Male Urinary Incontinence
Urinary incontinence, which refers to the inability to control bladder function, is a prevalent and frequently uncomfortable issue. Its severity can vary from minor leakage during activities like coughing or sneezing to experiencing a sudden and intense urge to urinate that makes it difficult to reach the bathroom in time.
While this condition tends to become more common with age, it is not an unavoidable part of getting older. If urinary incontinence interferes with your daily life, it’s important to consult your doctor. For many individuals, making straightforward lifestyle and dietary adjustments or seeking medical treatment can effectively manage the symptoms of urinary incontinence.
Symptoms
Many individuals may have occasional, minor urine leaks, while others may experience small to moderate amounts of leakage more frequently.
Types of urinary incontinence include:
- Stress Incontinence:
This occurs when urine leaks due to pressure on the bladder from activities like coughing, sneezing, laughing, exercising, or lifting heavy objects. - Urge Incontinence:
Characterized by a sudden, strong urge to urinate that results in involuntary leakage. You may find yourself needing to urinate frequently, even at night. This type can be caused by minor issues, such as an infection, or more serious conditions like neurological disorders or diabetes. - Overflow Incontinence:
This type involves frequent or constant dribbling of urine because the bladder does not empty completely. - Functional Incontinence:
This occurs when a physical or mental limitation prevents you from reaching the toilet in time. For instance, someone with severe arthritis might struggle to unbutton their pants quickly enough. - Mixed Incontinence:
This involves experiencing more than one type of urinary incontinence, most commonly a combination of stress and urge incontinence.
When to see a Physiotherapist?
It may feel awkward to discuss incontinence with your physiotherapist, but if it occurs frequently or affects your quality of life, seeking medical advice is crucial. Urinary incontinence can:
- Lead you to limit your activities and reduce social interactions.
- Diminish your overall quality of life.
- Increase the risk of falls in older adults as they hurry to the bathroom.
- Indicate a potentially serious underlying health issue.
Causes
Urinary incontinence can stem from daily habits, underlying medical conditions, or physical issues. A comprehensive evaluation by your doctor can help identify the root cause of your incontinence.
Temporary Urinary Incontinence
Certain beverages, foods, and medications can act as diuretics, stimulating your bladder and increasing urine production. These include:
- Alcohol
- Caffeine
- Carbonated beverages and sparkling water
- Artificial sweeteners
- Chocolate
- Chili peppers
- Spicy, sugary, or acidic foods, particularly citrus fruits
- Heart and blood pressure medications, sedatives, and muscle relaxants
- High doses of vitamin C
Temporary urinary incontinence may also be linked to easily treatable medical issues, such as:
- Urinary Tract Infections (UTIs): Infections can irritate the bladder, leading to strong urges to urinate and possible incontinence.
- Constipation: The rectum, located near the bladder, shares many nerves with it. Hard stool in the rectum can irritate these nerves, increasing urinary frequency.
Persistent Urinary Incontinence
Incontinence can also be a long-term issue caused by underlying physical changes or problems, including:
- Age-Related Changes: As the bladder muscle ages, its capacity to store urine may decrease, and involuntary contractions may become more frequent.
- Enlarged Prostate: Particularly in older men, an enlarged prostate (benign prostatic hyperplasia) often leads to incontinence.
- Prostate Cancer: In men, stress or urge incontinence may be linked to untreated prostate cancer, though it is more commonly a side effect of cancer treatments.
- Obstruction: Tumors anywhere in the urinary tract can obstruct urine flow, resulting in overflow incontinence. Urinary stones may also cause leakage.
Neurological Disorders: Conditions like multiple sclerosis, Parkinson’s disease, strokes, brain tumors, or spinal injuries can disrupt the nerve signals that control bladder function, leading to incontinence.
Risk Factors
Several factors can elevate your risk of developing urinary incontinence, including:
- Age: As you age, the muscles in your bladder and urethra may weaken, reducing bladder capacity and increasing the likelihood of involuntary urine leakage.
