Condition Overview

What is urinary incontinence in men?

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

Urine is made by the kidneys and stored in a sac made of muscle, called the urinary bladder. A tube called the urethra leads from the bladder through the prostate and penis to the outside of the body. Around this tube is a ring of muscles called the urinary sphincter. As the bladder fills with urine, nerve signals tell the sphincter to stay squeezed shut while the bladder stays relaxed. The nerves and muscles work together to prevent urine from leaking out of the body.

When you have to urinate, the nerve signals tell the muscles in the walls of the bladder to squeeze. This forces urine out of the bladder and into the urethra. At the same time the bladder squeezes, the urethra relaxes. This allows urine to pass through the urethra and out of the body.

Incontinence can happen for many reasons:

• If your bladder squeezes at the wrong time, or if it squeezes too hard, urine may leak out.
• If the muscles around the urethra are damaged or weak, urine can leak out even if you don't have a problem with your bladder squeezing at the wrong time.
• You can also have incontinence if your bladder doesn't empty when it should. This leaves too much urine in the bladder. If the bladder gets too full, urine will leak out when you don't want it to.
• If something is blocking your urethra, urine can build up in the bladder and cause leaking.

Urinary incontinence happens more often in older men than in young men, but it's not just a normal part of aging.

What are the different types of urinary incontinence?

Urinary incontinence can be short-term or long-lasting (chronic). Short-term incontinence is often caused by other health problems or treatments. This topic is about the different types of chronic urinary incontinence:

• Stress incontinence happens when you sneeze, cough, laugh, lift objects, or do something that puts stress or strain on your bladder and you leak urine.
• Urge incontinence is an urge to urinate that's so strong that you can't make it to the toilet in time. It also happens when your bladder squeezes when it shouldn't. This can happen even when you have only a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. But not everyone with an overactive bladder leaks urine.
• Overflow incontinence happens when your bladder doesn't empty as it should and then leaks urine later. This happens when bladder muscles are weak or the urethra gets blocked. These blockages can be related to an enlarged prostate or a narrow urethra.
• Total incontinence happens when you are always leaking urine. It happens when the sphincter muscle no longer works.
• Functional incontinence is rare. It happens when you can't make it to the bathroom in time to urinate. This is usually because something got in your way or you were not able to walk there on your own.

What causes urinary incontinence in men?

Different types of incontinence have different causes.

• Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone. The sphincter may be too weak to hold back the urine. And any extra pressure from sneezing, coughing, or straining can cause urine to leak.
• Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can't hold back the urine. This causes a very strong urge to urinate. Doctors don't know why this happens. But sometimes it can be caused by other urinary problems.
• Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. Over time, the bladder gets so full that pressure builds up and forces the extra urine to move past the blockage and out of the bladder. Overflow incontinence may also happen because of weak bladder muscles.

In men, incontinence is often related to prostate problems or treatments.

Drinking alcohol can make urinary incontinence worse. Taking prescription or over-the-counter drugs such as diuretics, antidepressants, sedatives, opioids, or non-prescription cold and diet medicines can also affect your symptoms.

What are the symptoms?

The most common sign of urinary incontinence is leaking urine from the bladder. Other signs will depend on the type of urinary incontinence you have.

• Stress incontinence: You release a small amount of urine when you cough, strain, lift something, or change position.
• Urge incontinence: The need to urinate is so strong that you can't reach the toilet in time.
• Overflow incontinence: You have the urge to urinate, but you can only release a small amount. And you can't control the constant dribbling of urine.

How is the cause of urinary incontinence in men diagnosed?

Your doctor will do a physical examination, ask questions about your symptoms and past health, and test your urine. Often this is enough to help the doctor find the cause of the incontinence. You may need other tests if the incontinence is caused by more than one problem or if the cause is unclear.

How is it treated?

Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. After your doctor knows what has caused the incontinence, your treatment may include medicines, simple exercises, or both. A few men need surgery, but most do not.

There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.

• Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And don't drink more than one alcoholic drink a day.
• Eat foods high in fibre to help avoid constipation.
• Don't smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Stay at a healthy weight.
• Try simple pelvic-floor exercises like Kegels.
• Go to the bathroom at several set times each day, and wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
• When you urinate, practice double voiding. This means going as much as you can, relaxing for a moment, and then going again.
• Keep track of your symptoms and any leaking of urine with a bladder diary. This can help you and your doctor find the best treatment for you.

