Frequent Urination and Urinary Incontinence in Men: An Overview

  • While it is arguably almost expected for women to have some degree of urinary incontinence, based on physiology and other factors, that is not the case for men.  Men may have a harder time discussing incontinence among people they are close with or even with a doctor or other medical professional.

    Urinary incontinence is an embarrassing topic for anyone to discuss. But now that pharmaceutical companies are allowed to advertise on television, many women have begun to seek treatment for their incontinence. Most women know that childbirth and age are risk factors for stress urinary incontinence, and knowing they are not alone has really opened up lines of communication between physicians and patients as well as other women, like friends and family. It is almost expected that women have some degree of urinary incontinence. This is not to say that it isn’t an embarrassing situation for women, but it’s more common, and there is much more information out there for women.
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    Men, on the other hand, are less likely to have incontinence. Men do not usually talk about such intimate symptoms with friends and may not even want to discuss it with their physician because they may not realize that it is a true medical condition.

    We “allow” women to have incontinence in the urologic community. Women have short urethras (the tube that carries urine from the bladder to the outside of the body). The total length in women is about 2 centimeters. It doesn’t take much increased pressure inside the bladder to overcome the resistance in the urethra and allow urine to leak out. I’m not saying that it isn’t a problem to have urinary leakage; it just isn’t necessarily a sign of something more serious.

    Men have much longer urethras as well as a prostate that increases the resistance and makes it almost impossible for urine to leak out in an otherwise healthy adult male. If a man is having urinary incontinence, it usually means something more significant is going on.

    Radical prostatectomy (removal of the prostate) for cancer, or other prostate cancer treatments (like radiation) are some of the most common causes of urinary incontinence in men. There are many statistics out there regarding the percentage of incontinence for these men, but it is not reliable.

    At least half of all men who have had radiation or surgery for prostate cancer have some degree of urinary incontinence. The reason for incontinence lies mainly in the fact the voluntary external sphincter is removed with the prostate or injured with radiation. The severity greatly differs, and what one man can live with by wearing pads, another man may find unacceptable. Luckily, we have gotten much better at treating this type of incontinence, and it can often be treated with minimally invasive surgery.

    Benign Prostatic Hypertrophy (BPH), is a benign enlargement of the prostate that occurs with age. Many people will know about it from TV commercials as well. Common symptoms are frequent urination, weakened stream and many night-time trips to the bathroom. BPH can be a cause of incontinence as well, and many people, including many physicians, do not realize this.

  • As the prostate increases in size, it increases the amount of resistance in the urethra to abnormal levels. The bladder needs to work extra hard to squeeze urine out. The bladder itself is a muscle, and if it has to work harder during urination, well, it’s like a work-out for the bladder, and it gets “pumped up.” It will get thicker and stronger, and often begins to get a mind of it’s own and will contract unpredictably. This is called detrusor instability or overactive bladder. Women can have this too, but for different reasons. The concern for men is that when there is increased pressure in the bladder forcing urine out the urethra, it can also put back pressure on the kidneys. If left untreated over time, it could ultimately result in kidney failure. It also over time can cause the bladder to lose all of it’s function as well, and that is a whole other situation to be discussed another time.
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    On the same lines as defunctionalized bladder, an obstructive prostate can keep the bladder from emptying completely, and we can get what is called overflow incontinence. The bladder is almost completely full at a resting level and the urine has no choice but to leak out in order to protect the kidneys.

    These are situations when medical treatment should be sought. It doesn’t mean you are going to need surgery. Many of the treatments are with medications or other therapies.

    There is much more information I could discuss about these causes of incontinence, but this was to be an overview and summary. There are many other causes of incontinence in men that need to be approached from a neurologic standpoint, but that topic is beyond the scope of this current blog. I would love to answer any more specific questions in upcoming blogs. Please email them to me at this site, and I will answer what I can.
Published On: March 19, 2007