- Being Overweight: Extra weight places additional pressure on the bladder and surrounding muscles, which can weaken them and lead to leakage, especially when coughing or sneezing.
- Smoking: Tobacco use has been linked to a higher risk of urinary incontinence.
- Family History: Having a close family member with urinary incontinence, particularly urge incontinence, can increase your own risk.
Certain Medical Conditions: Neurological diseases or diabetes may also heighten the likelihood of experiencing incontinence.
Complications
Chronic urinary incontinence can lead to various complications, including:
- Skin Issues: Continuous exposure to moisture can result in rashes, skin infections, and sores.
- Urinary Tract Infections (UTIs): The condition can increase the risk of recurrent UTIs.
- Impact on Personal Life: Urinary incontinence can negatively affect social interactions, work situations, and personal relationships.
Prevention
While urinary incontinence is not always preventable, you can take steps to reduce your risk:
- Maintain a Healthy Weight:
Keeping your weight in check can alleviate pressure on your bladder. - Practice Pelvic Floor Exercises:
Strengthening these muscles can improve bladder control. - Avoid Bladder Irritants:
Limit intake of caffeine, alcohol, and acidic foods. - Increase Fiber Intake:
Eating more fiber can help prevent constipation, which can contribute to urinary incontinence. - Quit Smoking: If you smoke, seek assistance to quit, as this can reduce your risk.
Diagnosis
Determining the type of urinary incontinence you have is crucial, as your symptoms often provide valuable insights that guide treatment decisions.
Your doctor will likely begin with a comprehensive medical history and a physical examination. You may also be asked to perform a simple maneuver, like coughing, to demonstrate incontinence.
Following this initial assessment, your therapist may recommend:
- Urinalysis:
A urine sample will be analyzed for signs of infection, blood traces, or other abnormalities. - Bladder Diary:
For several days, you will log your fluid intake, urination times, urine output, any urges to urinate, and instances of incontinence. - Postvoid Residual Measurement:
You will urinate into a container that measures your output. Then, your doctor will check for leftover urine in your bladder using a catheter or ultrasound. A significant amount of residual urine may indicate an obstruction in the urinary tract or issues with bladder nerves or muscles.
If additional information is necessary, your doctor may suggest more advanced tests, such as urodynamic testing or pelvic ultrasound, particularly if surgery is being considered.
Treatment
The treatment for urinary incontinence varies based on the type, severity, and underlying cause of the condition. Often, a combination of approaches is necessary.
You are suggested to be starting with less invasive treatments before considering other options if initial techniques are ineffective.
Behavioral Techniques
Your Physiotherapist may recommend several strategies, including:
- Bladder Training:
This involves delaying urination after you feel the urge. Begin by trying to hold off for 10 minutes each time you feel the urge, gradually increasing this time until you are urinating every 2.5 to 3.5 hours. - Double Voiding:
This technique encourages you to fully empty your bladder. Urinate, wait a few minutes, then try again. - Scheduled Toilet Trips:
Instead of waiting for the urge, plan to urinate every two to four hours. - Fluid and Diet Management:
Regaining control of your bladder may involve cutting back on alcohol, caffeine, or acidic foods, as well as reducing liquid intake, losing weight, or increasing physical activity.
Pelvic Floor Muscle Exercises
Your physiotherapist may recommend frequent pelvic floor exercises, commonly known as Kegel exercises, to strengthen the muscles that help control urination. These exercises are particularly effective for stress incontinence but can also benefit those with urge incontinence.
To perform Kegel exercises:
- Imagine you are trying to stop your urine flow.
- Tighten the muscles you would use to halt urination and hold for five seconds, then relax for five seconds. If this is challenging, start by holding for two seconds and relaxing for three.
- Gradually work up to holding contractions for 10 seconds at a time.
