Male Incontinence

Incontinence is a condition that mainly affects women due to effects of childbirth and the menopause on the pelvic floor. However, it is also a common condition in men. Increasingly so with age, with over 10% of men over the age of 65 suffer with a degree of urinary incontinence. This increases the chance of moving into a care home and your chance of suffering with bowel incontinence as well.


What is Male Incontinence?

Incontinence is recognised as the accidental leakage of urine, or faecal matter. It can be an embarrassing condition to suffer with and negatively impact your self-esteem and happiness.

Male incontinence is a growing problem, with 1 in 4 men suffering from urinary incontinence at some point during their life. The NHS estimates that between 3 and 6 million people in the UK have some degree of urinary incontinence; so if you suffer you are not alone.


What Causes Male Incontinence?

For the urinary and bowel systems to function properly, the muscles and nerves must work together in order to hold in urine and faeces, and then release at the right time. Conditions that affect this functionality and thus cause issues with continence include:

  • Weak pelvic floor muscles - Your pelvic floor and its muscles are responsible for supporting your bladder and bowel. If they are weakened, it can lead to the development of a pelvic floor disorder such as incontinence.
  • Diet - Certain drinks, foods, and medications may act as diuretics. Stimulating your bladder and increasing your volume of urine. These include; alcohol, caffeine, carbonated drinks, artificial sweeteners, foods that are high in spice, sugar or acid, and large doses of vitamin C.
  • Age - Aging of the bladder muscle can decrease the bladder's capacity to store urine.
  • Enlarged prostate - Common in older men, incontinence is often a result of enlargement of the prostate gland.
  • Prostate cancer - Incontinence is associated with both untreated prostate cancer, and as a side effect of the treatment for cancer.
  • Chronic cough - Persistent coughs, brought on by smoking or lung conditions, cause strain to your pelvic floor muscles and can weaken them over time.
  • Obesity - Extra weight on your midsection can place unnecessary pressure on your bladder and pelvic floor. This extra weight is multiplied when you begin exercising - so it is best to maintain a healthy weight.
  • Lack of physical activity - Although being active may increase urine leakage short term, being inactive leads to weight gain and decreases overall strength. This results in urinary incontinence symptoms worsening.
  • Bladder or urinary tract infections - Infections can irritate your bladder and cause you to have a strong urge to urinate leading to urge incontinence.
  • An obstruction in the urinary tract - A tumour within your urinary tract can block the regular flow of urine, leading to an overflow of incontinence. Urinary stones (hard masses that form in the bladder) can sometimes cause urine leakage.
  • Neurological disorders - Diseases such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis can interfere with your brain's ability to properly signal your bladder and urinary tract.

To learn more about the importance of the male pelvic floor, visit our page.


What Are The Different Types of Male Incontinence?

Incontinence within men can occur in a variety of forms. These include:

  • Urinary Incontinence - The inability to control bladder movements. This could just be a few drops of leaked urine, or a steady flow throughout the day.
  • Stress Incontinence - Leaking urine when your bladder is under pressure, e.g. sitting, standing, coughing, sneezing etc.
  • Urge Incontinence - A sudden urgency to urinate, and sometimes leaking before you go to the toilet.
  • Nocturia - Frequently needing to urinate, including several times during the night.
  • Post-micturition - Dribbling urine after you have finished urinating.
  • Coital Incontinence - Leakage of urine when sexually aroused.
  • Faecal Incontinence - The inability to control bowel movements.

How is Male Incontinence Diagnosed?

If you experience incontinence, you'll have to make a visit to your GP so that they can determine the type of incontinence affecting you. Try not to be embarrassed when speaking to your GP about your issue, as it is a common problem.

You will have to discuss your medical history in order for your doctor to gain a full perspective as to what could be causing the condition. You may have to give details regarding illnesses, surgeries, fluid intake, medicines (both prescribed and non-prescribed), as well as details about your incontinence.

Your doctor may suggest that you keep a voiding diary (bladder diary) to record your bladder habits for at least three days. This will give your GP a greater insight into your condition. This will include details such as:

  • The amount of fluid you drink
  • The types of fluid you consume
  • How often you need to pass urine
  • The amount of urine that you pass
  • How many episodes of incontinence you experience
  • How many times you experience a sudden urge to go to the toilet.

Your GP may also suggest a physical examination in order to assess the health of your urinary system. This would include your GP checking whether your prostate gland is enlarged. If it is, it can cause symptoms of urinary incontinence.

To learn more about your prostate and the pelvic floor, click here.


The Connection Between Prostate Cancer and Male Incontinence

Prostate cancer and any required surgery to remove the cancer can be a distressing journey both physically and emotionally. Urinary leakage is extremely common following prostate surgery. During removal of the prostate, your main control mechanism may be affected, leading to loss of bladder control.

The pelvic floor, which is responsible for part of your bladder control mechanism, will need to play a huge role to compensate this. Ideally, pelvic floor (Kegel) exercises should be commenced before undergoing pelvic surgery, but they can also help afterwards. It's important to remember that your bladder control can improve over time.


What Treatments are Available for Male Incontinence?