If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.

Cause

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.

A man may have one or more types of incontinence, and each type may have a different cause.

• Stress incontinence occurs when the muscle (sphincter) surrounding the urethra opens at an inappropriate time. This can happen when you laugh, sneeze, cough, lift something, or change posture. Stress incontinence can be caused by surgery to treat an enlarged prostate or prostate cancer, radiation therapy to treat prostate cancer, or removal of the prostate.
• Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter. Often the urge is a response to something that makes you anticipate urination, such as waiting to use a toilet, unlocking the door when returning home, or even turning on a faucet. The bladder contractions can be caused by many conditions, including:
  • Urinary tract infection.
  • Bowel problems, such as constipation.
  • Prostatitis, a painful infection of the prostate gland.
  • Certain neurological conditions that affect nerve signals from the brain, such as Parkinson's disease or stroke.
  • Kidney or bladder stones.
  • Blockage due to prostate cancer or benign prostatic hyperplasia (BPH).
  Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.
• Overflow incontinence usually is caused by obstruction of the urethra from BPH or prostate cancer or when the bladder muscles contract weakly or don't contract when they should. Other causes include:
  • Narrowing of the urethra (stricture).
  • Medicines, such as antihistamines and decongestants.
  • Nerve conditions, such as diabetes or multiple sclerosis.
• Functional incontinence is a rare form of incontinence caused by physical or mental limitations that restrict a man's ability to reach the toilet in time.

Symptoms

Your symptoms will depend on the type of urinary incontinence you have.

The main symptom of stress incontinence is the loss of urine while coughing, laughing, lifting, straining, or changing posture.

Symptoms of urge incontinence may include:

• A sudden, urgent need to urinate.
• Sudden accidents in which you lose a large amount of urine.
• The need to urinate frequently, often at night.

Symptoms of overflow incontinence may include:

• A urine stream that starts and stops during urination.
• An accidental release of a small amount of urine.
• A weak urine stream.
• A need to strain while urinating and a sense that the bladder is not empty.
• An urgent need to urinate, often at night.
• Loss of urine while asleep.

What Happens

Urinary incontinence in men is often related to prostate problems. As men age, the prostate gland grows larger, squeezing the urethra and pushing the neck of the bladder out of position. These changes can lead to incontinence. In most cases, incontinence due to prostate enlargement can be cured by medicine or prostate surgery.

But prostate surgery is also a major cause of urinary incontinence in men.

• Short-term (acute) incontinence following prostate surgery may go away with time, especially for younger men. In some cases, the incontinence may last up to a year.
• Stress incontinence is a common complication following prostate removal (radical prostatectomy) or radiation treatment for prostate cancer, though it is becoming less common with improving surgical techniques.
• Some treatments for an enlarged prostate (benign prostatic hyperplasia, or BPH) can also cause incontinence, but this is uncommon.

If your incontinence is not related to prostate surgery and it appears suddenly, it will usually clear up after you have received treatment for whatever is causing the incontinence. For example, incontinence related to a urinary tract infection, prostatitis, or constipation will most likely disappear when the infection or condition is cured.

For some men, incontinence may have more than one cause.

What Increases Your Risk

Many things have been associated with an increased risk of urinary incontinence in men. Incontinence may be the result of various health conditions or medical treatments, or it could be caused by family history or lifestyle. In some men, things from more than one of the lists below can combine to cause incontinence.

Physical conditions or lifestyle factors that may make urinary incontinence more likely include:

• Age-related changes, including decreased bladder capacity and physical frailty.
• Smoking tobacco.
• Injury to the bladder or urethra, such as from radiation therapy or prostate surgery.
• Bladder infection or prostatitis.
• Obesity.
• Structural abnormalities of the urinary tract.

Medicines and foods that may make urinary incontinence worse include:

• Caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
• Alcohol beverages.
• Prescription medicines that increase urine production, such as diuretics, or relax the bladder, such as anticholinergics and antidepressants.
• Other prescription medicines, such as sedatives, opioids, and calcium channel blockers.
• Non-prescription medicines, such as diet, allergy, and cold medicines.

