Urinary incontinence - Urinary incontinence in men

Urinary incontinence

Urinary incontinence in men
Incontinence (leakage of urine) is not just a women’s problem – plenty of men have difficulty controlling their urine.

5–7% of men under 64 years of age have urinary incontinence.
10–20% of men over 64 years of age have urinary incontinence.

In men, incontinence can take various forms.

If you have the commonest form, you have to rush to the toilet (urgency), and perhaps leak on the way (urge incontinence). This is often worse in cold weather or if you hear the sound of running water. You may notice some dribbling after you have passed urine. These problems are most common in older men. They are often partly related to a blockage at the outlet of the bladder, caused by enlargement of the prostate gland – benign prostatic hypertrophy (BPH).
Some men have had bladder problems all their lives, such as bedwetting, urgency, urge incontinence or having to pass urine frequently.
Difficulty in holding urine sometimes results from a previous prostate operation, especially when you cough, sneeze, during exercise or standing (stress incontinence). This is common straight after the operation, but often improves within weeks.

Why prostate enlargement causes incontinence. Enlargement of the prostate gland tends to occur with ageing. At 60 years of age, about 40% of men have enlarged prostates, but this rises to 75% by the age of 80. The reason is not known, but it is not a cancerous condition.

A normal adult prostate is about the size of a chestnut and weighs 20–25 g, but in benign prostatic hypertrophy (BPH), it can increase to 60 g or more. As it expands, the prostate wraps itself round the neck of the bladder like a collar, restricting the outlet, and the bladder muscle has to work harder to push the urine out.

Because of the obstruction, you notice that you have a poor stream or that starting the stream is difficult or that urine seems to flow in stops and starts.
The strain makes the bladder muscle misbehave so that it often starts to contract before the bladder is full, causing urgency. Because the bladder tends to contract before it is full, you will pass urine frequently in small amounts and often have to get up in the night to urinate.
The bladder has difficulty in emptying completely, because the outlet is restricted, and there is always some urine left inside. Gradually, more and more urine is left inside and, in severe cases, eventually overflows without any feeling of urgency. This is called ‘overflow incontinence’.

What you can do Try to work out if your prostate is enlarged. If you can answer ‘yes’ to any of the following questions, it is quite likely that you have an enlarged prostate.

Do you have difficulty in starting to pass urine?
Do you think it takes you too long to pass urine?
Do you pass urine in stops and starts?
Do you dribble urine without full control when you have tried to stop?
Do you have a sensation of not having emptied your bladder completely?
Do you have to get up more than twice a night to pass urine, but only pass small amounts?

If you do think that your prostate may be enlarged, then you should arrange to see your doctor to check that this is the cause of your symptoms. If the problem is really troubling you, your doctor may decide to try medication. A drug (finasteride) is available to shrink the prostate, but when you stop taking it the prostate starts to grow again. Other drugs (alpha-blockers) relax the bladder neck and the prostate itself, but have side effects in some people. You may need a prostatectomy operation to remove the enlarged prostate.

Decide whether urgency is your main symptom. If you have urgency, you could try ‘bladder retraining’. Some men find this helps, but generally it is not as effective in men as in women. Discuss the problem with your doctor, because there are various medicines that are very effective in calming an overactive bladder.

Dribbling after passing urine. If you dribble after passing urine, try running your finger along the underside of your penis to force out any remaining liquid.

Bed-wetting. If you have always had bladder problems, including wetting the bed at night as an adult, look at the section on bed-wetting and then discuss it with your doctor.

Other approaches. Even if your incontinence cannot be cured completely, there are ways of getting over problems.

After a prostate operation. Tell your doctor if you have incontinence after a prostate operation that has not improved within a few weeks. Pelvic floor exercises often help, especially if a ‘pelvic floor physiotherapist’ shows you how to do them properly. Various operations might be possible, such as insertion of a ‘sling’ to support the exit tube from the bladder, or an implanted device to replace the inadequate neck of the bladder.