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What is urinary incontinence in men?

Urinary incontinence is the accidental release of urine. It is not a disease but rather a symptom of a problem with a man’s urinary tract.

Urine is produced by the kidneys and stored in a muscular sac called the urinary bladder. A tube called the urethra, which is surrounded by a special ring of muscles called the urinary sphincter, leads from the bladder through the prostate and penis to the outside of the body. As the bladder becomes filled with urine, complex nerve signals ensure that the sphincter stays contracted and the bladder stays relaxed. This interaction between nerves and muscles prevents urine from leaking out of the body.

During urination, nerve signals cause the muscles in the walls of the bladder to contract, forcing urine out of the bladder and into the urethra. At the same time the bladder contracts, nerve signals cause the muscles surrounding the urethra to relax, allowing urine to pass through and out of the body.

Incontinence may occur if the bladder suddenly contracts or if it doesn’t contract when it should, leading to a buildup of too much urine in the bladder, which can cause leakage. Incontinence may also occur if the muscles around the urethra are damaged or suddenly relax or if the urethra is blocked, keeping urine from draining properly and causing eventual leakage around the blockage.

Incontinence affects 13 million Americans and occurs twice as often in women as in men.¹ Although incontinence occurs more often in older men than in young men, it is not considered a normal part of the aging process.

How is urinary incontinence in men classified?

Urinary incontinence may occur for only a short time (acute) or may become an ongoing problem (chronic). Acute incontinence is often related to other medical problems and treatments. This topic will focus on types of chronic urinary incontinence.

• Stress incontinence occurs when you sneeze, cough, laugh, lift objects, or do other activities that increase stress on your bladder.
• Urge incontinence is an urge to urinate that is so strong that you often cannot make it to the toilet in time. Urge incontinence occurs when your bladder contracts when it shouldn’t. This can happen even when you only have a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.
• Overflow incontinence is leakage that occurs when the bladder fails to empty properly, due to a blockage or weak bladder muscle contractions. Obstruction is usually related to either enlargement of the prostate or narrowing of the urethra from scar tissue.
• Total incontinence is a continual leakage of urine due to loss of sphincter function.

Functional incontinence is a rare form of urinary incontinence related to physical or mental limitations that restrict a man’s ability to reach the toilet in time.

What causes urinary incontinence in men?

Urinary incontinence occurs when the muscle (sphincter) that holds your bladder’s outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull. In men, urinary incontinence often is related to a problem or a treatment involving the prostate gland, such as enlargement of the prostate (benign prostatic hyperplasia, or BPH).

• Stress incontinence may develop when a man’s prostate gland is removed and there has been dysfunction of or damage to the nerves or the sphincter, resulting in inadequate support for the lower bladder (bladder neck). The sphincter must then do all the work of maintaining continence, and the extra pressure (stress) of sneezing, coughing, or straining forces urine past the sphincter and through the urethra.
• Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter, causing an irresistible need to urinate. In many cases, the cause of urge incontinence and overactive bladder cannot be determined, but sometimes it can be traced to urinary tract infections, early BPH, interstitial cystitis, or early bladder cancer.
• Overflow incontinence is usually caused by a blockage of the urethra that forces urine to build up in the bladder. Often the blockage stems from an enlarged prostate gland (benign prostatic hyperplasia) or a narrowing of the urethra. Eventually the pressure from the full bladder forces excess urine past the obstruction. Overflow incontinence may also occur because of muscle weakness of the bladder.

Urinary incontinence can sometimes be aggravated by drinking alcohol or by taking diuretics, antidepressants, sedatives, narcotics, or nonprescription cold or diet medicines.

What are the symptoms?

The main symptom of urinary incontinence is the accidental release of urine. Additional symptoms will vary depending on the type of urinary incontinence.

• Stress incontinence: Unintentional release of a small amount of urine occurs with coughing, straining, lifting, or changing posture.
• Urge incontinence: The need to urinate is so strong that you cannot reach the toilet in time.
• Overflow incontinence: You have uncontrolled dribbling of urine, or you have the urge to urinate but can only release a small volume of urine.

How is urinary incontinence in men diagnosed?

Your medical history and a physical examination, along with some simple diagnostic tests such as a urinalysis, often provide enough information for your health professional to determine the cause of your incontinence. Additional tests called urodynamics may be needed if the incontinence is caused by more than one problem or if the cause is unclear.

How is it treated?

Incontinence is usually treatable with medicines, specific exercises, or surgery, after a health professional has determined what is causing the problem. Treatment varies based on the type of incontinence and how much it is affecting your life.

Incontinence can be an embarrassing problem, and men are sometimes reluctant to seek help. Some men might find it more of a problem than others and choose more aggressive treatment. Most men don’t require surgery to treat their symptoms. All men with symptoms of urinary incontinence should see their health professional.