- Aim for at least three sets of 10 repetitions each day.
To ensure you’re targeting the correct muscles, you are highly recommended to work with a pelvic floor physiotherapist or utilizing biofeedback techniques.
Medications
Common medications for treating incontinence include:
- Anticholinergics:
These help calm an overactive bladder and are beneficial for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and trospium chloride. - Mirabegron (Myrbetriq): This medication relaxes the bladder muscle and can help increase bladder capacity and emptying.
- Alpha Blockers: For men with urge or overflow incontinence, these medications relax muscles in the bladder neck and prostate, making it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
- Topical Estrogen: Low-dose estrogen applied as a vaginal cream, ring, or patch can help tone and rejuvenate the urethral and vaginal tissues.
Electrical Stimulation
This treatment involves temporarily inserting electrodes into the rectum to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for both stress and urge incontinence, though multiple treatments over several months may be necessary.
Intervention Therapy
Several interventional therapies may be effective in managing urinary incontinence:
- Bulking Material Injections:
A synthetic material is injected into the tissue surrounding the urethra, helping to keep it closed and reduce urine leakage. This procedure is primarily used for stress incontinence and is generally less effective than surgical options. It may require repeat treatments. - OnabotulinumtoxinA (Botox):
Botox injections into the bladder muscle can benefit individuals with an overactive bladder and urge incontinence. This treatment is typically considered when other therapies have not succeeded. - Nerve Stimulators:
Two types of devices use painless electrical pulses to stimulate the nerves that control bladder function (sacral nerves). One device is implanted under the skin in the buttock, while the other is a removable plug inserted into the vagina. Stimulating the sacral nerves can help manage overactive bladder and urge incontinence when other treatments have failed.
Surgery
If non-surgical treatments are ineffective, various surgical procedures may be considered to address urinary incontinence:
- Sling Procedures:
This involves using synthetic mesh or strips of your own tissue to create a sling beneath the urethra and bladder neck. The sling helps keep the urethra closed, especially during activities like coughing or sneezing, and is commonly used for stress incontinence. - Bladder Neck Suspension:
This procedure supports the urethra and bladder neck and is performed through an abdominal incision under general or spinal anesthesia. - Artificial Urinary Sphincter:
This involves implanting a small, fluid-filled ring around the bladder neck to keep the urinary sphincter closed until it’s time to urinate. To initiate urination, a valve implanted under the skin is pressed, causing the ring to deflate and allowing urine to flow from the bladder.
Absorbent Pads and Catheters
If medical treatments do not fully resolve your incontinence, you can consider products designed to help manage leakage:
- Pads and Protective Garments:
Most absorbent products are discreet and can be worn under regular clothing. Men may use a drip collector, a small absorbent pouch worn over the penis and held in place by snug-fitting underwear. - Catheters:
For individuals whose bladders do not empty properly, learning to insert a soft catheter into the urethra several times a day may be recommended to drain the bladder. Instructions will be provided on how to clean and reuse the catheters safely.
Urinary Incontinence Care at Vigor Men’s Pelvic Health Centre
Your Vigor Care Team
At Vigor Men’s Pelvic Health Centre, our team includes specialists with advanced training in bladder and urinary function. They focus on diagnosing and treating urinary incontinence, bringing extensive experience to patients who have previously undergone unsuccessful treatments.
Advanced Diagnosis and Treatment
Our researchers are dedicated to enhancing the diagnosis and treatment of urinary incontinence. We are actively investigating the effectiveness of different exercises and protocols to effectively treating incontinence issues.
Location
We are located at Mid Valley Kuala Lumpur:
Vigor Men’s Pelvic Health Centre
Unit 1-10, Level 10, Boulevard 1&3,
Mid Valley City, Lingkaran Syed Putra,
59200, Kuala Lumpur, Malaysia.
WhatsApp Careline: 019-2828813
Inquiry Email: care@vigor.my