Sunday, April 15, 2012

Urinary Incontinence in Men during Andropause

Urinary Incontinence in Male and Female

Over a lifespan, there are gender differences in the frequency of urinary incontinence. In childhood, girls usually develop bladder control at an earlier age than boys, and bedwetting (nocturnal enuresis) is less common in girls than in boys. However, adult women are far more likely to experience urinary incontinence because of the anatomy of their urinary tract and the stresses caused by pregnancy and childbirth.

Nevertheless, men may experience urinary incontinence as a result of prostate problems, and both men and women can experience nerve damage that leads to urinary incontinence. Its prevalence increases with age, but it is not an inevitable part of aging.

Male incontinence is a medical problem. To find a treatment that addresses the root of the problem, you need to talk to your healthcare provider.

Bladder Control and Aging

The body stores urine in the bladder. During urination, muscles in the bladder contract or tighten. This forces urine out of the bladder and into a tube called the urethra that carries urine out of the body.

At the same time, muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move. Male incontinence occurs if the bladder muscles contract or the muscles surrounding the urethra relax without warning.

It was found that detrusor contractile function, bladder capacity and urinary flow rates all appear to decline in association with greater age.  There is also an increase in the prevalence of incomplete emptying as demonstrated by the existence of a significant residual volume of urine.

In men, the progressive enlargement of the prostate with age tends to dominate the behavior of the urinary outflow tract, up to half of all men suffering from outflow tract obstruction.  The changes in the bladder associated with prostatic hypertrophy; significant detrusor muscle hypertrophy; a reduction in the number of acetylcholinesterase containing nerves and an increase in the collagen to smooth muscle ratio which causes the bladder to be less compliant have all been demonstrated in association with age alone. Thus it is unclear to what extent prostatic hypertrophy alone may contribute to the observed changes.  However, as obstruction increases, the bladder requires a greater contractile effort to overcome the effects of the obstruction.

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Types of Bladder Problems

The four types of bladder problems in men are:

  • Stress incontinence, caused by weak pelvic and sphincter muscles
  • Urge incontinence (overactive bladder), caused by damaged or irritable nerves
  • Overflow incontinence, that results when an individual is unable to empty the bladder
  • Temporary or reversible incontinence, related to conditions, such as:
    • Urinary tract infection
    • Constipation
    • Delirium.
Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from menopause and andropause may cause this condition. However, this type of urinary incontinence is much more frequent in women.

Urge Incontinence (Overactive Bladder)

With this type of urinary incontinence, you lose urine for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Your doctor might call your condition "reflex incontinence" if it results from overactive nerves controlling the bladder.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower).

Involuntary actions of bladder muscles can occur because of damage to the:
  • Nerves of the bladder
  • Nervous system (spinal cord and brain)
  • Bladder muscles themselves.

Other problems that can harm bladder nerves or muscles include:
  • Multiple sclerosis
  • Parkinson's disease
  • Alzheimer's disease
  • Stroke
  • Injury, including injury that occurs during surgery.

Overflow Incontinence

If your bladder is always full so that it frequently leaks urine, you may have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is one, which is much more frequent in men.

Cause of Male Incontinence

Some of the causes of male urinary incontinence (UI) include: nerve problems and prostate problems.

Nerve Problems

Any disease, condition, or injury that damages nerves can cause male incontinence. Nerve problems can occur at any age, however, the male menopause associated changes may be the trigger for these conditions development.
  • Men who have had diabetes for many years may develop nerve damage that affects their bladder control, as well as their sexual function.
  • Stroke, Parkinson's disease, and multiple sclerosis all affect the brain and nervous system, so they can also cause incontinence.
  • Spinal cord injury can cause incontinence by interrupting the nerve signals required for bladder control.
  • In neural birth defects, such as spina bifida or myelomeningocele, the backbone and spinal canal do not close before birth. In severe cases, nerve damage can result in many problems, including lack of control over urination.
  • Overactive bladder is a condition in which the bladder squeezes at the wrong time. The condition may be caused by nerve problems, or it may occur without any clear cause. A person with overactive bladder may have any two or all three of the following symptoms:
    • Urinary frequency—urination eight or more times a day or two or more times at night
    • Urinary urgency—the sudden, strong need to urinate immediately
    • Urge incontinence—urine leakage that follows a sudden, strong urge.

Prostate Problems

The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra, just below the bladder, where it adds fluid to semen before ejaculation.

  • Radical prostatectomy: The surgical removal of the entire prostate gland -- called radical prostatectomy -- may be recommended to treat prostate cancer. The surgeon may approach the prostate through the abdomen, or through the perineal area (between the scrotum and the anus). The surgery may lead to erection problems and UI, although nerve-sparing procedures in the abdominal approach may make these side effects less likely.
  • External beam radiation: This therapy uses an x-ray machine to deliver radiation to the prostate gland. The treatment is not painful, but can cause side effects, including:
    • Loss of bladder control
    • Fatigue
    • Skin redness and irritation
    • Rectal burning or injury
    • Diarrhea
    • Inflammation of the bladder wall (cystitis)
    • Blood in the urine
    • Loss of sexual function
    • Loss of appetite.
  • BPH: The prostate gland commonly becomes enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra. The bladder wall thickens and becomes irritable, and the bladder begins to contract, even when it contains only small amounts of urine. This results in more frequent urination. BPH rarely causes symptoms before age 40, but more than half of men in their sixties, and up to 90 percent in their seventies and eighties, have some symptoms of BPH. The symptoms vary, but the most common ones involve:
    • Changes or problems with urination, such as a hesitant, interrupted, weak stream
    • Urgency and leaking or dribbling
    • More frequent urination, especially at night
    • Urge incontinence.

Problems with urination do not necessarily signal blockage caused by an enlarged prostate. Other changes associated with aging can cause urination problems experienced by both men and women.

Treatment Options

Today, there are multiple approaches to treat incontinence. The choice of incontinence treatment depends on:
  • The type of bladder control problem you have
  • How serious it is
  • What best fits your lifestyle.
Different treatment options for male incontinence may include:
  • Bladder or habit training.
  • Lifestyle changes, such as losing weight or cutting out certain foods
  • Medications
  • Surgery.
As a general rule, the simplest and safest treatments should be tried first. 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 fiber 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.

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How do you do Kegel exercises?

The first step is to find the right muscles. Imagine that you are trying to stop yourself from passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, those are the right muscles for pelvic exercises.

Some men found that the easiest ways to locate your muscles is during urination. Here’s how:
  • Halfway through urination, try to stop or slow down the flow of urine.
  • Don’t tense the muscles in your buttocks, legs, or abdomen, and don’t hold your breath.
  • When you can slow or stop the flow of urine, you’ve successfully located these muscles.
Other men need biofeedback to help them target the right muscles.

Do not squeeze other muscles at the same time or hold your breath. Also, be careful not to tighten your stomach, leg, or buttock muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Squeeze just the pelvic muscles.

Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This position is the easiest for doing Kegel exercises because the muscles then do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.

Be patient. Do not give up. It takes just 5 minutes, three times a day. Your bladder control may not improve for 3 to 6 weeks, although most people notice an improvement after a few weeks.

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