Topic Overview

What is urinary incontinence in men?

Urinary
incontinence is the accidental leaking of urine. It’s not a disease. It’s a
symptom of a problem with a man’s
urinary tract.

Urine is made by the
kidneys and stored in a sac made of muscle, called the
urinary
bladder. A tube called the
urethra leads from the bladder through the prostate
and penis to the outside of the body. Around this tube is a ring of muscles
called the urinary sphincter. As the bladder fills with urine, nerve signals
tell the sphincter to stay squeezed shut while the bladder stays relaxed. The
nerves and muscles work together to prevent urine from leaking out of the
body.

When you have to urinate, the nerve signals tell the muscles
in the walls of the bladder to squeeze. This forces urine out of the bladder
and into the urethra. At the same time the bladder squeezes, the urethra
relaxes. This allows urine to pass through the urethra and out of the body.

Incontinence can happen for many reasons:

  • If your bladder squeezes at the wrong time,
    or if it squeezes too hard, urine may leak out.
  • If the muscles
    around the urethra are damaged or weak, urine can leak out even if you don’t
    have a problem with your bladder squeezing at the wrong time.
  • If your bladder doesn’t empty when it should, you are left with too much urine in the bladder. If the bladder gets too full, urine will
    leak out when you don’t want it to.
  • If something is blocking your
    urethra, urine can build up in the bladder. This can cause leaking.

Urinary incontinence happens more often in older men than
in young men. But it’s not just a normal part of aging.

What are the types and symptoms of urinary incontinence ?

Urinary incontinence can be short-term or long-lasting (chronic).
Short-term incontinence is often caused by other health problems or treatments.
This topic is about the different types of chronic urinary incontinence:

  • Stress incontinence
    means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts
    stress or strain on your bladder.
  • Urge incontinence is an urge to urinate that’s so strong that
    you can’t make it to the toilet in time. It also happens when your bladder
    squeezes when it shouldn’t. This can happen even when you have only a small
    amount of urine in your bladder. Overactive bladder is a kind of urge
    incontinence. But not everyone with an overactive bladder leaks urine.
  • Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your
    bladder doesn’t empty as it should, it then leaks urine later.
  • Total incontinence means that you are always leaking urine.
    It happens when the sphincter muscle no longer works.
  • Functional incontinence means that you can’t
    make it to the bathroom in time to urinate. This is usually because something
    got in your way or you were not able to walk there on your own.

What causes urinary incontinence in men?

Different
types of incontinence have different causes.

  • Stress incontinence
    can happen when the prostate gland is removed. If there has been damage to the
    nerves or to the sphincter, the lower part of the bladder may not have enough
    support. Keeping urine in the bladder is then up to the sphincter alone.
  • Urge incontinence is caused by bladder muscles that squeeze so
    hard that the sphincter can’t hold back the urine. This causes a very strong
    urge to urinate.
  • Overflow incontinence can be caused by something blocking the urethra, which
    leads to urine building up in the bladder. This is often caused by an enlarged
    prostate gland or a narrow urethra. It may also happen because of weak bladder
    muscles.

In men, incontinence is often related to prostate
problems or treatments.

Drinking alcohol can make urinary
incontinence worse. Taking prescription or over-the-counter drugs such as
diuretics, antidepressants, sedatives, opioids, or nonprescription cold and
diet medicines can also affect your symptoms.

How is the cause diagnosed?

Your
doctor will do a physical exam, ask questions about your symptoms and past
health, and test your urine. Often this is enough to help the doctor find the
cause of the incontinence. You may need other tests if the leaking is
caused by more than one problem or if the cause is unclear.

How is it treated?

Treatments depend on the type of incontinence you have and how much it
affects your life. Your treatment may include medicines, simple exercises, or both. A few men need
surgery, but most don’t.

There are also some things you can do
at home. In many cases, these lifestyle changes can be enough to control
incontinence.

  • Cut back on caffeine drinks, such as coffee and
    tea. Also cut back on fizzy drinks like soda pop. And limit alcohol to no more than 1
    drink a day.
  • Eat foods high in fiber to help avoid
    constipation.
  • Don’t smoke. If you need help quitting, talk to
    your doctor about stop-smoking programs and medicines. These can increase your
    chances of quitting for good.
  • Stay at a healthy
    weight.
  • Try simple pelvic-floor exercises like Kegels.
  • Go to the bathroom at several set times each day. Wear clothes that you can
    remove easily. Make your path to the bathroom as clear and quick as you
    can.
  • When you urinate, practice double voiding. This means going
    as much as you can, relaxing for a moment, and then going again.
  • Use a diary to keep track of your symptoms and any leaking of urine. This can help you and your doctor find the best treatment for you.

