Urinary incontinence - Men

Urinary incontinence - Men

What is urinary incontinence in men?

Urinary incontinence is defined as any reported involuntary loss of urine. It is a symptom and not a disease that can appear either as a loss of a few drops of urine or as a complete inability to hold urine.

Types of incontinence

  • Urge incontinence: Any reported involuntary loss of urine accompanied by urgency. This type of incontinence is part of the overactive bladder syndrome which has a complex of symptoms dominated by urgency and frequency while it may be accompanied by urge incontinence and nocturia.
  • Stress incontinece: Any reported involuntary loss of urine during exercise, straining, coughing or sneezing. It happens due to insufficiency of the urethral sphincter and occurs when intra-abdominal pressure increases. In men, stress incontinence is mainly associated with operations on the prostate, mainly after radical prostatectomy. In these cases the damaged sphincter cannot press sufficiently and keep the urethra closed, resulting in involuntary loss of urine. 90% of men, who have stress incontinence after radical prostatectomy, have an improvement within one year.
  • Overfilling bladder incontinence: In this case, the existence of an obstruction leads progressively to a chronic residual urine with the final result being a permanently full bladder that cannot be emptied satisfactorily. The urine produced is excreted in small amounts continuously in a manner similar to the "overflow" of a container that continues to receive fluids if it has not been emptied since the previous ones.

How is urinary incontinence in men treated?

Urge incontinence:

  • Change in lifestyle: limiting the intake of factors that may irritate the bladder (coffee, chocolate, spicy foods, alcohol, carbonated drinks, etc.)
  • Pelvic floor exercises - bladder retraining: exercises to strengthen the pelvic floor muscles that when contracted strongly can inhibit bladder contraction and prevent incontinence.
  • Medication: nowadays there are many pharmaceutical preparations that have a very high efficiency in the treatment of urge incontinence.
  • 2nd line treatments: in a few cases where previous treatments fail, intravesical injection of specific medicinal substances and electrical neurostimulation can give results.

 

Stress incontinece: 

  • Limitation of fluid intake and frequent bladder emptying
  • Pelvic floor exercises: to strengthen the muscles of the pelvic floor (sphincter mechanism).
  • Surgical treatment:
  • Placement of tapes and other materials that are applying tension on the urethra causing partial obstruction, facilitating the work of the weak sphincter. Recommended for mild to moderate incontinence.
  • Placing an artificial sphincter. A device is surgically placed around the urethra near the sphincter, which applies tension and obstructs the urethra. When the patient needs to urinate, the control valve, located in the scrotum between the testicles, releases the sphincter causing the urethra to open and the urine to flow freely.
 

Overfilling bladder incontinence:

Usually, it is treated when the subcystic obstruction is treated. The usual causes of sybcystic obstruction are prostatic hypertrophy and urethral stricture. However, in cases where the chronic obstruction and distension of the bladder has led to myogenic damage, then it will not be able to function even if the obstruction is removed. In this case, the solution will be intermittent self-catheterization.