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For Men Only: The Prostate And Incontinence Question

While many think of urinary incontinence as a woman’s issue, over 2 million men wrestle with it. In men, incontinence often involves the muscle that holds the neck of the bladder closed; you might be unable to hold urine in the bladder because of weakness with this muscle, because the bladder isn’t emptied regularly or because bladder muscles contract strongly. Problems holding in urine may be detrusor hyperreflexia—small bladder capacity—or overflow incontinence. Problems emptying the bladder may indicate Intrinsic Sphincter Deficiency (ISD) or stress incontinence.

It’s important to remember that incontinence is not a disease, but rather a symptom of a problem with your urinary tract. Male urinary incontinence is usually related to a problem with the prostate, like prostate cancer, benign prostatic hyperplasia (BPH) or prostatitis (inflammation) and the treatments used for them, including surgery, radiation therapy and medication.

According to numbers from the experts at the Weill Cornell Medical College department of urology, 350,000 men in the US are diagnosed with prostate cancer every year, 180,000 radical prostatectomies are performed in the US every year and 75 to 85 percent of men report an occasional leak of urine after prostate surgery. The most common type of incontinence men experience after prostate cancer treatment is stress incontinence, the accidental release of urine due to pressure on the bladder from everyday actions like lifting a heavy object or even coughing. BPH is more associated with overflow incontinence, a leakage that occurs when your bladder does not empty properly. The concern over possible incontinence can be so great that some men debate or put off treating prostate cancer or BPH. Not a good idea, especially since treatments are available.

Lifestyle adjustments including behavior therapy (simple changes in habit), possibly in conjunction with medication, may provide the help you’re looking for. Advances in surgical techniques are also offering more innovative solutions.

Here are types of behavioral therapy that you can try:

Biofeedback uses a device that records electrical signals produced when urinary muscles contract. When turned into visual or auditory signals, they can alert you to better control function—to activate weak muscles as needed, relax tense muscles and learn better muscle coordination.

Bladder retraining involves keeping a diary of your bathroom visits and urinary leakage episodes for your urologist to analyze. Your doctor may see certain patterns that can lead you know when to empty your bladder to avoid a leak.

Kegel exercises contract and relax the muscles that make up part of the "pelvic floor"—by strengthening muscle tone, they may work better to avoid leakages.

Other steps to discuss with your urologist are: limiting beverages after dinner, emptying your bladder on a regular, frequent schedule to avoid emergencies, electrical stimulation and external penile clamps to prevent leakage.

What's most effective? A study conducted by researchers at the University of Alabama-Birmingham found that a behavioral therapy program of Kegels, bladder control methods, biofeedback and electrical stimulation of the pelvic floor lowered incontinence episodes by 55 percent among men who were still experiencing urinary incontinence from 1 to 17 years after prostate surgery, and 16 percent achieved complete urinary continence. The study showed that men who still had urinary incontinence a year or more after prostatectomy could improve continence levels.

Some medications may help lessen mild to moderate urinary incontinence. Alpha-1-adrenergic blocking agents like Cardura and Flomax and 5-alpha reductase inhibitors like Avodart and Proscar, used to treat BPH, may in turn improve continence. Anticholinergic agents, like Vesicare and Enablex, decrease involuntary bladder muscle contractions and are helpful with urge incontinence. Tricyclic antidepressants block nerve impulses and reduce urinary muscle spasms and may work on stress incontinence.

Surgical therapies for incontinence are increasing in scope. They include collagen injections near the neck of the bladder to prevent leakage; artificial urinary sphincters that are inflated to hold in urine and then relaxed to allow urine to flow out; and urethral slings, advances that involve surgically inserting a mesh-like material to compress the urethra and reduce leakage of urine.

With more and more options available, there’s no good reason not to talk to your doctor.