Urinary Incontinence in men is the loss of bladder control or accidental leaking of urine in men. It is not a disease but a symptom of a defect of the urinary tract. Urine is produced in the kidney and stored in the sac made of muscle known as the urinary bladder. A tube, connected to the urinary bladder, moves the urine out of the body. Around the tube is a ring of muscles called the urinary sphincter. This controls the passage of urine out of the body. When there is a need to urinate, nerve signals tell the urinary bladder to contract then urine is expelled.
Urinary incontinence in men increases with age. It is a very embarrassing and debilitating condition that keeps some men from enjoying many activities like exercise, swimming and dancing. Urinary incontinence occurs in 11 to 34 percent of older men. Two to 11 percent of older men report daily urinary incontinence.
Causes of Urinary Incontinence in Men
Incontinence can occur due to the following:
- Pressure on the urinary bladder e.g. constipation, ascites
- Surgery such as radical prostatectomy
- Prostate treatments for conditions like benign prostate hyperplasia
- Urinary tract infections
- Overflow of urinary bladder
- Prostatitis i.e. infection of the prostate gland
- Conditions associated with nerve problems e.g. stroke, diabetes and Parkinson disease
Types of Urinary Incontinence
- Urgency incontinence
- Stress incontinence
- Functional incontinence
- Overflow incontinence
- Transient incontinence
- Urgency incontinence: Urgency incontinence happens when a man urinates involuntarily after he has a strong desire, or urgency, to urinate. Triggers for men with urgency incontinence include drinking a small amount of water, touching water, hearing running water, or being in a cold environment, reaching into the freezer at the grocery store, Anxiety or certain liquids, medications.
- Stress incontinence: Stress incontinence results from movements that put pressure on the bladder and cause urine leakage, such as coughing, sneezing, laughing, or physical activity.
- Functional incontinence: Functional incontinence occurs when physical disability, external obstacles, or problems in thinking or communicating keep a person from reaching a place to urinate in time e.g. a man in a wheelchair or crutches.
- Overflow incontinence: this occurs as a result of weak bladder muscles or blocked urethra that causes the bladder not to empty properly and urine spill over.
- Transient incontinence: Transient incontinence is a short-term condition which is usually a side effect of certain medications, drugs, or temporary conditions, such as urinary tract infection (UTI). It can irritate the bladder and cause strong urges to urinate, caffeine or alcohol consumption. This can cause chronic coughing and rapid filling of the bladder, leading to increased urine production. Subsequently, it can put pressure on the bladder, constipation causing hard stool in the rectum.
Diagnosis of Urinary Incontinence
This is done through:
- Thorough medical history e.g. amount of water you take in a day
- Physical examination e.g. rectal exam, abdominal exam
- Diagnostic investigations like urine culture, urinalysis, and blood test
Treatment of Urinary Incontinence
Urinary incontinence is treated according to its causes and types but basic treatment includes the following:
- Pelvic exercises
- Bladder training
- Behavioural and lifestyle changes
- Pelvic exercises: it is otherwise known as kegels exercise. It involves the strengthening; tightening and relaxing the muscles around the penis to aid good bladder control thus prevent incontinence. Strong pelvic floor muscles hold urine more than weak ones. Patients should do this at regular intervals but avoid it during urination.
- Bladder training : This is a behavioural therapy that is effective in treating incontinence in men especially when combined with kegels exercises.it is a program of urinating on schedule to monitor the number of times you urinate or experience leaks in a day. It helps to overcome bladder abnormalities like frequency, incontinence and urgency. It is very important to void once you feel the need to.
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- Behavioural and lifestyle changes: this involves behavioural changes that help to prevent incontinence and improve bladder control. They include:
- Limit on alcoholic drinks which irritate the bladder
- Avoid tea, coffee or carbonated drinks that serve as bladder irritant
- Decrease drinking during sleep hours
- Ensure you void when you feel the urge to, don’t wait till you are overly pressed
- Participate in physical activities to keep you fit and reduce any pressure on the bladder
- Eat foods high in fibre to prevent constipation
- Fruits and vegetables prevent bladder irritation and infection.
- Medications: These medications, in certain conditions, relax bladder muscles and decrease spasms thus reducing contractions that can lead to urinary incontinence or urgency.
- Anti-muscarinic agents: Anti-muscarinic drugs can help relax bladder muscles and prevent bladder spasms e.g. oxybutynin (Oxytrol) and tolterodine (Detrol)
- Tricyclic antidepressants : Helps to decrease muscle spasm e.g. imipramine
- Alpha blockers: They help to relax smooth muscle of the bladder e.g. doxazosin and alfuzosin
- Beta 3 agonist: Suppresses involuntary muscle contraction e.g. mirabegron
- Urinary Incontinence Surgery: As a last resort, doctors use surgery to treat urgency incontinence in men. It includes the artificial urinary sphincter (AUS) and the male sling.