Several diseases or conditions may increase your risk of urinary incontinence, including:

• Neurological conditions such as Alzheimer's disease, Parkinson's disease, stroke, diabetes, spinal injury, and multiple sclerosis.
• Bladder cancer.
• Chronic bronchitis.
• Interstitial cystitis.
• Anxiety and depression.

When To Call

Call your doctor now if your urinary incontinence does not go away or you also have:

• Weakness or numbness in your buttocks, legs, and feet.
• Fever, chills, and belly or flank pain.
• Blood in your urine or burning with urination.
• A change in your bowel habits.

Call your doctor if:

• Your incontinence gets worse.
• Leaking urine is enough of a problem that you need to wear a pad to absorb it.
• Incontinence interferes with your life in any way.
• You have incontinence that begins suddenly (acute). Acute incontinence is often caused by urinary tract problems or medicines. It can be easily corrected.
• You have a sudden change in your ability to urinate and you aren't sure if it's related to your urinary incontinence.

Watchful waiting

If home treatment does not control your problem, or if incontinence interferes with your lifestyle, ask your doctor to recommend a treatment.

Examinations and Tests

The first steps your doctor will take to learn the cause of your urinary incontinence are a medical history and a physical examination. The physical examination will include examination of the penis, the prostate, and the nervous system. The history and examination, along with routine diagnostic tests such as a urinalysis, often provide enough information to determine the cause of the incontinence and enable your doctor to start treatment.

Your doctor may ask you to keep a voiding log, which is a record of the amount of liquids you drink and how much and how often you urinate.

Tests that may be done to determine the type and cause of your urinary incontinence include:

• Urinalysis and urine culture, which may be done to learn whether a urinary tract infection (UTI) or prostatitis is present or whether there is blood or sugar in your urine.
• Cough test to check for urine leakage while coughing.
• Urodynamic tests, which could include:
  • Uroflowmetry. The uroflowmetry test measures the rate of urine flow during urination. During the test, a flow curve will be charted to determine the peak flow rate. A low peak flow rate may be suggestive of an obstruction or a weak bladder causing the incontinence.
  • Pressure flow studies, which measure pressures produced in the bladder as the flow changes. Pressure studies may help distinguish between urinary symptoms caused by obstruction and those caused by a problem affecting the bladder muscles or nerves. This test is often used when the cause of a man's symptoms is uncertain.
  • Residual urine determination. Your doctor may measure your post-void residual volume by inserting a thin tube (catheter) into your bladder or by using a bladder ultrasound scan immediately after you have urinated.
• Cystometrogram (CMG). This test evaluates your bladder's ability to store and release urine.
• Electromyogram (EMG), which is used to record the electrical activity of muscles.

Your doctor may conduct a cystoscopic examination (a test that allows your doctor to see inside the urinary tract) to rule out other causes of incontinence.

Further tests may be required if the first treatment for incontinence has failed. Other tests may also be needed if you have had previous prostate surgery, radiation therapy, or frequent urinary tract infections, or if a catheter cannot be easily placed into your bladder.

Tests such as cystourethrogram, an X-ray taken of your bladder and urethra while you are urinating, are not often used to evaluate incontinence, but they may be helpful. If your doctor wants to do one of these tests, ask whether the test is needed to diagnose your type of incontinence.

Treatment Overview

The treatment you and your doctor choose will depend upon what type of urinary incontinence you have and how much you are bothered by your symptoms.

If there is no infection or cancer or other cause that could only be cured by surgery, treatment for incontinence proceeds in stages.

• Behavioural strategies are tried first for all types of incontinence. These include reducing the amount of liquids you drink, eliminating caffeinated and carbonated drinks, and setting a schedule for urinating. See Home Treatment for more information.
• Exercise on a regular basis is important for physical and emotional health. Some men with urinary incontinence stop exercising because they fear that it will cause leakage. But regular exercise is important and can help you manage stress and keep your muscles in tone.
• Continence products such as absorbent pads or diapers, incontinence clamps, and pressure cuffs may be used if you are progressing through a different treatment and are waiting to see whether your incontinence goes away or if other methods of treatment have failed. But these products should only be used along with a more specific treatment, since they can hide a more serious condition that may be curable.
• Medicines may be prescribed, depending on the cause of your incontinence.
  • Antispasmodics and anticholinergics may be prescribed to relax the bladder (for urge incontinence).
  • Antibiotics may be prescribed for incontinence caused by infection.
• Self-catheterization may be tried if you have overflow incontinence from a weak bladder or blockage or if surgery is not the best option for you.
• Surgery is usually considered when it is the only treatment that can cure the incontinence, such as when the condition is caused by a bladder obstruction.

