Male Urinary Incontinence
What is Male Urinary Incontinence?
Male urinary incontinence is characterised by urine leakage.
It can occur at any age, though it is more common in men over the age of 45-50 and, especially, over 70.
It may be due, among other things, to inherent defects in the urinary sphincter, post-traumatic or post-surgical situations, and bladder pathologies (hyperactive bladder or reduced bladder capacity), or as a consequence of prostate problems (and their repercussions on the bladder).
Risk Factors for Male Urinary Incontinence
Old age
Lower urinary tract symptoms (LUTS)
Infections
Cognitive, functional or neurological changes
Symptoms of Male Urinary Incontinence
Male urinary incontinence may be associated with a series of other urinary symptoms. At 50, around 20–30% of men have LUTS, a percentage that rises to 55% at 80.
LUTS are classified as symptoms of:
- Emptying;
- Storage;
- Post-void urine.
Emptying (obstructive) symptoms are delay in starting urination, urinating effort, reduced strength and calibre of the jet, and the prolonging and intermittency of urination.
The intensity of obstructive symptoms may range from a slight hesitation in early morning urination to acute urinary retention, which has to be resolved urgently via a catheter or suprapubic puncture.
Storage symptoms are the result of either anatomical or functional bladder changes. These are urination need (“urgency” – a sudden urge to urinate), the incontinence associated with this sudden urge, polaquiury (higher frequency of urination) and noctury (a rise in the number of urinations at night).
Post-void symptoms are the sensation of incomplete emptying of the bladder and post-void dribbling.
Diagnosing Male Urinary Incontinence
Male urinary incontinence must be studied carefully and completely to ensure a correct clinical and diagnostic assessment. Given this, the clinical history is analysed, a careful objective exam is conducted (including a DRE to assess the prostate’s characteristics) and a test performed to help understand the origin of the symptoms.
A DRE allows an assessment of:
- Approximate prostate size;
- Texture, surface and consistency of the prostate;
- Regularity, edges and nodules;
- Pain when massaged and anal sphincter tonus.
Abdominal massage also allows detection of the vesical globe in patients with urinary retention or post-void residual urine.
A genital exam is also important, including sensitivity and bulbocavernosus reflex.
Complementary tests, such as uroflowmetry and ultrasound scans (of the bladder, prostate and ideally also of the kidneys), are also essential, and in some cases it is necessary to have a cystoscopy and a complete urodynamic test.
Dr. Daniela Moutinho explains what urinary incontinence is.
Do you Have Any of these Symptoms of Urinary Incontinence?
Treatment of Male Urinary Incontinence
Treatment of this problem depends on the type of incontinence and its severity, cause and evolution.
Some therapies used are conservative and non-invasive; in others, a small procedure is needed to resolve the problem definitively.
Non-Invasive Measures:
- Changes in habits, behaviours and lifestyle;
- Medication;
- Pelvic rehabilitation/re-education. This includes electrostimulation and biofeedback, in addition to classical physiotherapy techniques, such as Kegel exercises (muscle strengthening and postural movements).
Invasive Techniques:
The most common treatments for male urinary incontinence involve a small procedure. They are more effective and definitive than non-invasive techniques. In other words, in each case the pros (greater effectiveness) and cons (a minimally invasive procedure) have to be assessed. These procedures involve anaesthetic, but the patient can be discharged from hospital on the same or next day. The following techniques stand out:
- A bulking injection to coapt/close the urethra, complementing the action of the sphincter – for mild incontinence.
- Insertion of a suburethral sling. Like the procedure for female incontinence, an inflatable or non-inflatable tape is placed under the urethra and through the obturator orifices ("transobturator") to help prevent urine leakage. An example of this technique is the use of the adjustable transobturator male system (ATOMS), which is suitable for moderate incontinence.
- Insertion of an artificial urinary sphincter. This involves placing a device that the patient themself activates whenever they want to urinate, ensuring continence whenever they do not want to. This is designed for more severe cases of incontinence.
Prognosis of Male Urinary Incontinence
Urinary incontinence is a curable condition with a very positive prognosis.
Known treatment options today help patients to significantly improve their quality of life.
Depending on the cause of the incontinence and treatment used, urine leakage ceases right after the treatment (in the case of minimally invasive techniques) or slowly improves over the weeks the selected treatment is applied (when non-invasive techniques like medication or pelvic rehabilitation are used).
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Male Urinary Incontinence
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References
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- Urinary Incontinence - https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808
- What is Urinary Incontinence? - https://patients.uroweb.org/other-diseases/urinary-incontinence/