Treatment Overview

Catheters used to manage urinary incontinence include:

• Standard catheter. This is a thin, flexible, hollow tube that is inserted through the urethra into the bladder and allows the urine to drain out. The standard catheter is used for intermittent self-catheterization.
• Indwelling Foley catheter. This type of catheter, which remains in place continuously, has a balloon on the end that is inflated with sterile water after the end is inside the bladder. The inflated balloon prevents the catheter from slipping out. Urinary tract infections are more likely to occur with long-term use of an indwelling catheter than with intermittent self-catheterization. For more information, see the topic Care for an Indwelling Urinary Catheter.
• Condom catheter or Texas catheter. This is a special condom that fits over the penis and is attached to a tube that collects urine. Condom catheters are only for short-term use, because long-term use increases the risk of urinary tract infections, damage to the penis from friction with the condom, and urethral blockage.

What To Expect After Treatment

Catheterization may cause some discomfort during the procedure. A condom or Texas catheter does not cause much discomfort, because it is not inserted into the urethra, but indwelling catheters may cause some discomfort while in place.

Why It Is Done

Catheters can be used to treat severe incontinence that cannot be managed with medicines or surgery.

How Well It Works

Catheters do not cure incontinence but rather allow you or a caregiver to manage incontinence.

These devices are effective. But some men find catheters uncomfortable or painful and stop using them.

Risks

Using a catheter increases your risk for:

• Urinary tract infection.
• Damage to the urethra.
• Damage to the skin of the penis.

What To Think About

The use of catheters can be under your control and can be designed to fit into your lifestyle.

Treatment Overview

Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. Men who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.

Bladder training

Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. A health professional will teach a person about the structure of the lower urinary tract and the causes of incontinence.

A voiding schedule is first established. Then you are trained to resist the first urge to urinate and refrain from urinating until the scheduled time. The intervals between scheduled bathroom visits are increased until you can refrain from urinating for several hours.

Biofeedback

Biofeedback is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.

Men with incontinence are taught bladder-sphincter biofeedback methods along with pelvic floor exercises. These techniques record bladder, rectal sphincter, and abdominal pressures as well as electrical activity. As the information is recorded, it is displayed for you. By watching the information, you learn to relax your bladder and abdominal muscles and contract your pelvic floor muscles based on the information displayed.

Learning biofeedback requires practice in a lab or other setting under the guidance of a trained therapist. Home biofeedback units also are available.

Timed voiding

Timed voiding is also called habit training. It is used to treat urge incontinence. It sets a schedule for urinating (voiding) that is determined by your personal habits and does not attempt to increase how long you can wait before having to urinate or to teach you to resist the urge to urinate.

Prompted voiding

Prompted voiding requires a caregiver to prompt the incontinent person to urinate. The goal is to decrease the chance of accidents by making the person aware of the need to urinate periodically. Prompted voiding usually is used in combination with timed voiding for people who are unaware of their bodily functions, such as people who have dementia.

What To Expect After Treatment

See the How Well It Works section below.

Why It Is Done

Behavioral methods may be used to treat urge incontinence.

How Well It Works

Bladder training

• The initial response rates to bladder training are moderate.
• Most people who use bladder training have fewer symptoms of incontinence. Some people completely eliminate their incontinence.

Biofeedback

Biofeedback has been successful in treating men who have urge incontinence following removal of their prostate gland.

Timed voiding

Timed voiding reduced the frequency of incontinence accidents in the majority of the people who used this method.

Prompted voiding

People who use prompted voiding generally have 1 to 2 fewer incontinence accidents per day.

Risks

There are no risks associated with this treatment.

What To Think About

Behavioral methods require a high level of motivation.

Prompted voiding requires a committed caregiver to be successful.

Surgery Overview

An artificial sphincter is a device made of silicone rubber that is used to treat urinary incontinence.

An artificial sphincter has an inflatable cuff that fits around the urethra close to the point where it joins the bladder. A balloon regulates the pressure of the cuff, and a bulb controls inflation and deflation of the cuff. The balloon is surgically placed within the pelvic area, and the control pump is placed in the scrotum.

The cuff is inflated to keep urine from leaking. When urination is desired, the cuff is deflated, allowing urine to drain out.

What To Expect After Surgery

Because these procedures involve abdominal surgery, hospitalization is required.

You will most likely be able to leave the hospital the day after having the surgery.

Why It Is Done

Installation of an artificial sphincter may be done for:

• Urinary incontinence caused by the removal of the prostate.
• Severe continual leakage of urine from the urethra.
• Severe urinary incontinence for which other methods of treatment have failed.

How Well It Works

Artificial sphincter placement is the most reliable treatment for men who have incontinence after prostate removal for cancer.

In cases of severe stress incontinence and persistent leakage, implantation of an artificial sphincter has been successful in relieving incontinence in up to 90% of men.

Risks

Complications with this type of surgery include needing another surgery, or revision, in 27% of cases, in which 5% reported erosion of the part of the urethra surrounded by the artificial sphincter and 3% developed infections.

What To Think About

Because complications may occur, this is a treatment method that generally is reserved for people for whom all other treatment options have failed. Some people may prefer to manage their symptoms with absorbent pads and changes in habits rather than have this surgery.