Urinary Incontinence in Men: When to worry?

Urinary incontinence (UI) is defined as “the inability of the body to control urination leading to socially inappropriate loss of urine”. It is always considered abnormal when it occurs. This is a very broad and complicated subject that we will confine to men over the age of 40 years of age. The anatomy of a man is a little different from that of a woman. A man has a prostate and a penis. The prostate surrounds the urethra and is below the bladder in men. The average prostate size is that of a “key lime”. The kidneys are connected to the bladder by long tubes called “ureters”. The kidneys filter the blood removing waste and toxins in the form of urine which is pumped into the bladder. The bladder acts as a urine storage tank. The system is designed to be “low pressure” and sterile. Under normal circumstances that bladder should fill to a reasonable capacity allowing an average time interval of 3 hours between voids.

The processes that lead to urinary incontinence are many. Any process that irritates the bladder can result is uncontrollable urges to void resulting in urinary incontinence (i.e., BPH, prostate cancer, urethral stricture, UTI, bladder stone, bladder tumor, parasites, & radiation injury). UI can occur as a side effect of certain medications like diuretics. Certain neurological conditions can result in uncontrolled urination like a cerebrovascular accident (stroke), multiple sclerosis, Parkinson’s disease, dementia (Alzheimer’s disease), spinal cord injury, and cerebral palsy. UI can be the result of a previous surgery like radical prostatectomy or TURP. Functional urinary incontinence may result from problems with mobility which make it difficult or impossible for the affected person to reach the bathroom in time. Certain psychological conditions can also be associated with urinary incontinence. Whatever the cause, an experienced urologist can perform the proper evaluation and identify the cause of the urinary incontinence.

The most common problem that we see in men associated with urinary incontinence (UI) is benign prostatic hypertrophy (BPH). Enlargement of the prostate begins in a man’s 30’s and progressed until death. As the prostate enlarges over time, it begins to compress the urethra impeding the flow of urine. We call this bladder outlet obstruction. Symptoms of bladder outlet obstruction include waking up at night to void, frequent daytime voiding, weak urinary stream, hesitancy, a deviated urinary stream, intermittent flow, straining to void, incomplete bladder emptying, dysuria (pain with urination) and blood in the urine. When the obstruction becomes severe the affected will feel extreme urgency to void and urge urinary incontinence. These symptoms should not be ignored. These symptoms usually indicated that the pressure in the bladder is very elevated.

If you have any of these annoying symptoms seek the care of an experienced urologist to evaluate the source of your symptoms and to offer you appropriate treatment advice. BPH can be treated with alternative remedies, medication, minimally invasive treatments, and surgery. Sometimes specialized testing is required to assess bladder function and to measure intravesical bladder pressure. Based on this testing the best treatment option can be offered to you. Please seek out the care of a urologist that is experienced in the management of urinary incontinence and stop living in shame.