Male Incontinence

Male urinary incontinence, or UI, is a health problem that can lead to significant quality of life issues for the men who are affected. It can affect men of all ages and is often associated with underlying medical issues or age-related changes in the urinary system. While there are many reasons why men can suffer from incontinence symptoms, fewer than half of those affected seek help from their doctor.

At The University of Kansas Health System, we understand the complexity of treating male incontinence. Our team offers a range of treatments and solutions to help you control the effects of incontinence and return to an active, healthy lifestyle.

Male urinary incontinence is when a man experiences accidental urine leakage. There are many possible underlying causes for male incontinence, including prostate conditions, nerve or muscle changes and certain medical treatments. Determining the cause can help your doctor decide on the best course of treatment and management options.

• Stress incontinence: This occurs when there is pressure on the bladder, such as when coughing, sneezing, laughing or lifting heavy objects, leading to urine leakage. It is often caused by weakened pelvic floor muscles or a malfunctioning sphincter.
• Urge incontinence: Also known as overactive bladder, this type is characterized by a sudden and intense urge to urinate, often followed by involuntary leakage. It may result from an overactive detrusor muscle or neurological issues.
• Overflow incontinence: In this type, the bladder doesn’t empty properly, leading to frequent dribbling or a constant trickle of urine. It can be caused by an obstruction (e.g., enlarged prostate), nerve damage or weak bladder muscles.
• Functional incontinence: This type is not directly related to bladder or urinary tract problems but is due to physical or cognitive limitations that prevent a person from reaching the toilet in time.

The primary symptom of male incontinence is the involuntary loss of urine. However, the severity and frequency of leakage can vary. Other common symptoms may include:

• Frequent urination (more than 8 times a day)
• Urgency to urinate
• Difficulty starting urination
• Weak urine stream
• Dribbling or post-void dribbling
• Feeling of incomplete bladder emptying
• Waking up multiple times at night to urinate (nocturia)

Male incontinence can have various underlying causes, and sometimes a combination of factors may contribute to the condition. Some common causes include:

• Prostate problems: Enlarged prostate (benign prostatic hyperplasia) or prostate cancer treatments can affect the urinary system and lead to incontinence.
• Neurological conditions: Diseases like multiple sclerosis, Parkinson’s disease or spinal cord injuries can disrupt the signals between the brain and the bladder, causing incontinence.
• Pelvic floor muscle weakness: Weakened pelvic floor muscles, often due to aging, obesity or previous surgery, can result in stress incontinence.
• Medications: Certain medications, such as diuretics, alpha-blockers or sedatives, can affect bladder control.
• Infections: Urinary tract infections (UTIs) can cause temporary incontinence.
• Bladder abnormalities: Conditions like bladder stones or bladder cancer can lead to incontinence.
• Injury or surgery: Trauma to the pelvic area or previous surgeries involving the bladder or prostate can result in incontinence.
• Chronic cough: Conditions like chronic obstructive pulmonary disease (COPD) can lead to stress incontinence due to the constant pressure on the bladder from coughing.

Male incontinence can have various underlying causes, and sometimes a combination of factors may contribute to the condition. Some common causes include:

Diagnosing male incontinence typically involves a thorough medical evaluation by a healthcare professional. The process may include:

• Medical history: Your doctor will ask about your symptoms, medical history, medications and any recent surgeries or injuries that could be contributing to the condition.
• Physical examination: A physical examination, including a genital and rectal examination, may be performed to assess the health of the prostate and pelvic muscles.
• Urinalysis: A urine sample may be analyzed for signs of infection or other abnormalities.
• Bladder diary: Keeping a bladder diary, where you record your daily fluid intake, urination frequency and instances of leakage, can provide valuable information about your condition.
• Urodynamic testing: This set of tests measures bladder function, including pressure, capacity and muscle strength. It helps determine the type of incontinence and its underlying causes.
• Imaging: In some cases, imaging tests like ultrasound, cystoscopy or MRI may be used to assess the bladder and urinary tract.

Your treatment plan for male incontinence will be customized to your type of urinary incontinence. We specialize in real solutions for male incontinence, from minimally invasive surgical procedures like the male sling for mild to moderate incontinence to the gold standard artificial urinary sphincter implant that can resolve even severe incontinence.

Following prostate surgery, bladder surgery or radiation therapy, men are encouraged to attempt active conservative management (fluid restriction, medication management and pelvic floor exercises, also known as Kegels). If these conservative measures fail, surgery may be recommended.

Nonsurgical treatment options

Many nonsurgical or minimally invasive treatment options exist for male incontinence. These include:

• Lifestyle modifications, such as dietary changes to avoid bladder irritants (caffeine, alcohol, spicy foods) or scheduled voiding to train the bladder.
• Weight management and regular exercise to improve overall health.
• Pelvic floor exercises (Kegels) to strengthen the pelvic muscles and improve bladder control. A physical therapist may provide guidance.
• Medications, such as anticholinergic drugs for overactive bladder, alpha-blockers or 5-alpha-reductase inhibitors for prostate-related incontinence, or topical estrogen therapy for men with incontinence due to low estrogen levels.
• Medical devices, like penile clamps or compression devices to control urine flow, or urethral inserts or pessaries to block urine leakage.
• Neuromodulation via sacral nerve stimulation or Botox injections may be considered for some cases of overactive bladder.

Surgical treatment options

In some cases, your doctor may recommend a surgical treatment option to address incontinence. The main surgical techniques are:

As with any surgical procedure, complications are possible. Although rare, some of the most severe risks may include infection and erosion and surgical, physical, psychological or mechanical complications. If these occur, the device may need to be removed or revised.