Male urinary incontinence: When the bladder rules the mind

Bedwetting is more common in boys but urinary incontinence (UI) is more common in adult women. That’s not to say though that incontinence is something men can simply outgrow. On the other hand, bladder issues should not be dismissed as a normal part of the aging process. Male incontinence is a problem with causes and solutions. it goes without saying that though the types UI may be the same for both genders, the causes of male incontinence are not necessarily the same as those of female incontinence. For example, pregnancy and childbirth can be safely ruled out – unless you’re taking Expectane, that is.


Types of urinary incontinence


Involuntary loss of urine occurs when laughing, coughing, sneezing, lifting and performing activities that exert abdominal pressure on the bladder.


An overwhelming need to urinate that can’t be controlled.


Constant dribbling linked to frequent urination in small amounts.


Since the brain and the spinal cord (i.e. the central nervous system) play a major role in evacuating the bladder – sending nerve signals to the bladder and sphincter muscles to either hold or release urine –, urinary incontinence can be a result of nerve problems. The notion that only elderly men experience incontinence flies in the face of the fact that nerve problems can arise at any age. Moreover, nerve problems are not a direct cause of UI but actually a symptom of an underlying condition that damages the nerves and results in the involuntary loss of urine. Such conditions include:

·         Diabetes

·         Stroke

·         Parkinson’s disease

·         Multiple sclerosis

·         Spinal cord injury

   Additionally, there is a condition known as overactive bladder in which the bladder squeezes in an untimely manner. This condition can occur due to a number of reasons, including nerve problems, and is characterized by:

·         Urinating 8 or more times a day or 2 or more times at night.

·         A sudden and strong need to urinate asap, followed by

·         Urine leakage.

On the other hand, male incontinence can also be caused by physical problems related not only to aging but which are also male-specific, such as prostate problems.

·         Benign prostatic hyperplasia (BPH). The prostate – a gland that surrounds the urethra below the bladder – tends to grow in size as a man grow older, and by doing so it may squeeze the urethra and have an effect on the flow of the urinary stream. BPH is associated with lower urinary tract symptoms including hesitant, interrupted, weak stream; urgency and leaking or dribbling; urinating more frequently particularly at night; and urge incontinence. These symptoms are seldom experienced before the age of 40, but more than 50% of men in their 60s and up to 90% of men in their 70s and 80s have at least some of them.

·         Radical prostatectomy. A treatment for prostate cancer that consists of removing the entire prostate and which can lead to erectile dysfunction and urinary incontinence.

·         External beam radiation. Another prostate cancer treatment in which temporary or permanent UI is a collateral effect.

 It is important for a doctor to diagnose the actual cause of male urinary incontinence to come up with the proper treatment alternative. Diagnosing tools include:

·         Medical history.

·         Voiding journal.

·         Physical examination.

·         EEG and EMG.

·         Ultrasound.

·         Urodynamic testing.

The treatment for UI will depend on the type and cause of incontinence. Certain patients need only change some of their daily habits, for instance limiting fluid intake at specific times of the day, especially in the evening, or scheduling regular trips to the bathroom – these adjustments are known as behavioral treatment. Other patients need to take prescription medications (alpha-blockers, 5-alpha reductase inhibitors, Imipramine, antispasmodics, &c.) or undergo surgery. There are also devices that can help manage UI, like artificial sphincters, male slings, and clamps.

There are several reasons that men shy away from having their bladder problems diagnosed and treated. Suffice it to say that many men see a digital rectal exam – a physical exam that checks for prostate enlargement or nerve damage – as the Fingerpoke of Doom. But the same reasons that make UI such a delicate issue among men are the same reasons that should persuade them to seek medical advice and treatment.