What is urinary incontinence?
Urinary incontinence is an inability to hold your urine until you get to a toilet. More than 13 million people in the United States -- male and female, young and old -- experience incontinence. It is often temporary, and it always results from an underlying medical condition. For the purposes of this FAQ the term "incontinence" will be used to mean urinary incontinence. Incontinence is defined as the unwanted loss of urine. Many men are too embarrassed to ask for help and don't realize that successful treatment is usually available for most of them. Incontinence is not a necessary part of aging; it can happen in young men as well as old, and often can be treated. There are many different types of incontinence, and the successful treatment depends on making the most accurate diagnosis of the type of incontinence that is affecting each individual patient. In some patients more than one type of incontinence is present.
The major types of incontinence in men are as follows:
If coughing, laughing, sneezing or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. It can be from any type of exercise, including simply getting out of a chair or walking. This form of incontinence is usually more prevalent in women.
If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable," "spastic" or "overactive." It might also be called "reflex incontinence" if it results from overactive nerves controlling the bladder. Urge incontinence can mean your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when someone is taking a shower or washing dishes). Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors and injury -- including injury that occurs during surgery -- can all harm bladder nerves or muscles.
If your bladder is always full and continually leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is more prevalent in men than women.
How is incontinence diagnosed?
Factors that need to be evaluated in any man with incontinence are the presence of urinary tract infection, the presence of constipation and a full list of medications that are being taken to see if they have any cause or effect. A complete medical history and examination and analysis of the urination are the most basic tests for evaluation of urinary incontinence. We may ask you to keep a chart of your voiding pattern to help us make a firm diagnosis, or to help us see how successful we are in treating your condition. The chart should document the following:
- When do you go to the bathroom and how much? (Use a jar to measure.)
- When do you experience wetness? During or after lifting? While coughing, sneezing or straining? Day, night, or both? Before or after going to the bathroom?
- How much urine do you lose? Estimate amounts in teaspoons, tablespoons or parts of a cup.
- Do you have trouble stopping or starting the flow of urine?
- What is your daily fluid intake? (amount and description of what you drink)
- Be prepared to name the medications you take and any surgery you have had on your urinary tract or around it. When you have this information ready, it is easier for us to proceed with an evaluation.
If you have had previous treatment for incontinence, bring those records or X-rays with you.
Other diagnostic tests that may be done include X-ray or telescopic examinations of the urinary tract, and nerve and muscle function testing of the bladder and sphincter or valve areas.
What are the treatments for incontinence?
Once the cause of the urinary incontinence is discovered, treatment can begin. There are three major treatment areas: medications, surgery and behavioral techniques.
Medications to treat incontinence depend on the cause of the incontinence. If the patient's bladder is contracting inappropriately, medicines can be used to slow down these contractions. Medications can be used to treat infections that may be stimulating the bladder to contract or are causing irritation. Muscle medications also exist that also help tighten the muscles of the sphincter area.
Surgery is often needed to help incontinence. If the prostate gland is blocking the urinary channel, or a stricture or scar exists in the urethra, this may need to be dealt with surgically. In patients who are incontinent (particularly the stress variety) and have had prostate surgery, artificial sphincters can be placed to aid the patient's own sphincter. A new development is the use of injectable collagen. Collagen is a safe material that can be injected just outside the sphincter to create increased resistance and achieve better control. In some patients who have very small bladders because of infections, inflammation or radiation, augmentation of the bladder size using intestine can be used to treat incontinence.
Behavioral techniques are now available that allow you to get better coordination of voiding function and strengthen the muscles. Biofeedback is a way of learning exactly how the bladder muscles and sphincters contract. By using biofeedback techniques increased resistance can be achieved. Pelvic exercises (known as Kegel exercises) can be used to help strengthen the muscles around the neck of the bladder.
In some circumstances cure is not possible, but products are available to help the patient manage incontinence. These include various types of protection devices, such as pads and diapers, that are available at most health care suppliers and drug stores. In some patients a catheter (tube) can be placed into the bladder. The catheter drains into a bag that needs to be emptied when full. Certain catheters cover the penis from the outside (condom catheters). Some men have poorly emptying bladders because of obstruction but they cannot tolerate surgery. These patients can achieve excellent results after being taught to catheterize themselves with a small tube three to five times a day.