What to think about

Many men who have urge incontinence or overflow incontinence also have an enlarged prostate gland (benign prostatic hyperplasia). They may want to talk to a doctor about medicine, surgery, or other treatment to relieve their symptoms. For more information, see the topic Benign Prostatic Hyperplasia (BPH).

Urinary incontinence can be a problem following treatment for prostate cancer, including radiation therapy and removal of the prostate.

Treatment will be different for men who have total incontinence or who cannot comply with or tolerate specific treatments because of a serious illness or disease.

Prevention

You may reduce your chances of developing urinary incontinence by:

• Limiting caffeine and alcohol.
• Getting to and staying at a healthy weight.
• Quitting smoking.
• Avoiding constipation by eating a healthy, high-fibre diet.
• Doing Kegel exercises to strengthen the muscles that control the flow of urine.

Self-Care

In many cases, behavioural changes, including changes to your diet, lifestyle, and urinary habits, can be enough to control urinary incontinence.

The following changes to diet and lifestyle may help reduce incontinence:

• Reduce or eliminate caffeinated and carbonated drinks—such as coffee, tea, and soda pop—from your diet.
• Do not drink more than one alcohol drink a day.
• Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, spicy foods, dairy products, and aspartame—and eat less of those foods.
• If you smoke, quit.
• Avoid constipation:
  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre.
  • Drink enough fluids. Don't avoid drinking fluid because you are worried about leaking urine.
  • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.^{footnote 1}
  • Take a fibre supplement with psyllium (such as Metamucil). Read and follow all instructions on the label.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
• If you are overweight, try to lose some weight. Remember that effective weight-loss programs depend on a combination of diet and exercise.
• Try pelvic floor (Kegel) exercises to strengthen your pelvic muscles.

The following changes to urinary habits may help reduce incontinence:

• Set a schedule for urinating every 2 to 4 hours, regardless of whether you feel the need.
• Practice "double voiding" by urinating as much as possible, relaxing for a few moments, and then urinating again.
• If you have trouble reaching the bathroom before you urinate, consider making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures). Or keep a urinal close to your bed or chair.

Talk with your doctor about all the medicines you take, including non-prescription medicines, to see whether any of them may be making your incontinence worse. Medicines that may cause urinary incontinence in men include certain antidepressants, sedatives, and even some allergy and cold medicines.

Medicines

Although some types of long-term (chronic) incontinence may be treated with medicine, the likelihood that medicines will improve your incontinence depends on the severity and cause of the problem. Some medicines that are used to treat incontinence may actually make the condition worse in men whose incontinence is caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consulting with a urologist is an important part of incontinence care.

Medication choices

• For overflow incontinence: If incontinence is caused by an enlarged prostate, medicines to treat benign prostatic hyperplasia may be prescribed. But these medicines don't always improve incontinence. For more information, see the topic Benign Prostatic Hyperplasia (BPH).
• For urge incontinence:
  • Anticholinergic and antispasmodic medicines, such as oxybutynin and tolterodine, calm the nerves that control bladder muscles and increase bladder capacity.
  • Alpha-blocker medicines, such as alfuzosin and tamsulosin, relax the muscles in the prostate and bladder.
  • The antidepressant medicine duloxetine may help with bladder control.
  • Botox (botulinum toxin) may be an option when other medicines don't work. A Botox shot helps relax the bladder muscles.
• For stress incontinence: The antidepressant medicine duloxetine may help with bladder control.

What to think about

For men with stress incontinence or urge incontinence, behavioural methods of treatment such as bladder training techniques are used in combination with medicine.

Surgery

If your urinary incontinence has not improved after you have tried behavioural methods and medicine, and if your doctor thinks surgery will be an effective treatment, you may choose to have surgery rather than live with your symptoms. In some cases, such as when a bladder outlet obstruction is affecting kidney function, surgery may be the only way to treat the problem that is causing the incontinence.

