Overview

Sometimes I feel hopelessly out of control. I can't predict when I'll need to urinate, or if I'll make it to the bathroom in time. *

Do you or a loved one experience embarrassing or troublesome symptoms like leaking or dribbling urine or not being able to hold it? Statistics show you're not alone.

• You may be surprised to learn that urinary incontinence affects more 3 million Japanese.
• At 60 or older, approximately 5% of men are incontinent. ¹
• For those older than 60, 15-30% of non-institutionalized people are incontinent. Fully half of nursing home residents have urinary incontinence. ²

1. Brocklehurst JC. Urinary incontinence in the community--analysis of a MORI poll. BMJ. Mar 1993 27 v.306(6881) p.832-4.
2. Urinary incontinence in adults: acute and chronic management. Clinical practice Guideline Number 2 (1996 update). AHCPR publication No. 96-0682. Mar 1996. website

Urinary incontinence is the medical term used to describe the condition of not being able to control the flow of urine from your body. It usually happens because the bladder sphincter is damaged or scarred and cannot squeeze or close off the urethra. This means urine can leak or flow freely from the bladder.

Within this section, we will explain possible causes and treatment options to help restore continence. If you are suffering in silence, understanding the prevalence, possible causes and treatment options may encourage you to make the first step to resolve your incontinence.

* These comments are based on the chat rooms where patients have shared their experiences. They are not reflective of individual patients, and may not be typical for all users.

Urination Mechanism

The Male Pelvic Area

To learn more about urinary incontinence, it is important to understand how the bladder works normally. In men, the urinary sphincter muscle is located below the prostate. The sphincter muscle surrounds the urethra. When the sphincter muscle tightens, it holds urine in the bladder. When it relaxes, the bladder contracts and the urethra opens, allowing urine to flow outside the body.

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Urinary Incontinence Symptoms

There are a number of signs of incontinence, depending on the type. You may be experiencing involuntary loss of urine during physical activity; a compelling need to urinate with inability to stop leakage long enough to reach a toilet; or continued leakage because the bladder is full beyond capacity.

Ask yourself the following questions:

• Do you leak urine unexpectedly?
• Is the urine leakage:
  • – Mild (a few drops)
  • – Moderate (wet underwear)
  • – Severe (wet outerwear)
• Does the urine loss occur during coughing, sneezing, laughing, bending or lifting?
• Does the urine loss occur when you change from a sitting or lying position to a standing position?
• Do you leak urine continuously?
• Is urine loss a problem to you?
• Has this urine loss caused you to change your lifestyle?
• If you have changed your lifestyle, how?
  • Examples:
  • – I limit the fluids I drink
  • – I stay at home
  • – I limit my choice of clothing to dark colors

If you answered Yes to any of these questions, or if your answers are of concern to you, you are not alone. These questions were designed to allow you to understand the different symptoms that indicate the various types of incontinence. Talk with a doctor to discuss the responses from these questions.

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Urinary Incontinence Causes

Incontinence is not a disease in itself, but rather a symptom or result of some underlying condition. It usually is caused by a damaged sphincter, the circular muscle that controls the flow of urine out of the bladder. When damaged—in men, often due to removal of the prostate to treat cancer—the sphincter cannot squeeze and close off the urethra. This causes the urine to leak.

To determine the type and cause of incontinence, specialists such as urologists take a complete medical history and conduct a variety of tests

Types of Urinary Incontinence

There are five basic types of incontinence. In many cases, individuals experience symptoms of more than one type of incontinence. Proper diagnosis of the type of incontinence is an important factor in successful treatment.

• Stress Incontinence — Occurs when you leak urine during a physical activity like lifting, exercising, sneezing and coughing.
• Urge Incontinence — Occurs when you have an overwhelming need to urinate and are not able to hold urine long enough to reach a toilet
• Mixed Incontinence — A combination of stress and urge incontinence, where you have symptoms of both conditions.
• Overflow Incontinence — When your bladder never completely empties, which causes urine to leak.
• Functional Incontinence — Factors outside the lower urinary tract, such as weaknesses in physical and/or cognitive function, cause this form of incontinence.

Causes of Urinary Incontinence

A variety of factors can result in urinary incontinence. To effectively diagnose and treat urinary incontinence, a doctor must determine the cause.

Removal of the Prostate
Urinary incontinence can occur following prostate surgery. For men, a radical prostatectomy to treat cancer is the most common cause of incontinence.¹ In order to remove the cancer, parts or all of the tissues that help control urine flow may need to be removed. The rate of incontinence following radical prostatectomy surgery ranges from 3% to 60%²,³ Incontinence is less frequent following prostate surgery to treat an enlarged prostate (benign prostatic hyperplasia or BPH). Severe incontinence following prostate surgery occurs in less than 5% of patients.⁴, ⁵ Several factors can affect rates of incontinence following prostate surgery, including age, general health and the amount of prostate and surrounding tissue removed during surgery. Patients often experience incontinence immediately following surgery but the leakage usually stops within weeks or a few months. When incontinence persists beyond a few months, you should consult your doctor.

