Urinary incontinence in men is a common condition among the elderly, impacting daily life and activities. This article explores its key causes and treatment options in Turkey.
Urinary incontinence in men
Urinary incontinence is defined as the loss of the bladder’s ability to store urine properly, resulting in unintentional leakage of urine through the urethra.
Incontinence is not a disease in itself but a symptom of a urinary tract issue.
Statistics indicate that 3.4 million men in the United States suffer from urinary incontinence and face difficulties in coping with society, and a Swedish study indicates that the prevalence of urinary incontinence in men is estimated at 22.6% compared to 49.0% in women.
There are several types of urinary incontinence in men and women, some of which are more common in men than in women, and the condition becomes more common with age, but it is not inevitable and is usually treatable.
Urinary incontinence needs serious medical treatment when it affects daily activities and hinders the owner from performing his work, some simple changes in daily behaviors and diet may be enough to treat the symptoms of urinary incontinence and may require special medical procedures in order to treat urinary incontinence in men.
Symptoms of urinary incontinence
Urinary incontinence is itself a symptom of another issue or underlying disease. Urinary incontinence may be short-term, indicating a pathological or therapeutic lesion, or it may be long-term (chronic), characterized by its gradual onset.
There are types of urinary incontinence that may cause distinctive symptoms in addition to involuntary urinary leakage, including chronic urinary incontinence:
- Stress incontinence: Occurs when external pressure on the weakened bladder is the cause of urine leakage. External pressure may come from coughing, sneezing, laughing, or lifting heavy objects.
- Urge incontinence: When you feel a sudden urge to urinate frequently, you may not be able to make it to the bathroom in time, and your bladder contracts on its own, leading to involuntary urine leakage.
- Mixed incontinence: This type of incontinence combines urge incontinence with urge incontinence.
- Overflow incontinence: This is characterized by the desire to urinate, but you can only urinate a small amount of urine, resulting in failure to empty the bladder and subsequent leakage of urine due to a blockage or obstruction of the bladder outlet, as in prostate enlargement.
- Functional incontinence: This type of incontinence is caused by a physical or mental abnormality that prevents you from getting to the restroom in a timely manner.
Studies have shown that only one in five men with urinary incontinence symptoms seek medical attention and that despite the availability of appropriate treatments, only half as many men seek care as women with urinary incontinence.
Causes of urinary incontinence in men
Different types of urinary incontinence have different causes. Some daily habits, underlying diseases, or physical problems may lead to urinary incontinence in men. The most common causes of urinary incontinence in men include:
Problems related to the prostate
The most common cause of urinary incontinence in men is prostate issues and the operations needed to treat them, as the prostate increases in size with age.
The prostate is often enlarged due to benign prostatic hyperplasia (BPH) in middle-aged men and may be enlarged due to prostate cancer (the most common cancer in men), especially in older ages.
When the prostate enlarges, it presses on the urethra, affecting the flow of urine and causing poor urine flow, polyuria, leakage, incontinence, and overflow.
Urinary incontinence in men can be caused by damage or weakness in the urinary sphincter after prostatectomy, resulting in stress incontinence that is triggered by increased pressure on the bladder.
Urinary incontinence after prostate surgery may be temporary, but in other cases, urinary incontinence persists and requires special care to treat.
If the prostate is enlarged, we recommend treating it with prostatic artery embolization or Holmium laser to prevent future incontinence.
Conditions that lead to neurological damage
Nerves alert a person when their bladder is full and control the work of the bladder muscle and urinary sphincters, so normal urination requires the integrity of both nerves and muscles, and any disease or damage to them can result in urinary issues.
This includes neurological damage:
- Parkinson’s disease
- Alzheimer’s disease
- cerebral infarction
- Diabetes
- Multiple sclerosis
- Disc or nucleus pulposus herniation
- Spinal cord injuries
- Dementia
- Cutting the nerves that supply the bladder and sphincters during surgery (especially prostate surgery)
Urinary issues associated with nerve damage vary depending on the location of the damage. Urge incontinence or overflow incontinence may occur, and a condition called overactive bladder may result; that is, the bladder involuntarily contracts and is no longer under the patient’s control.
Talk to your doctor to find out the exact neurological causes.
The amount and quality of fluids you drink
Certain types of drinks can stress the urinary system; coffee and alcohol have a diuretic effect, for example, and limiting their consumption can help you have better bladder control.
However, drinking fluids is essential for maintaining a healthy urinary system, but only if you don’t overload your body with fluids, as this can exacerbate bladder control issues.
Weight status
Being overweight can exacerbate urinary incontinence. When fat accumulates in the body, the bladder will feel more pressure, making the obese person feel the need to urinate more often and unable to hold urine for long periods of time.
How to diagnose urinary incontinence in men in Turkey
The doctor will ask you about your history and your current symptoms, as well as perform a clinical examination and some urine tests, usually enough to help the doctor reach a diagnosis and figure out the type and cause of your incontinence.
Your doctor may ask you to record how much fluid you drink, when and how often you urinate, and estimate the amount of urine each time for several days, and it’s important to mention to your doctor if you experience urinary urgency or incontinence and can’t make it to the bathroom in time.
To confirm the type of incontinence you have and to check for urinary tract obstruction, your doctor may need to measure your urine output with special devices that measure the maximum flow of urine and the average flow rate, and then calculate the amount of urine and the amount that remains in the bladder after urination (urinary dribbling).
