Approximately 5 million men in America suffer from urinary Incontinence. Common causes are prostate problems, injury, urinary tract infection, neurological disease, toxins such as alcohol, and simply aging.
Three common types of male urinary incontinence:
Urge Incontinence Urge incontinence, which is a sudden, uncontrollable urge to void, is caused by a sudden abnormal contraction of the bladder that is stronger than the urinary tract muscles can control. The patient generally leaks urine before he can get to a bathroom. The most common cause of this abnormal contraction is an enlarged, obstructed prostate gland — usually a benign condition. To overcome the obstruction caused by this enlarged gland, the bladder thickens and can develop abnormally strong involuntary contractions. Other causes of urge incontinence include neurological conditions such as stroke, spinal cord injury or multiple sclerosis.
Intrinsic Sphincteric Deficiency (ISD) ISD is a weakness of the bladder neck and sphincter muscles usually caused by a surgical procedure, such as a total prostatectomy, radiation or cryotherapy for prostate cancer, spinal cord or pelvic injury. Depending upon the severity of the weakness the patient may have small amounts of leakage with coughing or straining, which classifies as stress urinary incontinence. More severe forms may result in total incontinence and a constant leakage of urine 24 hours a day.
Overflow Incontinence Overflow incontinence is caused by a bladder that becomes completely dysfunctional. This usually is a chronic process but starts out with an obstruction at the prostate or urethral level. The bladder initially squeezes harder trying to empty but as it gradually weakens, more and more residual urine accumulates. As the bladder volume slowly increases, the bladder wall gets thinner and the contractions get less and less forceful. Eventually, the bladder function is completely destroyed and the volume of the bladder gets so large, that as the patient is active, small amounts of urine seep out of the urethra throughout the day.
Other causes of a dysfunctional bladder could be neurological injuries due to diabetes or B-12 deficiencies, spinal cord injury, stroke, dementia or the bladder simply wearing out with age.
Treatment Options for Male Incontinence
You don't have to live with urinary incontinence. Thousands of men each year see a urologist to get the help they need to resume a normal, active life.
During your first appointment at Stony Brook Urology, we'll take a complete medical history and conduct a physical exam. Our state-of-the-art video urodynamics lab provides us with simultaneous electronic tracings of bladder activity and video imaging of the bladder in motion. Both are important to determine the cause and type of incontinence you may be experiencing. Our specialists all have particular expertise in interpreting this data.
Based on the type, severity and cause of your incontinence your care team at the Stony Brook Urology will help you decide on the best treatment for you. For more information about the treatment options for male incontinence, call (631) 444-1910.
- Non-surgical options
- Surgical options
Intrinsic Sphincteric Dysfunction (ISD)
- Non-surgical options
- Surgical options
- Non-surgical options
- Surgical options
- Lifestyle Changes There are a number of things you can do on your own to assist your bladder's ability to function:
Limit your fluid intake to under 40 ounces a day.
Avoid bladder irritants. These include tobacco, coffee, tea, chocolate, sodas, and acidic and spicy foods.
- Physical Therapy Pelvic floor muscle exercises, supervised by a physical therapist, can help you isolate and train the muscles that support the pelvic floor to help reduce incontinence.
- Bladder Training Techniques If appropriate, we can teach you bladder-retraining techniques, which enable many people to learn to delay urination and suppress urge symptoms. These can be extremely helpful in reversing frequent urination and any associated incontinence.
- Neuromodulation Neuromodulation can be performed as a temporary procedure by stimulating the tibial nerve in the ankle, similar to acupuncture. The temporary stimulation method is applied weekly eight to 10 times and is then performed once a week in the clinic or by the patient at home.
- Medications There are three main types of medications for treating urge incontinence. Your physician may make a recommendation best suited to your needs.
The medications to control bladder spasm and overactivity are Myrbetriq, Ditropan, Detrol, Oxytrol patch, Vesicare, Santura and Enablex. These medications help manage urge incontinence by partially blocking the bladder's ability to contract.
Medications to reduce the muscular blockage to urine outflow associated with an enlarged prostate are the Alpha-blockers Flomax, Uroxatral, Hytrin and Cardura. Alpha-blockers relax the bladder neck and prostate tissue allowing improved urine flow.