Infections and Medications
Urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.

Diseases
Causes of chronic incontinence include diseases or conditions that damage or weaken the urinary sphincter muscle. Spinal cord problems such as spina bifida, spinal cord injury and sacral agenesis (malformation of the lower spine) can cause incontinence, as can neurological diseases such as multiple sclerosis, Parkinson's disease, stroke, and diabetes.

1. Blaivas JG. Conquering bladder and prostate problems. New York: Plenum Publishing Corporation, p. 208.
2. Litwin MS, Hays RD, Fink A. Ganz PA, Leake B, Leach GE, Brook RH. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. Jan 1995; 273(2):129-35.
3. Herr HW. Quality of life of incontinent men after radical prostatectomy. J. Urol. March 1994; 151(3):652-4.
4. Krane RJ. Urinary incontinence after treatment for localized prostate cancer. Mol. Urol. Fall 2000; 4(3):279-86.
5. Mulcahy JJ. Tips for successful placement of the artificial urinary sphincter. Contemp Urol. Sept. 1999; 46-51.

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Urinary Incontinence Effects

My husband didn't want to go out anymore because of his incontinence. He was afraid of embarrassing himself or inconveniencing others. We stopped going to dinner with our friends or seeing movies, and stayed home instead. *

Incontinence is a seldom-talked about condition that can change lives dramatically. It affects millions of men, often their lifestyles, activities and relationships because they fear embarrassment of odor and wetness. That might mean missing out on golf, running, swimming, dancing, playing with the grandkids...or any number of other activities previously enjoyed.

Incontinence can keep you...

• in costly diapers
• in constant search of restrooms
• homebound and constrained
• embarrassed and depressed

Calculating the Cost of Incontinence

But it doesn't have to be that way. Treatment options are available.

* These comments are based on the chat rooms where patients have shared their experiences. They are not reflective of individual patients, and may not be typical for all users.

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Treating Urinary Incontinence

People with incontinence can manage accidental urination by using a number of different options.

Absorbent Products
Absorbent pads, diapers and garments can help individuals to deal with bladder control problems. However, absorbent products should not be employed for long-term bladder control unless a physician has evaluated the patient's incontinence. In particular, early reliance on absorbent pads may be a stumbling block for bladder control. The wearer may develop a sense of security and acceptance of the condition, which could lessen the desire to seek adequate diagnosis and treatment.

Internal Collection Devices
An internal collection device, such as a catheter (a hollow plastic tube), may be recommended for certain individuals to ensure that the bladder is emptied on a regular schedule and does not overfill and leak. Intermittent catheterization (the periodic insertion of a catheter into the urethra and into the bladder) is performed at regular intervals each day (usually every three to six hours).

External Devices
External collection devices, such as external catheters, are urine storage products that may be useful for short-term incontinence treatment in men. They are attached to the penis by adhesive, latex or foam strap devices, and a tube to a urine-collecting bag connects them.

For men, external occluding (closing) devices can be used to block the flow of urine by squeezing the urethra shut or plugging the urethra. Mechanical devices include penile clamps (e.g., the Cunningham clamp) and compression rings. The penile clamp is a V-shaped casing with a foam cushion that fits over and under the penis. When closed, the penile clamp should stop the flow of urine without causing discomfort. Compression devices are adjustable rings that surround the penis and, when inflated with air, pinch off the urine flow. Improper use of penile clamps and compression rings can result in penile and urethral erosion, penile edema (swelling), pain and obstruction.

Biofeedback/Electrical Stimulation
Biofeedback/Electrical Stimulation is practiced to help people gain awareness and control of their urinary tract muscles. The principle of biofeedback is simple: a variety of instruments are used to record small electrical signals that are given off when specific muscles are squeezed to urinate. These muscle squeezings are then converted into audio (hearing) and/or visual (hearing) signs that patients can recognize and learn in order to control muscular activity. With biofeedback, weak muscles can be better activated on demand, overly tense muscles can be relaxed and overall muscle activity can be coordinated.

Surgical Options
Surgical procedures are available to treat male urinary stress incontinence.

• Injections of bulk-producing agents, such as collagen, into the urinary sphincter.
• Implanting an artificial urinary sphincter, which mimics the function of a normal, healthy urinary sphincter.

Seeing a Physician

Some people with urinary incontinence fear nothing can be done to alleviate their problem. As a result, they may never seek medical help. The first thing to do is talk to a physician or urologist.

To establish a diagnosis, your doctor will ask you about your medical history and urinary habits. It is important that you accurately describe when and under what conditions you have problems controlling your bladder. It may help to keep track of when you urinate, as well as how much fluid you drink or eat, by writing these activities in a voiding diary. It is important to understand when and under what conditions the incontinence occurs.

Because each patient with urinary incontinence is unique, doctors prescribe treatments based on the type and severity of incontinence.

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