Your form of treatment depends on a variety of factors such as severity, your lifestyle, and your preferences. Many men are able to regain control of their bladder or bowel by changing a few habits and doing exercises to strengthen the muscles that hold urine and stool in. These are a few ways in which your incontinence can be treated:

  • Pelvic floor muscle strengthening exercises - Also known as Kegel exercises, they can help you to rebuild strength and tighten the muscles in your pelvis and urinary tract system that are responsible for urine and faecal functions.
  • Fluid management - Timing your food and drink consumption around your daily activities may help you better control your urge to go to the toilet. Instead of drinking large amounts of fluids at once, try to drink smaller amounts at regular intervals throughout the day.
  • Bladder training - By actively delaying a trip to the toilet when you get the urge, you can train your bladder to gradually increase the amount of urine that it can comfortably hold. Scheduling trips to the toilet may help you to avoid urges, allowing your bladder and urinary tract to grow stronger. This is most effective when supported by a healthcare professional.
  • Male incontinence pads - Absorbent incontinence pads, pants and other products can make life easier for you if you are waiting for diagnosis or for an incontinence treatment to work. They can help improve your situation but are not a treatment and should not be considered as such. If you are wearing incontinence pads for more than a month, then speak to your GP about a permanent solution to your incontinence.

Speak to your GP if you have any queries about male incontinence.


Top Tips for Preventing Male Incontinence

Here are a few ways to reduce the chance of developing incontinence:

  • Do your Kegels - Strengthening your pelvic floor helps to strengthen the muscles that support your bladder. This means that you will be able to better control your bladder and bowel. Also, strong pelvic muscles help your prostate to function better. Kegels are a natural way to strengthen your erection and delay ejaculation! To learn how to exercise male pelvic muscles, visit our page.
  • Shed your weight - Being overweight or obese can increase your risk of developing incontinence problems. You can lower your risk by maintaining a healthy weight through regular exercise and healthy eating.
  • Manage your meal - It's important that your diet contains foods that are rich in fibre, as these help to prevent constipation. Your pelvic floor muscles are severely weakened from constipation due to the excess strain that is put on them.
  • Saddle up - If you ride a bicycle for long periods, make sure that you raise yourself off of the seat at regular intervals. This will help to take pressure off of your perineum. Alternatively, you can consider wearing padding shorts, or investing in special saddles that have been designed to help avoid this problem.
  • Prepare your weakness - If you are about to sit, stand, cough, sneeze, bend, or laugh, ensure you squeeze your pelvic floor muscles as you do so. It may just help in preventing a leakage.

Lower Urinary Tract Symptoms (LUTS)

One in three older men experience LUTS. The symptoms for the condition include nocturia (frequently needing to urinate, including several times during the night) and voiding problems, including straining to urinate, a weak or prolonged urine stream, or after-dribble. However, research has linked LUTS to pelvic floor health. Usually the first-line treatment for LUTS was Flomax Relief (tamsulosin), however, pelvic floor muscle training provide men with the same benefits as the drug.

To learn more about the benefits of pelvic floor exercise, visit Pelvic Floor Exercises for Men.


Sources

Allanda (2018) Incontinence Statistics [online]. Allanda [viewed 30/08/2018]. Available from https://www.allaboutincontinence.co.uk/incontinence-statistics

Hunskaar, S., Lose, et al. (2003) Prevalence of Stress Urinary Incontinence in Women in Four European Countries, 2002. ICS: UKEngstrom, G., et al. (2003) Prevalence of Three Lower Urinary Tract Symptoms in Men - a Population-Based Study. Family Practice. 20(1), pp. 7-10.

Irwin, D., Milsom, I. et al. (2005) Impact of overactive bladder symptoms on employment, social inteactions and emotional wellbeing in six European countries. British Journal of Urology International. 97, 96-100.

Mayo Clinic (2017) Urinary Incontinence [online]. Mayo Clinic. [viewed 02/08/2018]. Available from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

National Kidney and Urologic Diseases Information Clearinghouse (2007) Urinary Incontinence in Men [online]. US Department of Health and Human Services [viewed 02/08/2018]. Available from https://www.niddk.nih.gov/-/media/158A159C54A4449EBCB34985AD8730BC.ashx

NHS (2014) A Guide to the Pelvic Floor Muscles - Men [online]. NHS [viewed 02/08/2018]. Available from https://www.ouh.nhs.uk/patient-guide/leaflets/files/11124Ppelvic.pdf

NHS Choices (2016) Urinary Incontinence [online]. NHS [viewed 02/08/2018]. Available from https://www.nhs.uk/conditions/urinary-incontinence/.

NHS Choices (2016) Urinary Incontinence: Incontinence Products [online]. NHS [viewed 02/08/2018]. Available from https://www.nhs.uk/conditions/urinary-incontinence/incontinence-products/.

Pelvic, Obstetric and Gynaecological Physiotherapy (2015) Pelvic Floor Muscle Exercises and Advice for Men. [online] Chartered Society of Physiotherapy. [viewed 02/08/2018]. Available from www.csp.org.uk/sites/files/csp/secure/pogp-pelvicfloor-male.pdf.

Women's & Men's Health Physiotherapy (2018) Prostate Surgery [online]. Women's & Men's Health Physiotherapy [viewed 02/08/2018]. Available from http://www.wmhp.com.au/mens-pelvic-health/prostate-surgery.