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Urinary Incontinence in Men
How is UI treated?
No single treatment works for everyone. Your treatment will depend on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options. Many men regain urinary control by changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. If these behavioral treatments do not work, you may choose to try medicines or a continence device--either an artificial sphincter or a catheter. Finally, for some men, surgery is the best choice.
Behavioral Treatments
For some men, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom--a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips. Bladder training also includes Kegel exercises to strengthen the pelvic muscles, which help hold urine in the bladder. Extensive studies have not yet shown that Kegel exercises are effective in reducing incontinence in men, but many clinicians find them to be an important element in therapy for men.
Some people with nerve damage cannot tell whether they are doing Kegel exercises correctly or not. If you are not sure, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both. Biofeedback uses sensors to detect muscle activity and create a visual or audio signal when the appropriate muscles are being used. A small probe, about the size of a pen, is inserted in the anus to record muscle contractions during the exercises. If you squeeze the right muscle, you will see a change on a television screen or hear a tone from a speaker.
Mild electrical pulses delivered to the pelvic muscles cause them to contract and grow stronger. This technique can also help you locate the right muscles to use during Kegel exercises.
How do you do Kegel exercises?
The first step is to find the right muscles. Imagine that you are trying to stop yourself from passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, those are the right muscles for pelvic exercises.
It is important not to squeeze other muscles at the same time and not to hold your breath. Also, be careful not to tighten your stomach, leg, or buttock muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Squeeze just the pelvic muscles.
Repeat, but do not overdo it. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 3 sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest because the muscles then do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.
Be patient. Do not give up. It takes just 5 minutes, three times a day. Your bladder control may not improve for 3 to 6 weeks, although most people notice an improvement after a few weeks.
Medications
Medicines can affect bladder control in different ways. Some medicines help prevent incontinence by blocking abnormal nerve signals that make the bladder contract at the wrong time, while others slow the production of urine. Still others relax the bladder or shrink the prostate. Before prescribing a medicine to treat incontinence, your doctor may consider changing a prescription you already take. For example, diuretics are often prescribed to treat high blood pressure because they reduce fluid in the body by increasing urine production. Some men may find that switching from a diuretic to another kind of blood pressure medicine takes care of their incontinence.
If changing medicines is not an option, your doctor may choose from the following types of drugs for incontinence:
Alpha-blockers: Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfzosin (Uroxatral) are used to treat problems caused by prostate enlargement and bladder outlet obstruction. They act by relaxing the smooth muscle of the prostate and bladder neck, allowing normal urine flow and preventing abnormal bladder contractions that can lead to urge incontinence.
5-alpha reductase inhibitors: Finasteride (Proscar) and dutasteride (Avodart) work by inhibiting the production of the male hormone DHT, which is thought to be responsible for prostate enlargement. These 5-alpha reductase inhibitors relieve voiding problems by shrinking an enlarged prostate.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored the Medical Therapy of Prostate Symptoms (MTOPS) trial, a multicenter study that found that doxazosin and finasteride taken together reduced the risk of BPH progression by 67 percent compared with placebo. The risk of progression was reduced by 39 percent with doxazosin alone and by 34 percent with finasteride alone.
Imipramine: Marketed as Tofranil, this drug belongs to a class of drugs called tricyclic antidepressants. It relaxes muscles and blocks nerve signals that might cause bladder spasms. Imipramine is also used to treat bedwetting in children.
Antispasmodics: Propantheline (Pro-Banthine), tolterodine (Detrol LA), and oxybutynin (Ditropan XL) belong to a class of drugs that work by relaxing the bladder muscle and relieving spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, headache, and flushing.
Clean intermittent catheterization
Catheters
If all other methods fail or are found unacceptable, you may consider controlling incontinence by using a catheter, a thin tube inserted through the urethra to drain the bladder. Catheters must be managed with great care to avoid infection and stone formation.
Clean intermittent catheterization: If you have problems emptying your bladder because of an enlarged prostate or because of nerve damage, you may use a catheter at regular times, or as needed, to drain urine and prevent overflow incontinence. Depending on your situation, the catheterization may be done for you, or you may learn to do it yourself. You will need to learn sterile technique to avoid urinary tract infections.
Condom catheter: Some men may prefer a drainage system that fits over the penis like a condom. You must take the same care to avoid infection as you do with other catheters. Condom catheters can also carry a risk of skin breakdown.
Urethral injections. Adding bulk to the tissue around the bladder opening helps keep the urethra closed.
Urethral Injections
Another method to help keep the urethra closed is to inject a fat-like substance into the area that surrounds the opening of the bladder into the urethra. A variety of bulking agents are available for injection. Your doctor will discuss which one may be best for you. Collagen, for example, is a natural tissue from cows. After using local anesthesia or sedation, a doctor can inject the material in about half an hour. Over time, the body slowly eliminates the collagen, so you may need repeat injections. Before you receive collagen, a doctor will perform a skin test to determine whether you could have an allergic reaction to the material.
Artificial Sphincter
Some men may eliminate urine leakage with an artificial sphincter, an implanted device that keeps the urethra closed until you are ready to urinate. This device can help people who have incontinence because of weak sphincter muscles or because of nerve damage that interferes with sphincter muscle function. It does not solve incontinence caused by uncontrolled bladder contractions.
Artificial sphincter
Surgery to place the artificial sphincter requires general or spinal anesthesia. The device has three parts: a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum. The cuff is filled with liquid that makes it fit tightly around the urethra to prevent urine from leaking. When it is time to urinate, you squeeze the pump with your fingers to deflate the cuff so that the liquid moves to the balloon reservoir and urine can flow through the urethra. When your bladder is empty, the cuff automatically refills in the next 2 to 5 minutes to keep the urethra tightly closed.
Male Sling
Surgery can improve some types of urinary incontinence in men. In a sling procedure, the surgeon creates a support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the strip to the pelvic bone. The sling keeps constant pressure on the urethra so that it does not open until the patient consciously releases the urine.
Urinary Diversion
Urinary diversion
If the bladder must be removed or all bladder function is lost because of nerve damage, you may consider surgery to create a urinary diversion. In this procedure, the surgeon creates a reservoir by removing a piece of the small intestine and directing the ureters to the reservoir. The surgeon also creates a stoma, an opening on the lower abdomen where the urine can be drained through a catheter or into a bag.
Social Support
UI should not cause embarrassment. It is a medical problem like arthritis or diabetes. Your health care provider can help you find a solution. You may also find it helpful to join a support group. In many areas, men dealing with the aftereffects of prostate cancer treatment have organized support groups. Other organizations to help people with incontinence exist as well. .,