Urinary incontinence treatment for men in Turkey
The treatment of urinary incontinence in men depends mainly on the cause and type of incontinence. Treatment may include changes in daily life, medications, or both. In some cases, modern methods or surgeries are recommended.
Behavioral changes in daily life to treat urinary incontinence for men
Your doctor may advise you to:
- Go to the restroom several times a day and do not hold urine for long periods of time, choose to wear clothes that can be removed easily and pave the way to the restroom so you can get to it quickly before urine leaks out.
- Drinking enough fluids and following a healthy diet will help you lose weight and regain bladder control, choose healthy natural drinks and stay away from sodas, alcohol, coffee and tea.
- Train your bladder by holding urine and preventing it from leaking out after feeling urinary urgency. Try starting with ten minutes and gradually increasing the duration. This will help you lengthen the time between the urge to urinate and the leakage of urine so that you can get to the bathroom before you wet your clothes.
- Kegel exercises may help strengthen the pelvic floor muscles that help with urinary incontinence. This method is particularly effective for stress incontinence but may be useful for urge incontinence.
- Use a diary to record your daily urination and the symptoms that accompany urination and incontinence if it occurs. Doing so will help your doctor choose the best treatment for incontinence if changes in daily habits are not enough to treat your incontinence.
Pharmacological treatment of urinary incontinence
Pharmacologic treatments are often ineffective in treating stress incontinence, but there are several medications that are used to treat urge incontinence.
Urinary incontinence medications for men include the following:
- Anticholinergics: This drug class includes several medications, such as oxybutynin, that calm an overactive bladder and can be helpful in urge incontinence.
- Mirabegron: This drug relaxes the muscle of the bladder, increasing its ability to absorb urine and increasing the amount of urination, which helps to empty the bladder better, this drug is used in the treatment of urge incontinence in particular.
- Alpha blockers such as tamsulosin: They relax the bladder neck muscles and muscle fibers in the prostate making it easier to empty the bladder, alpha blockers are used to treat urge incontinence and overflow incontinence in men with enlarged prostates.
We advise against following people who talk about treating male urinary incontinence with herbs, as there is still no single piece of evidence that they work.
New techniques to treat urinary incontinence in men in Turkey
These non-surgical treatments are useful in treating types of incontinence, including:
- Electrical stimulation for urinary incontinence for men
Electrical stimulation via electrodes placed temporarily in the rectum to strengthen the pelvic floor muscles, gentle stimulation may be effective in treating stress incontinence and urge incontinence, this procedure must be repeated several times over a period of months.
- Bulking agents
It is an endoscopic procedure in which synthetic materials are injected under the lining of the urethra to narrow the lumen and help hold urine and prevent leakage, so it is used in the treatment of stress incontinence.
This procedure can be performed on an outpatient basis and does not require any incisions, but it has limited success compared to other more invasive procedures such as surgery and can be repeated more than once.
- Botulinum Toxin Type A (Botox)
It can be injected into the bladder muscle to help relax it; this procedure may be useful for those with an overactive bladder or urge incontinence and is often used when other treatments have failed.
- Sacral nerve stimulation
Sacral nerve stimulation, also known as sacral neuromodulation, is indicated when urge incontinence is caused by overly frequent contraction of the bladder muscle (neurogenic bladder).
The sacral nerves control the contraction of the bladder muscle. When these nerves are stimulated with moderate electrical impulses, the contraction of this muscle is affected, preventing urinary incontinence.
In this procedure, a small device (neurotransmitter) is implanted under the skin of the lower back near the location of the sacral nerves, and the device sends electrical signals to these nerves.
Surgical treatment of urinary incontinence in men in Turkey
If other non-invasive procedures fail, surgery can be used as a last resort. Surgical procedures to treat urinary incontinence in men include two types of procedures, and studies have shown that both procedures have improved the symptoms of urinary incontinence:
Male sling treatment for urinary incontinence in men
The doctor uses tissue or synthetic material to create a buttonhole that surrounds the urethra and bladder neck, which helps keep the urethra closed during coughing or sneezing.
The male sling provides greater urinary continence in patients with mild incontinence, and this minimally invasive technique can be performed and discharged on the same day for most patients.
Artificial urinary sphincter
An artificial sphincter implant is the gold standard treatment for male incontinence and is effective in treating moderate to severe incontinence.
In this procedure, a small, fluid-filled ring called a cuff is implanted around the bladder neck to keep the urinary sphincter closed until you need to urinate.
When urinating, the patient presses the valve of a pump implanted under the scrotal skin to empty the ring of fluid and allow his urine to exit the bladder, the fluid travels and collects in a cistern temporarily until the patient finishes urinating and then returns to fill the ring and close the sphincter again.
Tools and products for urinary incontinence in men
When all of the above treatments fail to stop urinary incontinence, you can use special products to alleviate the discomfort and embarrassment associated with urine leakage, including:
- Protective diapers and pants are underwear specially designed to absorb urine leaking from incontinence, and it is noted that this product does not stop incontinence, but it helps to live with it and prevent urine from reaching the outer clothing.
- Catheters: Catheters help to empty the bladder completely, so doctors recommend using this tool in the presence of urinary urgency after urination, where a flexible tube is inserted through the urethra several times a day to drain urine from the bladder. The patient must be aware and familiar with the method of applying the catheter for safe use.
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