Urinary Incontinence: It’s a Problem for Men, Too.
Contrary to a common myth, incontinence, the involuntary loss of urine, isn’t a condition that affects only women. In fact, in the 7th, 8th and 9th decades of life, more men than women are bothered with this problem as a result of enlarged prostate or treatment for prostate cancer.
Each year in the U.S., 300,000 men undergo surgery for prostate cancer and between 15 percent and 20 percent have problems with incontinence afterwards. About 250,000 men have surgery for prostate enlargement, or benign prostate hyperplasia.
Types of Incontinence
There are two types of incontinence. With stress incontinence, urine leaks during physical activity, such as sneezing or swinging a golf club. With urge incontinence, often called overactive bladder, leakage is associated with an overwhelming need to urinate. Triggers can include running water or the “key in the door” syndrome. Mixed incontinence is when someone has both types of urine leakage.
Causes of Incontinence
Stress incontinence results when the sphincter, the small circular muscle that controls the start and stop of urine, doesn’t function properly. The muscle can be damaged by surgery or radiation therapy that some men undergo as a result of prostate cancer. Less commonly, treatment for benign enlarged prostate can also damage the sphincter so that it doesn’t shut properly. Other physical conditions that can result in incontinence include spinal injuries and multiple sclerosis.
With mild cases, some patients prefer to manage their condition, rather than to seek treatment. Options include wearing pads or diapers and making lifestyle changes, such as limiting fluid intake. Patients are often asked to fill out a questionnaire that asks whether urine leakage affects their daily lives, such as:
- Ability to do household chores (cooking, laundry, housecleaning)
- Physical recreation such as walking, swimming or exercise
- Entertainment activities (movies, concerts, etc.)
- Ability to travel by car or bus more than 30 minutes from home
- Participation in social activities outside your home
- Emotional health (nervousness, depression, etc.)
There are no medications specifically for male stress incontinence. However, some medications designed for other uses, such as Sudafed and some psychiatric drugs, affect the sphincter valve and can improve incontinence.
Other options include the Cunningham clamp, which while inexpensive and easy to use, can be uncomfortable. The device, placed on the penis, closes the urine passage (urethra) that is close to the bottom of the penis. Other options, such as injecting collagen or body fat into the sphincter, last only a short period of time and are effective only about 17 percent of the time.
Surgical options include the male sling and the artificial sphincter. The sling, which has been available for about five years, is implanted during a minimally invasive surgery requiring only three small incisions. This is basically a “hammock” that supports the urethra and restores it to its proper position, to reduce pressure on the sphincter. The ideal candidate is the patient who uses two pads or less per day as a result of incontinence from prostate treatment.
The artificial sphincter is often recommended for patients with moderate to severe incontinence. This device is a “cuff” that fits around the urine passage. The patient squeezes a device implanted in the scrotum to open the valve and allow the passage of urine. All parts of the device are implanted in the body during an outpatient procedure.