Condition Overview

What is urinary incontinence in men?

Urinary incontinence is the accidental leaking 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:

• If your bladder squeezes at the wrong time, or if it squeezes too hard, urine may leak out.
• If the muscles around the urethra are damaged or weak, urine can leak out even if you don't have a problem with your bladder squeezing at the wrong time.
• If your bladder doesn't empty when it should, you are left with too much urine in the bladder. If the bladder gets too full, urine will leak out when you don't want it to.
• If something is blocking your urethra, urine can build up in the bladder. This can cause leaking.

Urinary incontinence happens more often in older men than in young men. But it's not just a normal part of aging.

What are the types and symptoms of urinary incontinence ?

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:

• Stress incontinence means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder.
• Urge incontinence is an urge to urinate that's so strong that you can't make it to the toilet in time. It also happens when your bladder squeezes when it shouldn't. This can happen even when you have only a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. But not everyone with an overactive bladder leaks urine.
• Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your bladder doesn't empty as it should, it then leaks urine later.
• Total incontinence means that you are always leaking urine. It happens when the sphincter muscle no longer works.
• Functional incontinence means that you can't make it to the toilet in time to urinate. This is usually because something got in your way or you were not able to walk there on your own.

What causes urinary incontinence in men?

Different types of incontinence have different causes.

• Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone.
• Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can't hold back the urine. This causes a very strong urge to urinate.
• Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. It may also happen because of weak bladder muscles.

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.

How is the cause diagnosed?

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 leaking is caused by more than one problem or if the cause is unclear.

How is it treated?

Treatments depend on the type of incontinence you have and how much it affects your life. Your treatment may include medicines, simple exercises, or both. A few men need surgery, but most don't.

There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.

• Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And limit alcohol to no more than 1 drink a day.
• Eat foods high in fibre to help avoid constipation.
• Don't smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Stay at a healthy weight.
• Try simple pelvic-floor exercises like Kegels.
• Go to the bathroom at several set times each day. Wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
• When you urinate, practice double voiding. This means going as much as you can, relaxing for a moment, and then going again.
• Use a diary to keep track of your symptoms and any leaking of urine. This can help you and your doctor find the best treatment for you.

If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.

Cause

Urinary incontinence occurs when the bladder's sphincter muscle is not strong enough to hold back the urine. This may happen when:

• The sphincter is too weak.
• The bladder muscles contract too strongly.
• The bladder is too full.

Prostate treatment is a major cause of urinary incontinence in men.

• Short-term incontinence after prostate surgery can go away with time, especially for younger men. In some cases, it lasts up to a year.
• Stress incontinence is a common problem after prostate removal (radical prostatectomy) or radiation treatment for prostate cancer. It is becoming less common with better surgical techniques.
• Some treatments for an enlarged prostate (benign prostatic hyperplasia, or BPH) can also cause incontinence. But this isn't common.

The bladder contractions that cause urge incontinence can be caused by many conditions, including:

• Urinary tract infection.
• Bowel problems, such as constipation.
• Prostatitis. This is a painful infection of the prostate gland.
• Certain conditions that affect nerve signals from the brain, such as Parkinson's disease or stroke.
• Kidney or bladder stones.
• Blockage from prostate cancer or benign prostatic hyperplasia (BPH).

Overflow incontinence is usually caused by blockage of the urethra from BPH or prostate cancer. Other causes include:

• Narrowing of the urethra (stricture).
• Medicines, such as antihistamines and decongestants.
• Nerve conditions, such as diabetes or multiple sclerosis.

You can have one or more types of incontinence. Each type may have a different cause.

Symptoms

Your symptoms will depend on the type of urinary incontinence you have.

The main symptom of stress incontinence is the leaking of urine when you cough, laugh, lift, strain, or change posture.

Symptoms of urge incontinence may include:

• A sudden, urgent need to urinate.
• Sudden accidents in which you lose a large amount of urine.
• The need to urinate frequently, often at night.

Symptoms of overflow incontinence may include:

• A urine stream that starts and stops during urination.
• An accidental release of a small amount of urine.
• A weak urine stream.
• A need to strain while urinating and a sense that the bladder is not empty.
• An urgent need to urinate, often at night.
• Loss of urine while asleep.

What Happens

Urinary incontinence is often related to prostate problems. As men age, the prostate gland grows larger. It can squeeze the urethra and push the neck of the bladder out of position. These changes can lead to incontinence.

• Stress incontinence happens when the muscle (sphincter) surrounding the urethra opens at the wrong time. This can be when you laugh, sneeze, cough, lift something, or change posture.
• Urge incontinence happens when bladder contractions are too strong to be stopped by the sphincter. Often the urge is a response to something that makes you expect to urinate. It can happen when you wait to use a toilet, unlock the door when you come home, or even turn on a faucet. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.
• Overflow incontinence usually is caused by blockage of the urethra from BPH or prostate cancer. It also happens when the bladder muscles contract weakly or don't contract when they should.
• Functional incontinence can happen when there are physical or mental limitations that restrict a man's ability to reach the toilet in time.

In most cases, incontinence caused by an enlarged prostate can be cured by medicine or prostate surgery.

If your incontinence is not related to prostate surgery and it appears suddenly, it will usually clear up after you get treatment for whatever is causing it. For example, incontinence related to a urinary tract infection, prostatitis, or constipation will most likely disappear when the infection or condition is cured.

What Increases Your Risk

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:

• Age-related changes, including decreased bladder capacity and physical frailty.
• Smoking tobacco.
• Injury to the bladder or urethra, such as from radiation therapy or prostate surgery.
• Bladder infection or prostatitis.
• Obesity.
• Structural abnormalities of the urinary tract.

Medicines and foods that may make urinary incontinence worse include:

• Caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
• Alcohol beverages.
• Prescription medicines that increase urine production, such as diuretics, or relax the bladder, such as anticholinergics and antidepressants.
• Other prescription medicines, such as sedatives, opioids, and calcium channel blockers.
• Non-prescription medicines, such as diet, allergy, and cold medicines.

Several diseases or conditions may increase your risk of urinary incontinence, including:

• Neurological conditions such as Alzheimer's disease, Parkinson's disease, stroke, diabetes, spinal injury, and multiple sclerosis.
• Bladder cancer.
• Chronic bronchitis.
• Interstitial cystitis.
• Anxiety and depression.

When To Call

Call your doctor now if your urinary incontinence does not go away or you also have:

• Weakness or numbness in your buttocks, legs, and feet.
• Fever, chills, and belly or flank pain.
• Blood in your urine or burning with urination.
• A change in your bowel habits.

Call your doctor if:

• Your incontinence gets worse.
• Leaking urine is enough of a problem that you need to wear a pad to absorb it.
• Incontinence interferes with your life in any way.
• You have incontinence that begins suddenly (acute). Acute incontinence is often caused by urinary tract problems or medicines.
• You have a sudden change in your ability to urinate and you aren't sure if it's related to your urinary incontinence.

Watchful waiting

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.

Examinations and Tests

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:

• Urinalysis and urine culture, which may be done to learn whether a urinary tract infection (UTI) or prostatitis is present or whether there is blood or sugar in your urine.
• Cough test to check for urine leakage while coughing.
• Urodynamic tests, which could include:
  • Uroflowmetry. The uroflowmetry test measures the rate of urine flow during urination. During the test, a flow curve will be charted to determine the peak flow rate. A low peak flow rate may be suggestive of an obstruction or a weak bladder causing the incontinence.
  • Pressure flow studies, which measure pressures produced in the bladder as the flow changes. Pressure studies may help distinguish between urinary symptoms caused by obstruction and those caused by a problem affecting the bladder muscles or nerves. This test is often used when the cause of a man's symptoms is uncertain.
  • Residual urine determination. Your doctor may measure your post-void residual volume by inserting a thin tube (catheter) into your bladder or by using a bladder ultrasound scan immediately after you have urinated.
• Cystometrogram (CMG). This test evaluates your bladder's ability to store and release urine.
• Electromyogram (EMG), which is used to record the electrical activity of muscles.

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.

Treatment Overview

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.

• Behavioural strategies may be enough to control your symptoms. These include simple changes to your diet, lifestyle, and urinary habits. See Home Treatment for more information.
• Medicines that treat infection or bladder muscle spasm may help.
• Self-catheterization may help you manage overflow incontinence from a weak bladder or blockage. It may also be used if surgery is not the best option for you. When you need to drain your bladder, you insert a thin, hollow tube through your urethra into the bladder. To learn more, see Other Treatment.
• Surgery is usually considered when it is the only treatment that can cure the incontinence, such as when the condition is caused by a bladder blockage.

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).

What to think about

Exercise is important for your physical and emotional health. Even if being active causes some leakage, get regular exercise. It can help you manage stress and keep your muscles in tone.

Continence products absorb urine or apply pressure to keep urine from leaking. To learn more, see Other Treatment.

Prevention

You may reduce your chances of developing urinary incontinence by:

• Limiting caffeine and alcohol.
• Getting to and staying at a healthy weight.
• Quitting smoking.
• Avoiding constipation by eating a healthy, high-fibre diet.
• Doing Kegel exercises to strengthen the muscles that control the flow of urine.

Self-Care

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:

• Reduce or eliminate caffeinated and carbonated drinks—such as coffee, tea, and soda pop—from your diet.
• Do not drink more than one alcohol drink a day.
• Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, spicy foods, dairy products, and aspartame—and eat less of those foods.
• If you smoke, quit.
• Avoid constipation:
  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre.
  • Drink enough fluids. Don't avoid drinking fluid because you are worried about leaking urine.
  • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.^{footnote 1}
  • Take a fibre supplement with psyllium (such as Metamucil) or calcium polycarbophil (such as Prodiem) daily. Read and follow all instructions on the label.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
• If you are overweight, try to lose some weight. Remember that effective weight-loss programs depend on a combination of diet and exercise.
• Try pelvic floor (Kegel) exercises to strengthen your pelvic muscles.

The following changes to urinary habits may help reduce incontinence:

• Set a schedule for urinating every 2 to 4 hours, regardless of whether you feel the need.
• Practice "double voiding" by urinating as much as possible, relaxing for a few moments, and then urinating again.
• If you have trouble reaching the bathroom before you urinate, consider making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures). Or keep a urinal close to your bed or chair.

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.

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.

Medication choices

• For overflow incontinence: If incontinence is caused by an enlarged prostate, medicines to treat benign prostatic hyperplasia may be prescribed. But these medicines don't always improve incontinence. For more information, see the topic Benign Prostatic Hyperplasia (BPH).
• For urge incontinence:
  • Anticholinergic and antispasmodic medicines, such as oxybutynin and tolterodine, calm the nerves that control bladder muscles and increase bladder capacity.
  • Alpha-blocker medicines, such as alfuzosin and tamsulosin, relax the muscles in the prostate and bladder.
  • The antidepressant medicine duloxetine may help with bladder control.
  • Botox (botulinum toxin) may be an option when other medicines don't work. A Botox shot helps relax the bladder muscles.
• For stress incontinence: The antidepressant medicine duloxetine may help with bladder control.

What to think about

For men with stress incontinence or urge incontinence, behavioural methods of treatment such as bladder training techniques are used in combination with medicine.

Surgery

Surgery may be an option for men who:

• Have ongoing (chronic) incontinence.
• Have severe symptoms and total incontinence.
• Are extremely bothered by their symptoms.
• Have problems with urinary retention.
• Have moderate to severe blood in the urine (hematuria) that keeps coming back.
• Have urinary tract infections that keep coming back.
• Have a medical problem that can only be treated with surgery. One example is a bladder outlet blockage that is affecting kidney function.

Surgery choices

Overflow incontinence caused by an enlarged prostate (benign prostatic hyperplasia, or BPH) is the form of incontinence most often treated with surgery. For more information about surgery options and treatment for BPH, see the topic Benign Prostatic Hyperplasia (BPH).

Stress incontinence caused by removal of the prostate gland may also be treated with surgery if the incontinence isn't cured after a period of watchful waiting.

Surgery for severe stress incontinence that does not improve with behavioural methods includes:

• Artificial sphincter. A silicone rubber device is fitted around the urethra (the tube that carries urine from your bladder to the outside of your body). It can be inflated or deflated to control urination.
• Urethral bulking. Material is injected around the urethra. This serves to control urination by either closing a hole in the urethra or building up the thickness of the wall of the urethra.
• Bulbourethral sling. A sling is placed beneath the urethra. It is attached to either muscle tissue or the pubic bone. The sling compresses and raises the urethra. This gives the urethra greater resistance to pressure from the belly. Sling surgery may be considered as a treatment for severe urinary incontinence from prostate surgery.
• Sacral nerve stimulation (SNS). An electrical stimulator under your skin sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.

Severe urge incontinence may be treated with surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

What to think about

Surgery works for some people and not others. It is most likely to improve incontinence when:

• The diagnosis is right.
• The cause of your symptoms is something that can be fixed by surgery.
• Your surgeon is very experienced and skilled with the surgery you're having.

Things that can lead to disappointing results include:

• Unrealistic expectations. Surgery won't always cure the symptoms, but it will usually improve them.
• Physical factors such as obesity, long-term cough, radiation therapy, poor nutrition, age, and heavy physical activity.

Other Treatment

Treatment other than surgery or medicine may be used to treat urinary incontinence.

• For stress incontinence, biofeedback, a technique that helps you learn to control a specific body function, may be an option for some men who have stress incontinence or urge incontinence.
• For urge incontinence, behavioural therapies such as biofeedback and bladder training can be used to treat urge incontinence.
• For overflow incontinence, some men may require intermittent self-catheterization. During this procedure, a catheter is inserted into the bladder, usually 3 or 4 times a day.

Other treatment choices

• Catheterization may be used to treat severe incontinence that cannot be managed with medicines or surgery. Catheters don't cure incontinence but rather allow you or a caregiver to manage incontinence.
  • Intermittent self-catheterization is done with a thin, flexible, hollow tube (catheter) that is inserted through the urethra into the bladder, allowing the urine to drain out.
  • Indwelling catheterization uses a catheter that remains in place continuously. For more information, see the topic Care for an Indwelling Urinary Catheter.
  • Condom or Texas catheter uses a special condom that can be attached to a tube for short-term use. The condom, placed over the penis, keeps the tube in place. The tube allows the urine to drain out.
• Behavioural therapies, including biofeedback and pelvic muscle exercises, are used to treat urge and stress incontinence.
• Continence products such as absorbent pads or diapers, incontinence clamps, or pressure cuffs may be used to manage any form of incontinence. Some of these products absorb leaked urine and some put pressure on the urethra to help prevent urine from leaking.

What to think about

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.