What Causes Incontinence In Men

What Causes Incontinence In Men?

Bladder leaks can happen to anyone at any age. While we’ve been conditioned to think that mostly older women are affected by the condition, many men suffer from incontinence too. 

There are many conditions that can lead to urinary incontinence in men. But luckily there are also many ways to treat it. Keep reading to learn some of the reasons men develop leaky bladders, how it’s diagnosed, and ways to treat it.

What is urinary incontinence?

Urinary incontinence is the accidental leakage of urine. Many people wrongly assume that developing urinary incontinence is something that just happens as you age. This couldn’t be further from the truth. It can develop in anyone, at anytime. And there are several possible causes for it.

First, let’s start off with learning a bit about how everything works.

The urinary system is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the urethra. A circular muscle, called the sphincter, controls the activity of the urethra and keeps urine in the bladder until it is time to urinate.

Normally, the bladder wall is relaxed while storing (or filling with) urine and the urethra is closed off by the sphincter. Your pelvic floor muscles also help keep the bladder outlet closed by supporting the urethra.

When the bladder is working correctly, the bladder sends signals to the brain to let you know how full it is, and to the sphincter to tell it to stay closed and prevent the bladder muscle from contracting.

When the bladder is full, you allow the pelvic floor as well as muscles at the outlet of the bladder to relax and open up. As this is happening, the muscle in the wall of the bladder (detrusor muscle) begins to contract and continues contracting until the bladder is completely emptied.

This process of bladder filling and emptying is obviously very complex. When any part of the urinary system or pelvic floor does not work correctly, incontinence can result.

If any of these signals don’t happen or get confused, bladder leakage can happen. 

What causes urinary incontinence in men?

Many things may contribute to bladder leakage in men.

The most common reason men experience incontinence is due to problems with the prostate. As men age, the prostate gland grows. It is estimated that 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). The prostate gland wraps around the urethra (the bladder outlet), so an enlarged prostate can constrict or block the urethra. This is known as prostatic obstruction.

Prostatic obstruction can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. This contributes to urgency and frequency because the bladder still signals that it needs emptying. If left untreated, the bladder can become distended, worsening its ability to contract and completely empty. It is possible to have prostatic obstruction even if the prostate is not enlarged.

Men may also experience Overactive Bladder (OAB) which is characterized by a sudden and urgent need to urinate, and needing to urinate frequently. This becomes urgency urinary incontinence when you are not able to reach the bathroom before losing control of the bladder.

Additionally, conditions that cause damage to the nerves, such as diabetes can cause bladder problems since it disrupts the normal signaling from the bladder to the brain to help control bladder function. Other conditions, such as stroke, can also cause incontinence, and even some medications or certain foods or drinks can contribute to urinary incontinence. 

How is urinary incontinence in men diagnosed? 

Before your appointment, take note of your symptoms so that you can relay them to your doctor. Symptoms of incontinence to look for are:

  • Diminished or interrupted urine flow

  • An urgent or sudden need to urinate

  • Increased frequency of urination

  • Inability to empty the bladder completely when urinating

  • Difficulty starting the urine flow, even when the bladder feels full

  • Getting up more than once per night to urinate (nocturia)

  • Accidental urine leakage

Talking to your doctor is the first step toward treatment.  At your appointment, your doctor will likely ask for your medical history, give you a complete physical examination, and provide a urine specimen. You may be asked to keep a bladder diary to record your symptoms.  Other tests to examine the bladder and/or prostate may also be necessary. 

Once your doctor has diagnosed your bladder condition, you can work together to decide on a treatment option that best fits your needs and works with your lifestyle.

What treatment options exist for men with urinary incontinence?

The good news is that there are lots of treatments available to men with urinary incontinence.  Your treatment path will depend on what is causing your condition.

For men with an enlarged prostate, your doctor may recommend medications to reduce symptoms and reduce the size of the prostate. Minimally invasive treatments, or even surgery is sometimes done to increase the flow of urine.  

Men with OAB may also be prescribed medications to help calm the bladder.  In cases where medication is not an option or isn’t working, minimally invasive treatments such as InterStim may be used.  This is an implanted device that helps to establish more normal function of the bladder by gently stimulating the sacral nerve. Behavioral modifications can also help with OAB. Changes in your diet, bladder training, and pelvic floor muscles are often used to help control urinary incontinence caused by OAB.

Many men also experience incontinence after prostate cancer surgery. When the prostate gland is removed, damage may occur to nerves, tissues, and the sphincter muscle that can impair the bladder's ability to store urine without leaking. This may last for just a few months during recovery, or longer. Depending on the severity of incontinence, there are several options that may help.  

Performing pelvic muscle exercises (kegels) are an important part of treating incontinence in men. Kegel exercise done before and after surgery can help to recover bladder control and are important for maintaining erectile function.  When done correctly, kegels can strengthen the muscles that support the bladder, causing fewer leaks, and improving bladder and bowel control. (Click here for a men’s guide to doing kegels.)

 If additional help is needed, other surgical options may be available. Your doctor can talk about the pros and cons of the various surgical options available.

Seeking Help Is The First Step

If you’re struggling with urinary incontinence, the most important thing to remember is that help is available. It’s not just a women’s issue – MANY men live with this condition too and there is no need to suffer in silence.  Talk with your doctor to learn the root cause of your bladder leakage and to find a treatment that works for you.