, leading to incontinence.

Several approaches are available to remedy incontinence caused by a prostatectomy:

• A hydraulic pump-like implant, called an artificial urinary sphincter
• A “sling” to support the urethra
• A variety of bulking agents used to narrow the urethra

Can Kegel exercises help?

Kegel exercises to strengthen the muscles of the pelvic floor are known to treat and manage mild-to-moderate urinary incontinence in women. It turns out that they’re equally helpful for men with the condition.

Start by finding the right muscles to squeeze. They’re the same ones you use to prevent yourself from passing gas. When you’ve found them, you’ll feel a pulling of the anus and movement of the penis. Then, just tense, hold and release them.

The Urology Care Foundation offers the following guidelines:

• Squeeze your pelvic floor muscles for five seconds and then relax the muscles for five seconds. Be sure to relax between squeezes before squeezing again. Each squeeze and relax counts as one repetition.
• Each set of exercises should include three different positions: 10 repetitions lying down, 10 sitting and 10 standing. Do your Kegel exercises at least twice a day.

Like any exercise routine, it can take a while to build up muscle strength and conditioning. You may not feel your bladder control issues improve until 3 to 6 weeks after you start your Kegel exercise regimen.

Can I gain control over leaks by training my bladder?

Absolutely, Dr. Lee says. First, keep a diary to track when you have an urge to go, when you actually go to the toilet and when you leak. Then, share the diary with your urologist so that you can work together to set up a plan. You might decide to urinate every hour to start and gradually extend the time between toilet breaks over the course of a few weeks.

Eventually, you may be able to space your bathroom visits so that you go every 3 to 4 hours. And your frequent urges to urinate may decrease as well.

Hope and help

Clearly, there’s a lot of help available for men with urinary incontinence, but it’s always wise to begin with approaches that are within your control, such as Kegel exercises, bladder training, fluid restriction and avoiding coffee and alcohol.

Beyond these behavioral changes, urologists offer a wide spectrum of treatments, depending on the nature and severity of the problem. It’s a hopeful time for men with urinary incontinence, so don’t hesitate to seek medical treatment for it.

Make an appointment here to receive world-class, compassionate care with a urologist at Weill Cornell Medicine.

Stay tuned for part 3 in our series on urinary incontinence, which will address bedwetting, a problem that affects children.