Urinary incontinence is the accidental release of urine. It's not a disease. It's a symptom of a problem with a man's urinary tract.
Urine is made by the kidneys and stored in a sac made of muscle, called the urinary 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 body.
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:
Different 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.
Your 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 incontinence.
If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.
Learning about urinary incontinence:
Living with urinary incontinence:
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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.
Symptoms of urge incontinence may include:
Symptoms of 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 a 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.
Physical conditions or lifestyle factors that may make urinary incontinence more likely include:
Medicines and foods that may make urinary incontinence worse include:
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 accompanied by:
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 treatment.
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.
Your 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.
Tests that may be done to determine the type and cause of your urinary incontinence include:
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 incontinence.
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 bladder.
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 incontinence.
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.
The following changes to diet and lifestyle may help reduce incontinence:
The following changes to urinary habits may help reduce incontinence:
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 medicines.
Although some 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 urge incontinence, behavioural methods of treatment such as bladder training techniques are used in combination with medicine.
If your 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 physical activity.
Treatment other than surgery or medicine may be used to treat urinary incontinence.
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
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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.
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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 ofMay 5, 2017
Current as of: May 5, 2017
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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