incontinence is the accidental release of urine. It's not a disease. It's a
symptom of a problem with a man's
Urine is made by the
kidneys and stored in a sac made of muscle, called the
bladder. A tube called the
urethra leads from the bladder through the prostate
and penis to the outside of the body. Around this tube is a ring of muscles
called the urinary sphincter. As the bladder fills with urine, nerve signals
tell the sphincter to stay squeezed shut while the bladder stays relaxed. The
nerves and muscles work together to prevent urine from leaking out of the
When you have to urinate, the nerve signals tell the muscles
in the walls of the bladder to squeeze. This forces urine out of the bladder
and into the urethra. At the same time the bladder squeezes, the urethra
relaxes. This allows urine to pass through the urethra and out of the body.
Incontinence can happen for many reasons:
Urinary incontinence happens more often in older men than
in young men, but it's not just a normal part of aging.
Urinary incontinence can be short-term or long-lasting (chronic).
Short-term incontinence is often caused by other health problems or treatments.
This topic is about the different types of chronic urinary incontinence:
types of incontinence have different causes.
In men, incontinence is often related to prostate
problems or treatments.
Drinking alcohol can make urinary
incontinence worse. Taking prescription or over-the-counter drugs such as
diuretics, antidepressants, sedatives, opioids, or non-prescription cold and
diet medicines can also affect your symptoms.
The most common sign of
urinary incontinence is leaking urine from the bladder. Other signs will depend
on the type of urinary incontinence you have.
doctor will do a physical examination, ask questions about your symptoms and past
health, and test your urine. Often this is enough to help the doctor find the
cause of the incontinence. You may need other tests if the incontinence is
caused by more than one problem or if the cause is unclear.
Treatments are different for
each person. They depend on the type of incontinence you have and how much it
affects your life. After your doctor knows what has caused the incontinence,
your treatment may include medicines, simple exercises, or both. A few men need
surgery, but most do not.
There are also some things you can do
at home. In many cases, these lifestyle changes can be enough to control
If you have symptoms of urinary incontinence, don't be
embarrassed to tell your doctor. Most people with incontinence can be helped or
Learning about urinary incontinence:
Living with urinary incontinence:
Health Tools help you make wise health decisions or take action to improve your health.
Urinary incontinence occurs when the muscle (sphincter) that holds your
bladder's outlet closed is not strong enough to hold back the urine. This may
happen if the sphincter is too weak, if the
bladder muscles contract too strongly, or if the
bladder is overfull.
A man may have one or more types of
incontinence, and each type may have a different cause.
Your symptoms will depend on the type of
urinary incontinence you have.
The main symptom
of stress incontinence is the loss of urine
while coughing, laughing, lifting, straining, or changing posture.
urge incontinence may include:
overflow incontinence may include:
Urinary incontinence in men is often related to prostate problems. As men age,
the prostate gland grows larger, squeezing the
urethra and pushing the neck of the
bladder out of position. These changes can lead to
incontinence. In most cases, incontinence due to prostate enlargement can be
cured by medicine or prostate surgery.
But prostate surgery is
also a major cause of urinary incontinence in men.
If your incontinence is not related to prostate surgery and
it appears suddenly, it will usually clear up after you have received treatment
for whatever is causing the incontinence. For example, incontinence related to
urinary tract infection,
prostatitis, or constipation will most likely
disappear when the infection or condition is cured.
For some men, incontinence
may have more than one cause.
Many things have been
associated with an increased risk of
urinary incontinence in men. Incontinence may be the
result of various health conditions or medical treatments, or it could be
caused by family history or lifestyle. In some men, things from more than one of
the lists below can combine to cause incontinence.
conditions or lifestyle factors that may make urinary incontinence more likely
Medicines and foods that may make urinary incontinence
Several diseases or conditions may increase your risk of urinary incontinence, including:
See your doctor immediately if your
urinary incontinence does not go away or is
Call your doctor if:
Do not be embarrassed to discuss incontinence with your
doctor. Incontinence is not an inevitable result of aging. Most people with
incontinence can be helped or cured.
If you have a sudden change
in your ability to urinate and you are not sure if it is related to your
urinary incontinence, see the topic
Urinary Problems and Injuries, Age 12 and Older.
If you have chronic
urinary incontinence that begins slowly, you may be
able to control the problem yourself. If home treatment does not control your problem, or if incontinence
interferes with your lifestyle, ask your doctor to recommend a
If you have urinary incontinence that begins suddenly
(acute), call your doctor. Acute incontinence is often caused by urinary tract
problems or medicines and can be easily corrected.
Your family doctor or general practitioner can diagnose and treat some causes of urinary incontinence. You may
also be referred to a specialist, such as an internal medicine doctor, a urologist, or a geriatrician.
If you need surgery to treat your incontinence, it is
important to find a surgeon who is experienced in the type of surgery you need,
usually a urologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
The first steps your doctor will take
to learn the cause of your
urinary incontinence are a
medical history and a physical examination. The
physical examination will include examination of the penis, the prostate, and the
nervous system. The history and examination, along with routine diagnostic tests such
as a urinalysis, often provide enough information to determine the cause of the
incontinence and enable your doctor to start treatment.
doctor may ask you to keep a
voiding log, which is a record of the amount of
liquids you drink and how much and how often you urinate.
that may be done to determine the type and cause of your urinary incontinence
Your doctor may conduct a cystoscopic examination (a test that
allows your doctor to see inside the urinary tract) to rule out other causes of
Further tests may be required if the first treatment
for incontinence has failed. Other tests may also be needed if you have had
previous prostate surgery,
radiation therapy, or frequent
urinary tract infections, or if a
catheter cannot be easily placed into your
Tests such as cystourethrogram, an X-ray taken of your
bladder and urethra while you are urinating, are not often used to evaluate
incontinence, but they may be helpful. If your doctor wants to do one of these
tests, ask whether the test is needed to diagnose your type of
The treatment you and your doctor
choose will depend upon what type of
urinary incontinence you have and how much you are
bothered by your symptoms.