If you have symptoms of urinary incontinence, don’t be
embarrassed to tell your doctor. Most people with incontinence can be helped or
cured.

Frequently Asked Questions

Learning about urinary incontinence:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with urinary incontinence:

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.

Cause

Urinary incontinence occurs when the bladder’s sphincter muscle is not strong enough to hold back the urine. This may
happen when:

  • The sphincter is too weak.
  • The
    bladder muscles contract too strongly.
  • The
    bladder is too full.

Prostate treatment is a major cause of urinary incontinence in men.

  • Short-term incontinence after
    prostate surgery can go away with time, especially for younger men. In some
    cases, it lasts up to a year.
  • Stress incontinence is a common problem after
    prostate removal (radical prostatectomy) or
    radiation treatment for prostate cancer. It is
    becoming less common with better surgical techniques.
  • Some treatments for an
    enlarged prostate (benign prostatic hyperplasia, or BPH)
    can also cause incontinence. But this isn’t common.

The bladder contractions that cause urge incontinence can be caused by
many conditions, including:

  • Urinary tract infection.
  • Bowel problems, such as
    constipation.
  • Prostatitis. This is a
    painful infection of the prostate gland.
  • Certain
    conditions that affect nerve signals from the brain, such as
    Parkinson’s disease or
    stroke.
  • Kidney or
    bladder stones.
  • Blockage from
    prostate cancer or
    benign prostatic hyperplasia (BPH).

Overflow incontinence is usually caused by blockage of the urethra from BPH or prostate cancer. Other causes include:

  • Narrowing of the
    urethra (stricture).
  • Medicines, such as
    antihistamines and decongestants.
  • Nerve conditions, such as
    diabetes or
    multiple sclerosis.

You can have one or more types of
incontinence. Each type may have a different cause.

Symptoms

Your symptoms depend on the type of
urinary incontinence you have.

The main symptom
of stress incontinence is the leaking of urine
when you cough, laugh, lift, strain, or change posture.

Symptoms of
urge incontinence may include:

  • A sudden, urgent need to
    urinate.
  • Sudden leakage of a large amount of
    urine.
  • The need to urinate frequently, often at night.

Symptoms of
overflow incontinence may include:

  • A urine stream that starts and stops when you urinate.
  • Leakage of a small amount of
    urine.
  • A weak urine stream.
  • A need to strain while
    urinating and a sense that the bladder is not empty.
  • An urgent need
    to urinate, often at night.
  • Leaking urine while asleep.

What Happens

Urinary incontinence is often related to prostate problems. As men age,
the prostate gland grows larger. It can squeeze the
urethra and push the neck of the
bladder out of position. These changes can lead to
incontinence.

  • Stress incontinence happens when the
    muscle (sphincter) surrounding the
    urethra opens at the wrong time. This can
    be when you laugh, sneeze, cough, lift something, or change posture.
  • Urge incontinence happens when bladder contractions are too strong to be stopped by the
    sphincter. Often the urge is a response to something that makes you expect to urinate. It can happen when you wait to use a toilet, unlock the door when you come
    home, or even turn on a faucet.
    Overactive bladder is a kind of urge incontinence. But not
    everyone with overactive bladder leaks urine. For more information, see the
    topic
    Overactive Bladder.
  • Overflow incontinence usually is caused by blockage of the urethra from
    BPH or
    prostate cancer. It also happens when the bladder muscles contract
    weakly or don’t contract when they should.
  • Functional incontinence can happen when there are physical or mental limitations that restrict a man’s ability to reach
    the toilet in time.

In most cases, incontinence caused by an enlarged prostate can be
cured by medicine or prostate surgery.

If your incontinence is not related to prostate surgery and
it appears suddenly, it will usually clear up after you get treatment
for whatever is causing it. For example, incontinence related to
a
urinary tract infection,
prostatitis, or constipation will most likely
disappear when the infection or condition is cured.

What Increases Your Risk

Many things have been
linked to an increased risk of
urinary incontinence in men.

