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.
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.
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.
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.
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.
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.
Sources
and Additional Information:
