Although statistically men experience urinary incontinence less than women, about six million men in America do experience urinary incontinence. About 17% of men over the age of 60 experience some form of urinary incontinence. In many cases, urinary incontinence in men is caused by prostate problems, or the methods used to treat prostate problems, such as surgery.In some cases, men can experience the same types of incontinence as women, and for the same reasons. However, the most common cause for men is something having to do with the prostate gland. According to the US National Institutes of Health, “The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation.”
There are three major problems that can lead to incontinence:
Prostatitis: Prostatitis, or inflammation of the prostate, is the most common prostate problem in men under the age of fifty.
Benign Prostatic Hyperplasia (BPH): As men age, their prostate gland grows. In some cases the enlargement can become troublesome – a condition called benign prostatic hyperplasia (BPH). BPH is a common condition, affecting more than 50% of men in their sixties. As the gland grows, it closes off the urethra (the tube leading the urine out of the body from the bladder), and the bladder needs to contract harder to get the urine out. After struggling to push urine out, the bladder can become weakened and end up holding urine in, causing overflow incontinence. BPH has many symptoms that vary from person to person, and it can be treated in many different ways. Depending on the severity of symptoms, BPH can be managed with lifestyle changes, medication, or surgery, and some of these treatments, especially surgery, can lead to incidences of incontinence. The illustration below shows an enlarged prostate.
Prostate Cancer Treatments: An abnormal growth of cells in the prostate gland is prostate cancer. Prostate cancer is the second most common cause of cancer-related deaths among men, but when discovered and treated early-on, prostate cancer is often very treatable. As with BPH, many of the treatment options for prostate cancer can lead to varying degrees of incontinence, because the prostate itself is very closely entwined with the sphincter (the small muscle that clamps the urethra closed), so treatment of BPH and prostate cancer can cause damage to the sphincter, which can result in stress urinary incontinence.
While the two main causes of incontinence in men – BPH and prostate cancer – can’t necessarily be prevented, early intervention can mean gentler treatment and a reduced risk of incontinence. The signs of prostate problems include difficulty urinating, a slow or “stop and go” stream while urinating, a painful or burning sensation during urination, frequent urination, and blood in your urine or semen. If you notice any of these symptoms, it’s important to see a doctor immediately.
The recommendations vary as to how men should be screened for prostate cancer, but generally men over the age of fifty are recommended to have an annual prostate exam, including a digital rectal exam (DRE) and a blood test for the prostate-specific antigen (PSA). African-American men and men with a history of prostate problems in their family are recommended to begin these tests at the age of forty or forty-five. Some doctors prefer to review the risks and benefits, along with your specific risk factors, so that you can make a personal and informed choice regarding the screenings.
Pelvic floor exercises before and after prostate treatment can also potentially reduce your risk of incontinence and help you retain bladder control.
Treatment and Management Options
Incontinence is not uncommon for up to a year following prostate treatment, however in most cases it will go away after a while. Waiting for it to resolve itself can feel like a long and agonizing time, and in some cases the incontinence will remain forever. While waiting to see if the incontinence will dissipate it may be best to use absorbent products designed specifically for men and/or urine collection devices (such as a condom catheter) or a penile clamp. Men are often more uncomfortable than women with using these products, perhaps because women are accustomed to buying and using similar products for their menstrual cycle. Also, women generally carry purses and men often don’t know how to carry products when they are out in public. Many men remedy this by carrying a gym bag, briefcase, or backpack.
If incontinence becomes a long-term challenge (more than a year post-treatment), you may want to discuss them many different treatment options available with your physician.
Medical Reviewer: Nejd Alsikafi, M.D.
Dr. Alsikafi is a 1997 graduate of the Pritzker School of Medicine at the University of Chicago. Following medical school he was a resident in urology at the University of Chicago and completed his chief resident year in 2003. Afterwards he was accepted for a prestigious fellowship in urologic trauma and reconstruction at the University of California San Francisco. There he served as Clinical Instructor and was the author of many publications. Afterwards he joined the faculty at the University of Chicago as Clinical Associate and was an attending urologist at Mount Sinai Hospital in Chicago. In 2006 he was recruited to move his urologic trauma and reconstructive practice to the Loyola University Health System, where he currently serves as Clinical Assistant Professor. He is head of the Chicago Center for Urologic Reconstruction and Trauma. In late 2006 he joined the practice of Urology Specialists of Lake County. Dr. Alsikafi is board certified in adult and pediatric urology by the American Board of Urology and is an active member of the American Urological Association. He is a Fellow of the American College of Surgeons and is a member of many honorary and academic medical societies.