The loss of urine control or the inability to hold urine until the person can reach a toilet. It can range from the slight loss of urine to severe, frequent wetting and may be triggered by a condition such as benign prostatic hyperplasia or prostate cancer. It also is a problem for many men after the removal of the prostate (prostatectomy), and the older the man, the higher the risk of incontinence after prostatectomy.
Urine is formed in the kidneys and then flows down the ureters into the bladder, where it is stored until it is eliminated. Urination is controlled by the urinary sphincter (rings of muscles at the base of the bladder and in the wall of the urethra). The sphincter normally controls the flow and leakage of urine by tightening and closing around the neck of the bladder and urethra. When the bladder is full, the sphincter relaxes and allows urine to leave the bladder. At the same time, the bladder muscles contract and squeeze urine out of the bladder. When a man finishes urinating, the sphincter contracts and the bladder relaxes.
The prostate gland lies directly below the bladder and completely encircles the urethra at the point where it leaves the bladder. When the prostate gland is removed in a radical prostatectomy or when it receives radiation therapy, damage can occur to the urinary sphincter, and can trigger temporary or permanent incontinence. However, when the operation is performed by an experienced surgeon who preserves the urinary sphincter and carefully rebuilds the urinary tract, there is a low risk of total incontinence.
A recent study at a medical center with extensive experience in performing radical prostatectomy reported that 93 percent of patients had complete continence 18 months after surgery. Studies from other health centers report patients had a consistently high rate of continence (between 85 percent and 100 percent) two months to 18 months after radical prostatectomy.
Types of Incontinence
There are several of incontinence: stress incontinence, urge incontinence, overflow incontinence, and functional incontinence.
Stress incontinence is the most common type; in it urine leaks occur when pressure rises in the abdomen, as when a patient laughs, coughs, or bends. Leaking of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder is the most common type of incontinence and can almost always be cured.
Urge incontinence is the inability to hold urine long enough to reach a toilet. It may be a sign of enlarged prostate, although it can also occur in otherwise healthy older men. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson’s disease, and multiple sclerosis, and it can also be a warning sign of early bladder cancer.
Mixed incontinence is a combination of stress and urge incontinence.
Overflow incontinence is leakage of small amounts of urine from a bladder that is always full.
Functional incontinence is difficulty reaching a toilet in time because of physical conditions such as arthritis and is not related to male reproductive cancer.
There are a number of symptoms of urinary incontinence:
- • Leaking of urine that prevents activities, causes embarrassment, and begins or continues after surgery
- • Inability to urinate or retention of urine
- • More frequent urination than usual without a proven bladder infection
- • Need to rush to the bathroom
- • Pain related to filling of the bladder
- • Pain related to urination without a proven bladder infection
- • Frequent bladder infections
- • Progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying
Treatment of incontinence depends on its type, cause, and severity, in general, the problem can be treated and often cured. When treatment is not completely successful, management plans can help reduce complications, anxiety, and stress.
First, a man who is experiencing incontinence problems should see a doctor for a complete medical examination, a detailed personal and family history of health and related problems, a physical examination that focuses on the urinary and nervous systems and reproductive organs, and urine samples. In many cases, patients are then referred to a urologist.
Treatment may include behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training; medication; or surgery if the incontinence is related to a structural problem such as an enlarged prostate.
Incontinence also may be managed by inserting a catheter into the urethra and collecting the urine in a container. An alternative to the catheter for men is an external collecting device that fits over the penis and connects to a drainage bag.
In addition, special absorbent underwear can be worn easily under clothing.