Male Incontinence Review
How Common Is Incontinence?
Incontinence affects approximately 10 million Americans, without regard to sex and age. That means one out of every 25 Americans suffer from some type of incontinence.
Why Seek Help?
Besides the social stigma of embarrassing odor and wetness, skin may be damaged by urine. With the technology of the 90s, most incontinence can be treated or at least managed to allow full participation in a satisfactory life-style.
Urinary incontinence is defined as the unwanted loss of urine. Urinary incontinence is very common, affecting many millions of Americans. Many men are too embarrassed to ask for help, and many men don't realize that successful treatment is usually available for most of these patients. Urinary incontinence is not a necessary part of aging, and can happen in young men as well as old and often can be treated.
There are actually many different types of incontinence, and the successful treatment of incontinence depends on making the most accurate diagnosis of the type of incontinence that is affecting each individual patient.
The major types of incontinence are urgency incontinence, which means that the man loses urine when he feels a strong urge to go to the bathroom, but cannot get to the bathroom quickly enough. This is also associated with the urge to urinate when drinking even small amounts of liquids, or associated with severe frequency of urination, day or night, and even associated with bed-wetting.
The second type of incontinence is stress incontinence, which means that patients will have unwanted loss of urine when they exercise, or have any sudden movements such as coughing or sneezing or laughing. It can be from any type of exercises, including simply getting out of a chair or walking.
The last type of incontinence is overflow incontinence in which the patients have a very poorly emptying bladder, and the urine leaks out uncontrollably often in very small, frequent amounts. In many patients the types of incontinence seem to run together.
Factors that need to be evaluated in any man with incontinence is the presence of urinary tract infection, the presence of constipation and a full list of medications that are being taken to see if they have any use or effect. A complete medical history and examination and an analysis of the urination are the most basic tests that start any evaluation for urinary incontinence.
We may ask you to keep a chart of your voiding pattern to help us make a firm diagnosis or to help us with treatment to see how successful we are in treating your condition:
• When do you go to the bathroom and how much? (Use an old jar to measure.)
• When do you experience wetness? During or after lifting? While coughing, sneezing, or straining? Day, night, or both?
Before or after going to the bathroom?
• How much urine do you lose? Estimate amounts in teaspoons, tablespoons, or parts of a cup.
• Do you have trouble stopping or starting the flow of urine?
• What is your daily fluid intake? (Amount and description of what you drink.)
• Be prepared to name the medications you take and any surgery you have had on your urinary tract or around it. When you have this information ready, it is easier for the doctor to proceed with an evaluation.
• If you have had previous treatment for incontinence, bring those records or X-rays with you.
Once the cause of the urinary incontinence can be discovered the man can begin treatment. There are three major treatment areas; medications, surgery, and behavioral techniques.
Medications to treat incontinence again depend on the cause of the incontinence. If the patient's bladder is contracting inappropriately, medicines can be used to slow down these contractions. Certainly, medications can be used to treat infections that may be stimulating the bladder to contract or causing irritation. Muscle medications also exist that also help tighten the muscles of the sphincter area.
Surgery is often needed to help incontinence. If the prostate gland is blocking the urinary channel, or a stricture or scar exists in the urethra, this may need to be dealt with surgically. In patients who have had prostate surgery who are incontinent, particularly the stress variety, artificial sphincters can be placed to aid the patient's own sphincter. A new development from Bard Urological is the use of injectable collagen. Collagen is a safe material that can be injected just outside the sphincter to create increased resistance and hopefully achieve better control. In some patients who have very small bladders because of infections or inflammation or radiation, augmentation of the bladder size using intestine can be used to treat incontinence.
Behavioral techniques are now available that allow you to get better coordination of voiding function and strengthen the muscles. Biofeedback is a way of learning exactly how the bladder muscles and sphincters contract, and by using biofeedback techniques increased resistance can be achieved. Also pelvic exercises called Kegel's exercises can be used to help strengthen the bladder.
In some circumstances cure is not possible, and products are available to help the patient manage incontinence. These include various types of protection devices such as pads and diapers that are available at most health care suppliers and drug stores. In some patients a catheter or tube can be placed into the bladder that drains into a bag that needs to be emptied when full. Catheters also exist that cover the penis from the outside (condom catheters). In some men who have poorly emptying bladders because of obstruction, but who cannot tolerate surgery, patients can be taught to catheterize themselves with a small tube three to five times a day with excellent results.
Many national organizations exist for people with incontinence that have local groups that can give patients more information, ideas, and support in treating urinary incontinence. These include the Simon Foundation, Help for Incontinent People, and the Alliance for Aging Research.
For more extensive information about the various types of urinary incontinence in adults, one can order a clinical guideline from the U.S. Department of Health and Human Services, 2101 East Jefferson Street. Suite 501, Rockville, Maryland 20852, and ask for publication AHCPR 92-0038.