Urinary Incontinence in Men: The Type Decides the Fix

Many men never mention leaking urine to a doctor; the NIDDK notes that many people feel too embarrassed to talk about bladder control problems. It feels like an old man's problem, or an embarrassing one, or simply the price of getting older. The NIDDK's message is different: it calls bladder control problems common, says proper treatment may improve your quality of life, and adds that the sooner you get help, the sooner it may improve.

This article covers what urinary incontinence is, how common it is in men, the different types, the prostate connection, other causes, how it is diagnosed, what you can do yourself, the medical treatments, and the warning signs that mean calling 911. It sits in this site's Prostate section because, in men, the NIDDK links it to prostate problems.

What urinary incontinence is

The NIDDK defines bladder control problems as conditions that affect the way a person holds or releases urine, and says that accidental loss or leaking of urine, called urinary incontinence, is one of the most common of them. It stresses that incontinence "is not a disease but a condition that may be related to another health problem or life event," such as prostate problems.

The effects go beyond wet clothes. The NIDDK says untreated bladder problems can lead people to avoid activities they once enjoyed, which can lead to depression or social anxiety, and that some people avoid intimacy because they worry about leaking during sex. It says to talk with a health care professional if either is happening.

How common it is in men

The NIDDK says incontinence is more common in women, but that as many as 1 in 3 men over the age of 65 may lose urine by accident, and that about half of men who seek treatment for lower urinary tract symptoms experience it. It explains the age link directly: "A man is more likely to develop UI with age because prostate problems occur more often with age."

Its list of factors that make incontinence more likely includes being older (as you age, your urinary tract muscles weaken), prostate problems in men, health problems such as diabetes, obesity, Parkinson's disease, multiple sclerosis or long-lasting constipation, and smoking.

The types, and why they matter

The NIDDK says types of bladder control problems are identified by their symptoms. The main ones:

• Stress incontinence: movement such as coughing, sneezing, laughing or physical activity puts pressure on the bladder and causes urine to leak.
• Urgency incontinence: a strong urge to urinate, and urine leaks before you can get to a toilet. The NIDDK says this is often referred to as overactive bladder.
• Mixed incontinence: urgency and stress incontinence at the same time.
• Overflow incontinence: the bladder doesn't empty all the way, and urine leaks because the bladder becomes too full.
• Reflex incontinence: urine leaks without warning, often because bladder nerves are damaged, for example by multiple sclerosis or a spinal cord injury.
• Functional incontinence: a physical disability or barrier, or a problem speaking or thinking, prevents you from reaching the toilet in time.
• Temporary incontinence: a short-lived cause, such as a certain medicine, a urinary tract infection or a bad cough.

MedlinePlus is clear on why the type matters: which treatment you get "depends on what caused your incontinence and what type you have." Urgency in men has its own article on this site, overactive bladder in men, and the bladder that doesn't empty, behind overflow incontinence, is covered in bladder not emptying.

The prostate connection

The NIDDK explains that the prostate surrounds the opening of the bladder and gets bigger as a man grows older. When it is enlarged but not cancerous, a condition called benign prostatic hyperplasia (BPH), a man may have trouble starting to urinate, a slow stream, and trouble fully emptying the bladder. It adds that treatment for BPH can lead to stress incontinence, "but it is usually temporary."

Prostate cancer treatment can have longer-lasting effects. The NIDDK says men who have had radiation or surgery for prostate cancer may have short-term or long-term incontinence, because these treatments can lead to nerve damage, bladder spasms or stress incontinence, and that bladder control problems after prostate cancer treatment can get better over time. MedlinePlus lists weakness of the urinary sphincter, the muscles that open and close the bladder, among the longer-term causes, and says it can be caused by prostate surgery in men.

The surgical options for an enlarged prostate are compared in this site's prostate surgery options article, and the bigger picture of enlargement is in the enlarged prostate guide.

Other causes, including temporary ones

Incontinence isn't always about the prostate. The NIDDK lists health changes and problems that can lead to it, including aging, bladder infection, constipation, a blocked urinary tract from a tumor or kidney stone, a chronic cough, diabetes, and overweight or obesity. It says bladder nerves and muscles can be affected by conditions including diabetes, stroke, Parkinson's disease, multiple sclerosis, Alzheimer's disease and brain or spinal cord injury.