Surgery may be appropriate for men who:

• Have ongoing (chronic) incontinence.
• Have severe symptoms and total incontinence.
• Are extremely bothered by their symptoms.
• Have problems with urinary retention.
• Have moderate to severe blood in the urine (hematuria) that is recurrent (keeps coming back).
• Have recurrent urinary tract infections.

Overflow incontinence caused by enlargement of the prostate (benign prostatic hyperplasia, or BPH) is the form of incontinence most often treated with surgery.

Stress incontinence caused by removal of the prostate gland because of prostate cancer or an enlarged prostate may also be treated with surgery, if the incontinence isn't cured after a period of watchful waiting.

Surgery choices

If overflow incontinence is caused by benign prostatic hyperplasia (BPH), prostate surgery may relieve the incontinence. For more information about surgery options and treatment for BPH, see the topic Benign Prostatic Hyperplasia (BPH).

Surgery for severe stress incontinence that does not improve with behavioural methods includes:

• Artificial sphincter, which is a device made of silicone rubber that fits around the urethra (the tube that carries urine from your bladder to the outside of your body) and can be inflated or deflated to control urination.
• Urethral bulking, which involves injecting material around the urethra to control urination by either closing a hole in the urethra or building up the thickness of the wall of the urethra.
• Bulbourethral sling, which may be considered as a treatment for severe urinary incontinence that results from prostate surgery. In this procedure, a sling is placed beneath the urethra to support it and is attached to either muscle tissue or the pubic bone. The sling compresses and elevates the urethra, giving the urethra greater resistance to pressure from the abdomen.
• Sacral nerve stimulation (SNS). In SNS, the doctor puts an electrical stimulator under your skin above your buttocks. This stimulator looks like a pacemaker. It is attached to electrodes that send pulses to a nerve in your lower back (sacrum). The sacral nerve plays a role in bladder storage and emptying.

Severe urge incontinence may be treated with surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

What to think about

Surgery usually isn't considered for urinary incontinence unless it is the only reasonable way to cure it or after attempts to treat the problem with conservative measures or other treatment have failed. The decision to have surgery must always be based on an accurate diagnosis and realistic expectations for the surgery.

Factors that increase the chances that surgical treatment will fail to correct incontinence include obesity, long-term (chronic) cough, radiation therapy, age, poor nutrition, and strenuous physical activity.

Other Treatment

Treatment other than surgery or medicine may be used to treat urinary incontinence.

• For stress incontinence, biofeedback, a technique that helps you learn to control a specific body function, may be an option for some men who have stress incontinence or urge incontinence.
• For urge incontinence, behavioural therapies such as biofeedback and bladder training can be used to treat urge incontinence.
• For overflow incontinence, some men may require intermittent self-catheterization. During this procedure, a catheter is inserted into the bladder, usually 3 or 4 times a day.

Other treatment choices

• Catheterization may be used to treat severe incontinence that cannot be managed with medicines or surgery. Catheters don't cure incontinence but rather allow you or a caregiver to manage incontinence.
  • Intermittent self-catheterization is done with a thin, flexible, hollow tube (catheter) that is inserted through the urethra into the bladder, allowing the urine to drain out.
  • Indwelling catheterization uses a catheter that remains in place continuously. For more information, see the topic Care for an Indwelling Urinary Catheter.
  • Condom or Texas catheter uses a special condom that can be attached to a tube for short-term use. The condom, placed over the penis, keeps the tube in place. The tube allows the urine to drain out.
• Behavioural therapies, including biofeedback and pelvic muscle exercises, are used to treat urge and stress incontinence.
• Continence products such as absorbent pads or diapers, incontinence clamps, or pressure cuffs may be used to manage any form of incontinence. Some of these products absorb leaked urine and some put pressure on the urethra to help prevent urine from leaking.

What to think about

Men often use absorbent products, such as pads or diapers, when other methods of treating incontinence have failed or cannot be used. Some men may prefer to use absorbent products rather than taking medicines or having surgery. They may also use absorbent products after surgery for prostate cancer, while they are waiting to see if their incontinence goes away. This method doesn't treat the incontinence but instead manages the problem. In general, absorbent products should only be used along with a more specific treatment, because use of absorbent products can hide a more serious condition that may be curable.