Ask The Expert: How Do I Talk With My Husband About His Incontinence?

How Do I Talk With My Husband About His Incontinence

Question:  My husband of 47 years has recently started experiencing incontinent episodes. He’s a very proud man and doesn’t want to admit them to me, but it’s starting to become a problem due to the increased laundry, smell and his overall depressed attitude about it. How can I get him to open up and talk with me about it?

 

Answer:  This is a common problem in marriages, especially pertaining to men. Most men don’t want to admit they have a problem with bladder control. They feel ashamed, and hate the idea of wearing protection. He may never come out and admit it to you on his own, so here are some tips to broach the subject with him:

1. Make him feel comfortable.

As you’ve already figured out, incontinence is a very uncomfortable subject for your husband. Make him feel at ease and approach him about his bladder leakage in a way that is not threatening or accusatory. Find some neutral territory and talk to him at a time when he feels good. Don’t try to broach this subject right after he’s had an accident.  That will only make him feel more embarrassed and ashamed.

2. Show him that you are understanding and want to help him with his bladder leakage.

Before you talk with him, do a little research on incontinence and learn what may be causing the issue. Did he just have prostate surgery? Is there something else that has changed recently that could be contributing to his accidents? Read about the causes, and the many different treatment options and management strategies for bladder leakage. Show him that there are ways to manage the condition and that he doesn’t have to just live with it. Let him know that you care about him and want to help. Show him that you are a team so that he doesn’t feel so alone.

3. Encourage him to seek treatment for his incontinence.

Incontinence can often be a symptom of an underlying condition. Let your husband know that you want him to talk with a doctor to make sure that there is nothing serious going on, and to help him get the problem under control. He may be resistant to speaking with his doctor, but press on (slowly). The sooner he confronts his incontinence with a professional, the sooner he can begin treatment and start feeling like himself again. (Find a specialist in your area with our Specialist Locator.)

4. Be his advocate for care.

Because your husband is so embarrassed about his incontinence, you may need to be his voice when seeking out treatment options. Help him research incontinence so that you both can learn more about it. Write out questions that he can bring with him to the doctors office to ensure he doesn’t forget anything important. Be sure to voice any concerns over treatment options. And help him stay the course on his path to treatment.

5. Introduce him to the NAFC message boards.

The NAFC message boards are a great place for your husband to explore and ask questions – anonymously! There are many people on the boards who may be experiencing the same things he is who he can talk to. Plus, with so many people dealing with incontinence in the same spot, there are lots of learnings and tips he may be able to pull from to help his own situation. (As an aside, the message boards may also be a great spot for you to do some research too.  Talk with other caregivers to get some ideas. Or ask other men living with incontinence how you might be able to best approach your husband about the topic.)

It’s never easy talking about incontinence to a loved one – especially men. But by being a caring and supportive spouse, you’ll show your husband that you are in his corner, and that you are there to help. Good luck!

Gender Neutral Pelvic Floor Tips

Gender Neutral Pelvic Floor Tips

Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women.  The pelvic floor helps keep us dry.  More than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.  

Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.  

Here are my best pelvic floor tips.

Start a Bladder or Bowel Diary

For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking. Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks. Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.But, please consider what you can do with the information. Are there any trends you are seeing? Do you have more problems in the morning, afternoon or evening? Do you need to space out your fluid intake?  ou may be able to cue into changes that may positively impact your bladder control and confidence.  

Drink more water and consider cutting down on alcohol and caffeine

Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass. Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse.  Hydration with plain, old water is one of the keys to improved bladder function.  And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern.  Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?  

Kegels

Yes – we need to talk about this.  Men can do Kegels and should do Kegels to improve bladder control.  Kegels are not just meant for women.  Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance.  Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry.  Here are some cues that may help you or your loved one perform a Kegel.   

 Return to the idea that pelvic floor is a muscular sling.  It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.

  • Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly. When you do this – you may feel a gentle tightening of the muscles underneath your navel. Your tailbone may gently rises up and in. Continue your normal breath. Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.

  • Continue breathing and hold the Kegel for a few seconds. Then gradually relax. Repeat until you’re fatigued or have completed your goal.

That concludes my list of my best pelvic floor tips. What are your best practices?