Medications to block hormonal stimulation to the prostate and lead to prostate size reduction are the 5-Alpha Reductase Inhibitors Proscar and Avodart. These medications reduce the size of the prostate and can help relieve obstruction if present. As with alpha-blockers, this helps urine flow and improves urge incontinence.
- Botox Treatment - Botox injection is an FDA-approved therapy for urinary urgency incontinence. Multiple small injections into the floor of the bladder through a small needle under local or regional anesthesia. The results are immediate and last six to nine months in most patients.
- Neuromodulation Neuromodulation - Neuromodulation is also known as a “bladder pacemaker” and is used in patients with urgency incontinence when other therapies have not worked well. InterStimTM has been an FDA-approved therapy since 1998. It involves placing permanent electrodes near the bladder nerves as they exit the spinal cord. This therapy has an extremely high success rate, even when other therapies have failed.
- Bladder Augmentation (Augmentation Cystoplasty) Bladder augmentation is a surgical treatment to increase the storage capacity of the bladder. It involves taking a section of the small intestine and attaching it to the bladder, creating a larger, low-pressure addition to the bladder and preventing leakage. This treatment is reserved for people who have not responded to other medical therapies or neuromodulation. Patients who have bladder augmentation usually require lifelong, intermittent catheterization four times per day to drain the bladder.
Intrinsic Sphincteric Dysfunction (ISD) Incontinence
Non-surgical Options: ISD Used in conjunction with the lifestyle recommendations above, incontinence aids can be helpful for men with ISD who are not candidates for surgery.
- Male Pads — Pads continue to be improved and refined. The newer gel-type pads absorb wetness and have a dry layer next to your skin for more comfort.
- Penile Clamps — Penile clamps put pressure on the penis in order to compress the urethra and prevent leakage. A variety of external penile clamps are available. These clamps are kept in place until your bladder is full and then removed to allow urination.
- Condom Catheter (External Catheter Drainage) — A condom catheter is a sheath with a tube at the end that slides over and fits on the penis. The tube allows urine to drain into a storage bag.
Surgical Options: ISD
- Male Sling — The male sling creates support for the urethra by partially wrapping a strip of material, often polypropylene mesh, around the urethra. This material is then attached to the pelvic bone with tiny screws. This keeps constant pressure on the urethra so that it only opens when you consciously try to urinate. This approach is generally recommended only if you have a lesser amount of incontinence.
- Artificial Urinary Sphincter — An artificial urinary sphincter is a common choice for men who have not responded to other forms of treatment. During the surgery, a storage reservoir is placed near the bladder, a fluid-filled cuff is wrapped around the urethra and a pump is placed in the scrotum. The procedure takes approximately 60 minutes to an hour and most patients stay in the hospital overnight. The devices will not be activated for six weeks, giving you time to heal. Once your doctor has activated the devices, you simply squeeze the pump a few times when you want to urinate. This opens the urethra and allows the bladder to empty. The sphinter automatically closes again in one to two minutes when the bladder is empty.
Non-surgical Options: Overflow
- Self-intermittent Catherization (SIC) — Self-intermittent catherization involves the patient inserting a small catheter into the urethra to drain the bladder and then removing the catheter. The patient uses a clean, but not sterile, catheter each time and does this four to six times a day.
- Foley Catheter (Indwelling Catheter Drainage) — A Foley catheter is a thin tube inserted through the urethra into the bladder, allowing urine to drain from the body into an external bag. A balloon filled with sterile water is at the end of the tube and holds it in place. This is typically used as a last resort for men who are unable to empty their bladder and/or have severe leakage.
Surgical Options: Overflow
- In some cases of overflow incontinence the cause is an obstruction of the prostate in those individuals who continue to have reasonable bladder function. Surgical relief of this obstructing tissue can correct the urinary retention and thus the overflow incontinence. A variety of methods including microwave therapy, laser therapy and transurethral resection of the prostate exists. The standard for treatment is a transurethral resection of the prostate. This requires a spinal anesthesia and a 30 to 60-minute surgical procedure done through the patient's urethra. The patient remains in the hospital one night, leaves the hospital with no catheters and is usually feeling completely normal in two weeks.