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Urinary Incontinence in Men
What causes UI in men?
Nerves carry signals from the brain to the bladder and sphincter. Any disease, condition, or injury that damages nerves can lead to urination problems.
What causes UI in men?
For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Babies are not born with the ability to control urination. As children grow, they learn to interpret nerve signals and develop the muscle control required to stay dry. In children between the ages of 5 and 10, some incontinence may result from limited bladder capacity or delayed development of the nerve pathways that signal a full or emptying bladder. This form of incontinence fades away as the bladder grows and nerves become mature. Other types of nerve problems, however, can cause urination problems that are more difficult to overcome.
Nerve Problems
Any disease, condition, or injury that damages nerves can lead to urination problems. Nerve problems can occur at any age.
Men who have had diabetes for many years may develop nerve damage that affects their bladder control as well as their sexual function.
Stroke, Parkinson's disease, and multiple sclerosis all affect the brain and nervous system, so they can also cause incontinence.
Overactive bladder is a condition in which the bladder squeezes at the wrong time. The condition may be caused by nerve problems, or it may occur without any clear cause. A person with overactive bladder may have any two or all three of the following symptoms:
urinary frequency--urination eight or more times a day or two or more times at night
urinary urgency--the sudden, strong need to urinate immediately
urge incontinence--urine leakage that follows a sudden, strong urge
Spinal cord injury can cause incontinence by interrupting the nerve signals required for bladder control.
In neural birth defects such as spina bifida or myelomeningocele, the backbone and spinal canal do not close before birth. In severe cases, nerve damage can result in many problems, including lack of control over urination.
Prostate Problems
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.
BPH: The prostate gland commonly becomes enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra. The bladder wall thickens and becomes irritable, and the bladder begins to contract even when it contains only small amounts of urine. This results in more frequent urination. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and up to 90 percent in their seventies and eighties have some symptoms of BPH. The symptoms vary, but the most common ones involve changes or problems with urination, such as a hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence. Problems with urination do not necessarily signal blockage caused by an enlarged prostate. Other changes associated with aging can cause urination problems experienced by both men and women.
Radical prostatectomy: The surgical removal of the entire prostate gland--called radical prostatectomy--may be recommended to treat prostate cancer. The surgeon may approach the prostate through the abdomen or through the perineal area (between the scrotum and the anus). The surgery may lead to erection problems and UI, although nerve-sparing procedures in the abdominal approach may make these side effects less likely.
External beam radiation: This therapy uses an x-ray machine to deliver radiation to the prostate gland. The treatment is not painful but can cause loss of bladder control as well as fatigue, skin redness and irritation, rectal burning or injury, diarrhea, inflammation of the bladder wall (cystitis), blood in the urine, loss of sexual function, and loss of appetite.
Radical prostatectomy
Prostate Symptom Scores
If your prostate could be involved in your incontinence, you may be asked a series of standardized questions, either the International Prostate Symptom Score or the American Urological Association (AUA) Symptom Scale. Some of the questions you will be asked for the AUA Symptom Scale will be the following:
Over the past month or so, how often have you had to urinate again in less than 2 hours?
Over the past month or so, from the time you went to bed at night until the time you got up in the morning, how many times did you typically get up to urinate?
Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Over the past month or so, how often have you had a weak urinary stream?
Over the past month or so, how often have you had to push or strain to begin urinating?
Your answers to these questions may help identify the problem or determine which tests are needed. Your symptom score evaluation can be used as a baseline to see how effective later treatments are at relieving those symptoms.
