Male urinary incontinence: risk factors and treatment

There is stress incontinence (10%), urge incontinence (60%) and mixed incontinence (30%).

What are the risk factors?

  • Age: as in women, the incidence – number of new cases – increases with age.
  • Alterations of the lower urinary tract: it appears in 34% of men who have these alterations and in 15% of those who do not. Thus, for example, it is more frequent in those who suffer from prostatism or benign prostatic hypertrophy -a clinical condition caused by obstruction of the prostate to the outflow of urine-, and even overflow incontinence occurs.
  • Motor and cognitive impairment: more frequent in men who have mobility and intellectual problems, such as Parkinson’s disease, senile dementia, depression, Multiple Sclerosis, or cerebral infarction.
  • Surgery on the lower urinary tract: especially those performed on the prostate, especially if it is a tumor, since during surgery the urethra must be sectioned and the sphincter may be damaged.
  • Lung diseases and smoking: diseases and situations that increase the pressure in the abdomen, such as chronic bronchitis (due to continuous coughing) and emphysema, increase the risk of urinary incontinence.
  • Treatment with diuretics: since they increase the production of urine by the kidneys, overfilling the bladder.

What types of incontinence are there?

  • Incompetence of the external sphincter of the urethra.
  • By involuntary contractions of the bladder that the brain is unable to control.
  • Neurogenic bladder: originating in the brain, spinal cord, or peripheral nerves.
  • Overflow: when the bladder is full and “overflows”; it is more frequent in patients with benign prostatic hyperplasia.
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How is it diagnosed?

By means of the Clinical History and Physical Examination, being very important to palpate the abdomen to rule out the presence of masses or even a bladder full of urine – what we understand by bladder balloon -, which will already be warning us that the bladder does not empty properly.

Of course, the neurological examination is essential and, especially, the urodynamic study, which will determine the overall functioning of the entire lower urinary system (bladder and sphincter). This test includes flowmetry, through which we will know the strength of the urine stream; it will also be necessary to assess the residue that remains after urination (postvoid residue).

It is essential to request an ultrasound scan of both kidneys, bladder and prostate, as it can guide us regarding the existence of anatomical alterations, cysts, lithiasis, both at renal and bladder level, tumors or prostatic growth that hinders the outflow of urine.

What is its treatment?

  • Incontinence of sphincteric origin

Generally, sphincter involvement is due to sphincter injury after prostate surgery. The treatment, therefore, will be rehabilitation of the pelvic floor muscles; if it is not effective, an intervention can be performed which consists of the injection, through the urethra (endoscopic), of substances that form swellings in the neck of the bladder, reducing the urethral lumen and thus hindering the leakage of urine. Currently, tapes can also be placed, as a mesh, just below the urethra, whose function is to act as a “hammock” for the urethra, especially when straining, thus preventing urine leakage. As a last resort we have the possibility of implanting an artificial urethral sphincter.

  • Incontinence due to bladder instability
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The bladder spasms due to involuntary contractions of the detrusor muscle. In other words, it would be a “nervous” bladder. Nervousness, cold, alcohol, coffee, carbonated beverages, diabetes mellitus, lumbar disc herniations and some neurological diseases favor these spasms. Nowadays we have drugs to prevent these contractions: most of them are called anticholinergics.

  • Neurogenic bladder incontinence

Its treatment is more complex and sometimes requires several daily catheterizations by the patient himself (self-catheterization), in order to evacuate the urine from the bladder.