Physical
conditions or lifestyle

  • Age-related changes, including decreased
    bladder capacity and physical frailty
  • Smoking
    tobacco
  • Injury to the bladder or
    urethra, such as from radiation therapy or prostate surgery
  • Bladder infection or
    prostatitis
  • Obesity
  • Structural
    abnormalities of the
    urinary tract

Medicines and foods

  • Caffeinated and carbonated drinks, such as
    coffee, tea, and soda pop
  • Alcohol
  • Prescription medicines that increase urine production,
    such as diuretics, or relax the bladder, such as anticholinergics and
    antidepressants
  • Other prescription medicines, such as sedatives,
    opioids, and calcium channel blockers
  • Nonprescription medicines,
    such as diet, allergy, and cold medicines

Diseases and health conditions

  • Neurological conditions such as
    Alzheimer’s disease,
    Parkinson’s disease,
    stroke,
    diabetes, spinal injury, and
    multiple sclerosis
  • Bladder cancer
  • Chronic bronchitis
  • Interstitial cystitis
  • Anxiety and
    depression

When To Call a Doctor

See your doctor right away if your
urinary incontinence does not go away or you also have:

  • Weakness or numbness in your buttocks, legs,
    and feet.
  • Fever, chills, and belly or flank pain.
  • Blood in your urine or burning with urination.
  • A
    change in your bowel habits.

Call your doctor if:

  • Your incontinence
    gets worse.
  • Leaking urine is enough of a
    problem that you need to wear a pad to absorb it.
  • Incontinence
    interferes with your life in any way.

Don’t be embarrassed to discuss incontinence with your
doctor. It is not something that always happens with aging. Most people with
incontinence can be helped or cured.

If you have a sudden change
in your ability to urinate and you are not sure if it is related to your
urinary incontinence, see the topic
Urinary Problems and Injuries, Age 12 and Older.

Watchful waiting

If you have chronic
urinary incontinence that begins slowly, you may be
able to control the problem yourself. If home treatment doesn’t control your problem, or if incontinence
bothers you, ask your doctor about treatment.

If you have incontinence that begins suddenly
(acute), call your doctor. Acute incontinence is often caused by urinary tract
problems or medicines. It can be easily corrected.

Who to see

Any of the following health professionals can diagnose
and treat
urinary incontinence:

If you need surgery to treat your incontinence, make sure to find a surgeon who is experienced in the type of surgery you need,
usually a urologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

To learn the cause of your
urinary incontinence, your doctor will first review your medical history and give you a physical exam. Along with routine testing, such
as a urinalysis, this may be all your doctor needs to diagnose the cause and start treatment.

Your
doctor may ask you to keep a
voiding log. This is a record of the amount of
liquids you drink and how much and how often you urinate.

Incontinence testing

Tests
that may be done to find the type and cause of your urinary incontinence
include:

  • Urinalysis and
    urine culture. These tests show whether you have a
    urinary tract infection (UTI) or
    prostatitis, or blood or
    sugar in your urine.
  • Cough test. It checks for urine leakage while
    you cough.
  • Urodynamic tests, which may include:
    • Uroflowmetry.
      This test measures your rate of urine flow. A low
      peak flow rate can be a sign of a blockage or a weak bladder.
    • Pressure flow studies. This testing measures pressure changes in the bladder as the flow changes. It is often used when
      the cause of a man’s symptoms is uncertain. It can help show if the cause may be a blockage or a problem with the bladder muscles or nerves.
    • Post-void residual volume. This test
      measures the amount of urine left after you empty your bladder.
  • Cystometrogram (CMG). This test measures how well your
    bladder can store and release urine.
  • Electromyogram (EMG). This test records the
    electrical activity of muscles.

Your doctor may do a cystoscopic exam. This is a test that
allows your doctor to see inside the urinary tract.

Other tests

You may need more tests if:

  • The first treatment
    for incontinence has failed.
  • You have had
    previous prostate surgery,
    radiation therapy, or frequent
    urinary tract infections.
  • A
    catheter cannot be easily placed into your
    bladder.

Some tests aren’t often used for
incontinence, but they may be helpful. One example is cystourethrogram. It’s an X-ray of your
bladder and urethra while you are urinating.

If your doctor wants to do more tests, ask how the test can help your doctor treat your
incontinence.

Treatment Overview

The treatment you and your doctor
choose depends on your type of
urinary incontinence and how bad your symptoms are.

If there is no infection or
cancer or other cause that could only be cured by surgery, treatment is done in stages.