Some causes pass. MedlinePlus lists causes of sudden or temporary incontinence that include bedrest after surgery, certain medicines (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies and antihistamines), mental confusion, prostate infection or inflammation, stool impaction from severe constipation, a urinary tract infection, and weight gain. The NIDDK adds lifestyle factors, including alcohol and caffeinated or carbonated drinks. Prostate inflammation is covered in this site's prostatitis vs enlarged prostate article.

How it is diagnosed

The NIDDK says a health care professional will ask about your family and medical history and give you a physical exam, and may ask you to cough with a full bladder to see whether you leak. You may be asked to keep a bladder diary, recording what, when and how much you drink, when and how much you urinate, how often you leak, whether you felt a strong urge first, and what you were doing at the time. It suggests keeping one for 2 to 3 days before your appointment.

Tests may include a urinalysis, blood tests, urodynamic testing (which looks at how the bladder, urethra and sphincters store and release urine), cystoscopy, and imaging. What happens at a cystoscopy is explained in this site's cystoscopy article.

What you can do yourself

Depending on the type, the NIDDK says lifestyle changes may reduce leaks. Its advice on fluids is more careful than most people expect: ask your health care professional whether you should drink less during the day, but "don't limit liquids to the point of becoming dehydrated." Stopping drinks a few hours before bed may help with nighttime trips, but only if your provider suggests it. It says limiting caffeine may help reduce leaks, and to limit alcohol, which can increase how much urine your body makes.

Its other steps are keeping a healthy weight (it says losing weight can help you have fewer leaks), avoiding constipation, staying physically active, and stopping smoking, which it links to stress incontinence through chronic coughing. MedlinePlus adds avoiding foods and drinks that may irritate the bladder, such as spicy foods, carbonated drinks and citrus, and, for men with diabetes, keeping blood sugar under good control. Which foods and drinks affect prostate symptoms is covered in this site's foods and drinks article.

Bladder training and pelvic floor exercises

The NIDDK describes bladder training as urinating on a schedule, called timed voiding, and gradually lengthening the time between trips. On pelvic floor exercises, it is specific about men: "Men can also benefit from pelvic floor muscle exercises. Strengthening these muscles may help a man leak urine less often, especially dribbling after urination." It says a physical therapist trained in pelvic floor therapy can help, and that biofeedback can show whether you are doing the exercises correctly. How to do them properly is the subject of this site's pelvic floor exercises article.

Medical treatments

If lifestyle changes don't work, the NIDDK says a provider may prescribe medicine, a medical device, a bulking agent, or, as a last resort, surgery. For urgency incontinence, medicines to relax the bladder include anticholinergics, beta-3 agonists and tricyclic antidepressants, and Botox injected into the bladder may be used when other treatments don't work. It adds that men with incontinence who have an enlarged prostate may also be prescribed alpha-blockers, 5-alpha reductase inhibitors or phosphodiesterase-5 inhibitors. These prostate medicines are explained in this site's prostate medications article.

For other types, the NIDDK lists catheters for overflow incontinence, bulking agents injected near the urinary sphincter for stress incontinence, and electrical nerve stimulation for urgency incontinence. For stress incontinence in men, surgical options include the male sling, in which mesh is placed under the urethra to support it, and an artificial urinary sphincter, a device that helps keep the urethra closed. Overflow caused by a blockage, including an enlarged prostate, can be treated with surgery to remove the blockage. What living with a catheter involves is covered in the urinary catheter article.

For leaks that remain, the NIDDK lists protective products, including absorbent or waterproof underwear, pads, skin cleaners and creams, and an external catheter for men that drains into a bag strapped to the thigh. MedlinePlus notes that many of these products are designed so that no one else will notice.

When to see a doctor, and when to call 911

MedlinePlus says to call 911 or go to an emergency room if you suddenly lose control over urine and you have difficulty talking, walking or speaking; sudden weakness, numbness or tingling in an arm or leg; loss of vision; loss of consciousness or confusion; or loss of bowel control.

Under the heading "seek care right away," the NIDDK says to see a health care professional if you can't pass urine or empty your bladder, which is a sign of urinary retention; urinate eight or more times a day; see blood in your urine; or have bladder infection symptoms, including painful urination. Blood in the urine has its own article on this site, blood in urine after 40.

MedlinePlus says to contact your provider if you have cloudy or bloody urine, dribbling, a frequent or urgent need to urinate, pain or burning when you urinate, trouble starting your urine flow, or a fever. And for incontinence itself, without any of these, the NIDDK's advice is simply not to wait: talk with a health care professional, even if you feel embarrassed.