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Incontinence During Sex - It Happens To Men Too

Incontinence During Sex Happens To Men Too

Prostate cancer is one of the most common types of cancer in men. According to the American Cancer Society, 1 in 7 men will get prostate cancer in their lifetime (only skin cancer has a higher rate).  And, while many men will go on to survive prostate cancer, the side effects of treatment can be difficult to deal with for many.

A common treatment for prostate cancer is a radical prostatectomy, or the complete removal of the prostate.  This is generally considered a good approach especially if the cancer is contained within the prostate gland and has not spread.  However, one side effect of this procedure is often incontinence.

Stress urinary incontinence, the type of incontinence that happens when you place pressure on the bladder, is common for men who have had their prostate removed or are undergoing other treatments for prostate cancer.  Treatment can sometimes weaken the bladder muscles, causing leakage when a man sneezes, coughs, exercises, or even during sex.  This can be extremely embarrassing for men, and can be discouraging when going through the healing process of having a prostatectomy. The good news is that many men regain full control of their bladder with time after a prostatectomy.

here are 4 tips that may help you avoid some awkward situations in the bedroom:

  • Try to watch your fluid intake in the hours leading up to sex.

  • Avoid consuming bladder irritating food and drinks, such as caffeine, chocolate, or alcohol.

  • Prior to sex, completely empty your bladder.

  • Keep a thick towel nearby in case of any accidents

While this problem can be an embarrassing one, keep in mind that many men deal with this in the months after prostate cancer treatment and with time, this condition should improve.  If you still experience problems a few months after your treatment, talk to your urologist about treatments for incontinence.  He or she can help you navigate the many options available to you and find one that fits best with your needs.

Overactive Bladder in Men

Overactive Bladder In Men

You've all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That's overactive bladder (OAB). You've also seen ads of men rushing to the bathroom at football games. Those ads say it's a prostate or "growing problem" - the prostate is getting too big or causing a blockage resulting in the bladder becoming overactive. Whether you are a man or a woman, if you have to rush to get to the bathroom to urinate, you might have overactive bladder.

Most of the time, there are other symptoms that accompany OAB - including frequency of urination, loss of urine control on the way to the bathroom, or waking from sleep to urinate. Sometimes OAB presents with other related symptoms such as difficulty starting urination, having to push or strain, and having a weak stream. Occasionally it can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted temporarily into the bladder to let the urine out.

The causes of overactive bladder are different in men and women. In men, about two-thirds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well. These include weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones, and even bladder cancer. Neurologic conditions such as Parkinson's disease, nerve damage from a stroke, multiple sclerosis, and diabetes can also cause symptoms of OAB.

So, if you're a man and you have OAB, what should you do? The first step is to see your doctor. The doctor should take a brief history focusing on the urinary tract and previous medical conditions and procedures. The doctor then should examine you.

Typical examinations include a digital rectal examination, focus neurological examination, and anal sphincter tone. The doctor should also check a urine specimen for infection or microscopic blood. He/she should also check how well you are emptying your bladder. That can be done by a simple examination or by an ultrasound - a simple, non-invasive, painless test done in the office. If there are signs of infection, you will be started on antibiotics and you should be better within a matter of days.

Once you are better the doctor might suggest that you have more tests to determine why you got the infection in the first place. The usual reason is that there is a blockage by the prostate and he/she might recommend treatment for that.

If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, your doctor will probably recommend either a medication called an alpha-blocker or want you to see a urologist right away.

An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage. It is also effective in relieving the OAB symptoms. If the medication alone or a combination with other medications does not alleviate your symptoms, then you should see a urologist.

The urologist will likely recommend more tests to determine the cause of your symptoms. He/she may want you to complete a diary for 24 hours in which you record the time and amount of each urination, perform an uroflow test (urinating into a special toilet in the bathroom that measures how fast the urine comes out) and check for residual urine with an ultrasound.

On the basis of these tests, he can determine whether there might be a blockage by the prostate. If there is, he will likely prescribe an alpha-blocker, if you are not already taking one, or possibly add another type of medication called a 5 alpha reductase inhibitor, if the prostate is enlarged. If there are no signs of a blockage he/she may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate.

These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, surgical treatment of the blockage by the prostate is effective in the vast majority of men and those results are long lasting too.

The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions, and no or very short hospital stay. There are very few serious complications and the success rate is very high.

In conclusion, most men with OAB also have prostatic obstruction. Treatment of the obstruction is effective in majority of patients. For those without obstruction, there are a variety of effective treatments.