  • Behavioral strategies may be enough to control your symptoms. These include simple changes to your diet, lifestyle, and urinary habits. See Home Treatment for more information.
  • Medicines that treat infection or bladder muscle spasm may help.
  • Self-catheterization may
    help you manage
    overflow incontinence from a weak bladder or blockage. It may also be used if surgery is not the best option for you. When you need to drain your bladder, you insert a thin, hollow tube through your urethra into the bladder. To learn more, see Other Treatment.
  • Surgery is usually considered when it is the only treatment
    that can cure the incontinence, such as when the condition is caused by a
    bladder blockage.

Many men who have
urge incontinence or
overflow incontinence also have an
enlarged prostate gland (benign prostatic
hyperplasia, or BPH). For more information, see the topic
Benign Prostatic Hyperplasia (BPH).

What to think about

Exercise is important for your physical and emotional health. Even if being active causes some
leakage, get regular exercise. It can help you manage stress and
keep your muscles in tone.

Continence products absorb urine or apply pressure to keep urine from leaking. To learn more, see Other Treatment.

Prevention

You may reduce your chances of developing
urinary incontinence by:

  • Limiting caffeine and
    alcohol.
  • Getting to and staying at a healthy weight.
  • Quitting smoking.
  • Avoiding constipation
    by eating a healthy,
    high-fiber diet.
  • Doing
    Kegel exercises to strengthen the muscles that control the flow of urine.

Home Treatment

You can use behavioral strategies to help control urinary incontinence. These include simple changes to your diet, lifestyle, and urinary habits.

Diet and lifestyle strategies

  • Reduce or stop drinking caffeinated and carbonated
    drinks, such as coffee, tea, and soda pop.
  • Limit alcohol to no more than 1 drink a day.
  • Eat less of any food that might irritate your
    bladder. Then look for changes in your bladder habits. Such foods include citrus fruit, chocolate, tomatoes, vinegars, spicy foods,
    dairy products, and aspartame.
  • If you
    smoke, quit.
  • Avoid constipation:
    • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
    • Drink enough fluids. Don’t avoid drinking fluid because you are worried about leaking urine.
    • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It’s fine to be active in blocks of 10 minutes or more throughout your day and week.
    • Take a fiber supplement with psyllium (such as Metamucil) or methylcellulose (such as Citrucel) each day. Read and follow all instructions on the label.
    • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and don’t strain.
  • If you are
    overweight, try to lose some weight. Be more active, and make small, healthy changes to what and how much you eat. You will notice good results over time.
  • Try
    pelvic floor (Kegel) exercises to strengthen your pelvic
    muscles.

Urinary habits

Try one or more of these tips. They may help you gain some control over your symptoms:

  • Set a schedule for urinating every 2 to 4
    hours. Go whether or not you feel the need.
  • Practice “double
    voiding.” This means urinating as much as possible, relaxing for a few moments, and then
    urinating again.
  • If you have trouble reaching the bathroom before
    you urinate, consider making a clearer, quicker path to the bathroom. Wear clothes that are easy to take off (such as those with elastic waistbands
    or Velcro closures). Or keep a urinal close to your bed or chair.

Talk with your doctor about all the medicines you take,
including nonprescription medicines, to see if any of them may be making
your incontinence worse.
Medicines that may cause urinary incontinence in men
include certain antidepressants, sedatives, and even some allergy and cold
medicines.

Medications

Medicine can help with some types of urinary incontinence.

Medicine choices

  • For
    overflow incontinence: If incontinence
    is caused by an enlarged prostate, medicines to treat
    benign prostatic hyperplasia may be prescribed. But
    these medicines don’t always improve incontinence. For more information, see
    the topic
    Benign Prostatic Hyperplasia (BPH).
  • For
    urge incontinence:

    • Anticholinergic and antispasmodic medicines such as oxybutynin and tolterodine calm the nerves that
      control bladder muscles and increase bladder capacity. Taking an alpha-blocker medicine with an anticholinergic may help with symptoms of urge incontinence and overactive bladder better than either medicine alone.footnote 1, footnote 2
    • Antidepressant medicines, such as imipramine, may help with bladder control.
    • Botox (botulinum toxin). Botox may be an option when other medicines don’t work. A Botox shot helps relax the bladder muscles. You may need to get a shot every 3 months.
  • For stress incontinence:
    • Anticholinergic medicines may help, especially if you have both
      stress and urge incontinence.
    • Antidepressant medicines, such as imipramine, may help with bladder control.

