Treating 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—such as an artificial sphincter or a catheter. 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 conclusively 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.

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.

Do not squeeze other muscles at the same time or 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.

Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This position is the easiest for doing Kegel exercises 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.

Incontinence Protection

While incontinence is being evaluated and treated, there is no reason to curtail your active lifestyle because of fear of embarrassing accidents. The newest disposable male guards, underwear and briefs contain a ploymer that effectively absorbs and wicks urine away from the skin. Most odor is neutralized with this type of product so you can be discreet, even in close situations.

Men's products fall into two categories:

1. DISPOSABLE:

  • Guards - small anatomically shaped pads which adhere to the inside of your own underwear, best used for light to moderate incontinence, discreet and easily changed, come in many shapes so you can choose the best fit
  • Underwear - pull-ups which have elasticized waist and can be pulled up and down like regular underwear, many different absorbencies for even moderate to heavy incontinence, will accommodate an active lifestyle, most with a cloth-like outer cover
  • Briefs - diapers that are fastened with Velcro or tape tabs, offer the most absorbency, useful in situations of limited mobility or heavy leaking

2. REUSABLE (WASHABLE):

  • Daytime briefs - look like men's briefs with the addition of a sewn-in absorbent pad, machine washable and reusable
  • Nighttime pants - waterproof boxer brief with absorbent pad, can be used with disposable booster pad for extra absorbency

Some users find that one type of product may be useful during the day, when bathroom access is easier, and another product may be used at night or in situations where bathroom access is limited.

Medicines

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 may help to relieve voiding problems by shrinking an enlarged prostate.

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.

Antispasmodics: Propantheline (Pro-Banthine), tolterodine (Detrol LA), oxybutynin (Ditropan XL), darifenacin (Enablex), trospium chloride (Sanctura), and solifenacin succinate (VESIcare) 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 large doses may cause blurred vision, constipation, a fast heartbeat, headache, and flushing.

artificial sphincter

Artificial sphincter

Surgical Treatments

Surgical treatments can help men with incontinence that results from nerve-damaging events, such as spinal cord injury or radical prostatectomy.

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.

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.

artificial sphincter

urinary diversion

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: 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 and 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 after effects of prostate cancer treatment have organized support groups. Other organizations to help people with incontinence exist as well. See the For More Information section.


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