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Urinary Incontinence—Male

(Incontinence, Urinary; Incontinence, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)

Definition

Urinary incontinence is a problem with the control of urine as it flows out of the body. It may cause rare, minor leaks or more severe wetting. There are different type of urinary incontinence including:

  • Stress incontinence—urine leaks out when you are active and when you cough, sneeze, or laugh
  • Urge incontinence (overactive bladder)—the muscle of the bladder squeezes when it shouldn't and lets urine leak
  • Overflow incontinence—bladder does not empty properly; urine builds up in the bladder and overflows
  • Functional incontinence—the bladder is normal, but you are unable to reach the toilet in time

Causes

There are several different causes for incontinence. In some cases, the cause may be unclear. Causes can also vary by the type of incontinence:

  • Stress Incontinence may be caused by:
    • Weakening of the muscles that hold the bladder in place
    • Weakening of the muscles that control the flow of urine
    • Damage to the muscles that control urine flow after prostate surgery
    • Obesity
  • Urge Incontinence may be caused by:
  • Overflow Incontinence may be caused by:
    • Prostate enlargement
    • Bladder that is blocked, such as by a scar in the urethra (stricture)
    • Fecal impaction putting pressure on the urethra
    • Drugs, such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, and calcium channel blockers
    • Vitamin B12 deficiency
    • Weak bladder muscles
    • Nerve damage
  • Functional Incontinence may be caused by:
    • Conditions like severe arthritis that make movement difficult
    • Drugs that cause confusion or sedation

Risk Factors

Men who are older than 65 are most affected. Things that may increase your risk of incontinence include:

Some medicine may increase the risk of incontinence:

  • Caffeine
  • Alcohol
  • Beta-blockers
  • Alpha-agonists
  • Cholinergic agents
  • Cyclophosphamide

Symptoms

Incontinence is any loss of bladder control. Examples include:

  • Leakage during laughing, sneezing, lifting heavy object, or any other activity that increases pressure on bladder (stress incontinence)
  • Leakage plus strong urge to urinate (urge incontinence)
  • Difficulty holding urine long enough to make it to bathroom

When Should I Call My Doctor?

Urinary incontinence is a symptom of a change in your body. Call your doctor if you have any loss of urine control. Your doctor can help you find the cause.

Diagnosis

The doctor will ask about symptoms and past health. They will ask about urine leakage and how often the bladder is emptied. A physical exam will be done. A specialist may also be needed. Urologists are doctors who focus on urinary issues.

Tests to help find the cause of the incontinence may include:

  • Stress test—you relax, and then cough as your doctor watches for loss of urine (this will confirm if you have stress incontinence)
  • Urine tests
  • Tests to explore problems with your prostate, such as a prostate exam or blood tests
  • Blood tests to detect diabetes
  • Ultrasound—can show if any urine remains in your bladder after urinating
  • Cystoscopy —a thin tube with a tiny camera is passed into the bladder through the urethra (tube that carries urine out of the body); it can show any problems with the urethra or bladder
  • Urodynamic tests—measures the flow of urine and the pressure in the bladder

Treatment

Treating the cause may help to stop or decrease incontinence. If the cause cannot be changed, there are steps to help deal with leakage. Options include:

Home Care

Some steps you can take at home include:

  • Kegel exercises —to strengthen the muscles that hold the bladder in place and control urine flow.
  • Painless electrical stimulation to muscles—may help increase muscle strength faster than exercises alone. It is helpful for stress incontinence.
  • Bladder training—empty your bladder on a regular schedule.
  • Avoiding caffeine and alcohol which can make incontinence worse.

Weight Loss

Losing weight may help reduce leakage due to stress or urge incontinence.

Medication

Medications may help for urge incontinence. These types of medications can help to relax the bladder muscles.

Botulinum toxin injections may also be recommended. This can also help the bladder muscle relax.

Devices

Tools that may help include:

  • Absorbent diapers or briefs are often used by men with mild incontinence.
  • A catheter is a small tube that collects urine leaving the body and stores it into a bag. This may be used for more severe incontinence. The catheter may be:
    • External (condom)—slips over the penis like a condom
    • Internal (Foley)—tube is inserted into the urethra
  • Penile clamp—puts light pressure on penis to help stop dribbling.

Condom Catheter
condom catheter

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Surgery

You may need surgery if a blockage is causing the problem. The most common problem is an enlarged prostate.

Sometimes the incontinence is caused by a problem with the bladder sphincter. This sphincter is a tight group of muscle that allows urine to flow or stops urine from passing. Surgery may be needed to repair it.

Prevention

To help prevent incontinence:

  • Avoid food or drinks that can irritate the bladder such as caffeine, alcohol, or spicy foods.
  • Maintain a healthy weight.
  • Eat plenty of fruits and vegetables to decrease the risk of constipation.
RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Nurse Continence Advisors Association
http://www.cnca.ca

Health Canada
https://www.canada.ca

REFERENCES:

Bladder control problems in men (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-men. Accessed December 19, 2020.

Occhino J, Siegel S. Sacral nerve modulation in overactive bladder. Curr Urol Rep. 2010;11(5):348-352.

Subak L, Wing R, West, DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481-490.

Treatment of incontinence. Continence Foundation website. Available at: http://www.continence-foundation.org.uk. Accessed December 19, 2020.

Urinary incontinence. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/urinary-incontinence. Accessed December 19, 2020.

Urinary incontinence in men. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T900624/Urinary-incontinence-in-men. Accessed December 19, 2020.

Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175(3 Pt 2):S5-S10.

7/28/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116944/Benign-prostatic-hyperplasia-BPH: Mangera A, Apostolidis A, Andersson KE, et al. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol. 2014;65(5):981-990.

Last reviewed November 2020 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 1/31/2021