The Psychological Hurdle of Male Urinary Incontinence
Urinary incontinence (the involuntary leakage of urine) can occur in both males and females. And in both sexes, psychological distress can occur. But the treatment of urinary incontinence in females is far more publicized than that in men, since men rarely feel comfortable when discussing urinary incontinence.
The image of the “Macho” man that most of us have does not include this individual leaking urine. Do you think that the ‘World’s Most Interesting Man’ portrayed in the Dos Equis commercials leaks urine?
But large numbers of men suffer from this problem and it is far more common than most people believe it to be. The National Association for Continence estimates that between 2-15 percent of men ages 15-64 and 5-15 percent of men over the age of 60 who are not residents of skilled nursing facilities suffer from urinary incontinence. Symptoms of male incontinence can vary from several drops, such as that seen with post-void dribbling to a near complete and continuous leakage.
It is not inevitable in elder patients, however those that do suffer from this problem are extremely bothered by it. Therefore the true incidence of urinary incontinence is often underreported.
Incontinence and the Male Image_Urinary incontinence may result in psychological distress for many patients. _ Possibly walking around with the odor that is associated with urinary incontinence is considered socially unacceptable. It could also potentially result in social isolation. To avoid this, many refuse to go to work as a result of their incontinence. It may lead to depression as well as create great anxiety. Patients with incontinence may also suffer from shame, low self-esteem, irritability, and most commonly, embarrassment.
Numerous studies have demonstrated that males who experience urinary incontinence after surgical procedures report a lower quality of life than those who do not experience this problem. The symptoms affect many quality of life factors such as changes in lifestyle, refraining from sexual activity, altering clothing choices, and a decreased sense of self-worth.
Finding a SolutionIn order to overcome the psychological and psychosocial issues associated with urinary incontinence,** the cause of the problem must first be identified.** One of the more common causes of male stress incontinence (occurs with an increase of the intra-abdominal press with coughing, sneezing, movement, strenuous activity) is radical prostatectomy. Other causes may include enlargement of the prostate, obesity, neurological disorders, diabetes and spinal cord injury.
Men can also experience urge incontinence or overactive bladder. This is the involuntary release of urine prior to getting to the bathroom, or may even occur if just sitting still. Various medications are on the market for the treatment of urge incontinence and are fairly effective.
Treatment Optionnce the root cause is identified, the treatment of incontinence symptoms as well as the negative effects on self-image should initially be directed at that underlying causation. Prostatic enlargement can easily be treated by medical therapy or numerous minimally invasive surgical alternatives. Controlling neurological diseases such as Parkinson’s disease can be helpful. Improving diabetic control can also result in an improvement in the urinary incontinence that may be occurring. Weight loss should be initiated if you are significantly overweight.
Severe stress incontinence usually is best treated with surgical therapy. Male slings are offered to many patients who have minor incontinence. This procedure involves positioning a piece of mesh in the perineum where the urethra exist that pelvis. This mesh causes a compression of the urethra and may rrestore urinary continence. An artificial device known as a sphincter may also be utilized. This is where a cuff of tissue is placed around the urethra and then is controlled by a small pump mechanism that place in the scrotum When the bladder feels full, a release valve is activated and the cuff of tissue relaxes around the urethra and urine can flow.
Simple alterations in life-style may also be effective in controlling incontinence. Limiting caffeine intake can be effective. Decreasing fluid intake may be beneficial. Alcohol results in an increased urine production, and limited this is wise. Today there are many products on the market that are male specific that help control the absorption of the leakage. These products include absorbent pads, and disposable underwear. Several manufacturers now offer undergarments that will accommodate these pads.
Men need not despair and keep this problem to themselves. The first step in overcoming the psychological problems associated with incontinence is to discuss it with your healthcare providers. Once that occurs, you should be well on your way to relief and feeling more like yourself
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.