If there is no infection or
cancer or other cause that could only be cured by surgery, treatment for
incontinence proceeds in stages.
Many men who have
urge incontinence or
overflow incontinence also have an
enlarged prostate gland (benign prostatic
hyperplasia). They may want to talk to a doctor about medicine, surgery, or
other treatment to relieve their symptoms. For more information, see the topic
Benign Prostatic Hyperplasia (BPH).
Urinary incontinence can be a problem following treatment for
prostate cancer, including radiation therapy and
removal of the prostate.
Treatment will be
different for men who have total incontinence or who cannot comply with or
tolerate specific treatments because of a serious illness or disease.
You may reduce your chances of developing
urinary incontinence by:
In many cases,
behavioural changes, including changes to your diet,
lifestyle, and urinary habits, can be enough to control urinary incontinence.
changes to diet and lifestyle may help reduce incontinence:
The following changes to urinary habits may help reduce
Talk with your doctor about all the medicines you take,
including non-prescription medicines, to see whether any of them may be making
your incontinence worse.
Medicines that may cause urinary incontinence in men
include certain antidepressants, sedatives, and even some allergy and cold
types of long-term (chronic) incontinence may be treated with medicine, the
likelihood that medicines will improve your incontinence depends on the
severity and cause of the problem. Some medicines that are used to treat
incontinence may actually make the condition worse in men whose incontinence is
caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consulting with a urologist is an important
part of incontinence care.
For men with
stress incontinence or
behavioural methods of treatment such as bladder
training techniques are used in combination with medicine.
urinary incontinence has not improved after you have tried
behavioural methods and medicine, and if your doctor thinks
surgery will be an effective treatment, you may choose to have surgery rather
than live with your symptoms. In some cases, such as when a bladder outlet
obstruction is affecting kidney function, surgery may be the only way to treat
the problem that is causing the incontinence.
Surgery may be
appropriate for men who:
Overflow incontinence caused by enlargement of the
prostate (benign prostatic hyperplasia, or BPH) is the form of
incontinence most often treated with surgery.
Stress incontinence caused by removal of the prostate gland because of
prostate cancer or an
enlarged prostate may also be treated with surgery, if
the incontinence isn't cured after a period of watchful waiting.
If overflow incontinence is caused by benign prostatic
hyperplasia (BPH), prostate surgery may relieve the incontinence. For more
information about surgery options and treatment for BPH, see the topic
Benign Prostatic Hyperplasia (BPH).
Surgery for severe stress incontinence that does not improve with
behavioural methods includes:
Surgery usually isn't considered
for urinary incontinence unless it is the only reasonable way to cure it or
after attempts to treat the problem with conservative measures or other
treatment have failed. The decision to have surgery must always be based on an
accurate diagnosis and realistic expectations for the surgery.
Most surgical failures are due to incorrect diagnoses. Other reasons for
failure include healing problems, additional causes of incontinence that aren't
apparent before the surgery, and a lack of experience or skill on the part of
the surgeon performing the procedure.
Factors that increase the
chances that surgical treatment will fail to correct incontinence include
obesity, long-term (chronic) cough,
radiation therapy, age, poor nutrition, and strenuous
Treatment other than surgery or
medicine may be used to treat
Men often use absorbent products,
such as pads or diapers, when other methods of treating incontinence have
failed or cannot be used. Some men may prefer to use absorbent products rather
than taking medicines or having surgery. They may also use absorbent products
after surgery for prostate cancer, while they are waiting to see if their
incontinence goes away. This method doesn't treat the incontinence but instead manages
the problem. In general, absorbent products should only be used along
with a more specific treatment, because use of absorbent products can hide a
more serious condition that may be curable.
Canadian Society for Exercise Physiology (2011). Canadian Physical Activity Guidelines For Adults. Available online: http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_adults_en.pdf. Accessed October 28, 2014.
MacDiarmid SA, et al. (2008). Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: Randomized, double-blind, placebo-controlled study. Mayo Clinic Proceedings, 83(9): 1002–1010.
Kaplan SA, et al. (2006). Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA, 296(19): 2319–2328.
Other Works Consulted
Chapple CR, Milson I (2012). Urinary incontinence and pelvic prolapse: Epidemiology and pathophysiology. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 1871–1895. Philadelphia: Saunders.
Herschorn S (2012). Injection therapy for urinary incontinence. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2168–2185. Philadelphia: Saunders.
Naumann M, et al. (2008). Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1707–1714.
Resnick, NM (2012). Incontinence. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 110–114. Philadelphia: Saunders.
Silva LA, et al. (2011). Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database of Systematic Reviews (4).
Wadie BS (2010). Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. Journal of Urology, 184(6): 2446–2451.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineBrian D. O'Brien, MD - Internal MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerAvery L. Seifert, MD - Urology
Current as ofNovember 28, 2016
Current as of:
November 28, 2016
E. Gregory Thompson, MD - Internal Medicine
& Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Avery L. Seifert, MD - Urology
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