What to think about

Some medicines that are used to treat
incontinence may actually make it worse in men whose incontinence is
caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consulting with a urologist is an important
part of incontinence care.

Surgery

Surgery may be
an option for men who:

  • Have ongoing (chronic)
    incontinence.
  • Have severe symptoms and total
    incontinence.
  • Are extremely bothered by their
    symptoms.
  • Have problems with urinary retention.
  • Have
    moderate to severe blood in the urine (hematuria) that keeps coming back.
  • Have urinary tract infections that keep coming back.
  • Have a medical problem that can only be treated with surgery. One example is a bladder outlet
    blockage that is affecting kidney function.

Surgery choices

Overflow incontinence caused by an enlarged
prostate (benign prostatic hyperplasia, or BPH) is the form of
incontinence most often treated with surgery. For more
information about surgery options and treatment for BPH, see the topic
Benign Prostatic Hyperplasia (BPH).

Stress incontinence caused by removal of the prostate gland may also be treated with surgery if
the incontinence isn’t cured after a period of watchful waiting.

Surgery for severe stress incontinence that does not improve with
behavioral methods includes:

  • Artificial sphincter. A silicone rubber device is fitted around the urethra (the tube that carries
    urine from your bladder to the outside of your body). It can be inflated or
    deflated to control urination.
  • Urethral bulking. Material is injected around the urethra. This serves to control
    urination by either closing a hole in the urethra or building up the thickness
    of the wall of the urethra.
  • Bulbourethral sling. A sling is placed beneath the
    urethra. It is attached to either muscle
    tissue or the pubic bone. The sling compresses and raises the urethra. This gives
    the urethra greater resistance to pressure from the belly. Sling surgery may be considered as a treatment for severe urinary incontinence from prostate
    surgery.
  • Sacral nerve stimulation (SNS). An electrical stimulator under your skin sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.

What to think about

Surgery works for some people and not others. It is most likely to improve incontinence when:

  • The diagnosis is right.
  • The cause of your symptoms is something that can be fixed by surgery.
  • Your surgeon is very experienced and skilled with the surgery you’re having.

Things that can lead to disappointing results include:

  • Unrealistic expectations. Surgery won’t always cure the symptoms, but it will usually improve them.
  • Physical factors such as obesity, long-term cough, radiation therapy, poor nutrition, age, and heavy physical activity.

Other Treatment

Treatment other than surgery or
medicine may be used to treat
urinary incontinence.

  • For stress incontinence, biofeedback can help you learn to read your body’s signals. This helps you improve control.
  • For urge incontinence, behavioral
    therapies such as biofeedback and bladder training can help you control the bladder muscles.
  • For overflow incontinence, using a catheter tube to drain your bladder can help you keep your bladder from getting too full.

Catheters

  • Catheterization may be used to treat
    severe incontinence that cannot be managed with medicines or surgery. Catheters
    don’t cure incontinence. But they do allow you or a caregiver to manage
    it.

    • Intermittent self-catheterization is done with a thin,
      flexible, hollow tube (catheter) that is inserted through the
      urethra into the
      bladder. This allows the urine to drain
      out.
    • Indwelling catheterization uses a catheter that remains in
      place at all times. For more information, see the topic
      Care for an Indwelling Urinary Catheter.
    • Condom or Texas catheter uses a special condom
      that can be attached to a tube for short-term use. The condom, placed over the
      penis, keeps the tube in place. The tube allows the urine to drain out.

Behavioral therapy

Behavioral therapies, including
biofeedback and pelvic muscle exercises, are used to
treat urge and stress incontinence.

Continence products

Products such as
absorbent pads or diapers, incontinence clamps, or
pressure cuffs may be used to manage any form of incontinence. Some of these
products absorb leaked urine. Others put pressure on the urethra to help
prevent urine from leaking.

Other Places To Get Help

Organizations

National Kidney and Urologic Diseases Information Clearinghouse (U.S.)
www.kidney.niddk.nih.gov

Urology Care Foundation (U.S.)
www.urologyhealth.org

References

Citations

  1. MacDiarmid SA, et al. (2008). Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: Randomized, double-blind, placebo-controlled study. Mayo Clinic Proceedings, 83(9): 1002-1010.
  2. Kaplan SA, et al. (2006). Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. JAMA, 296(19): 2319-2328.

Other Works Consulted

  • Chapple CR, Milson I (2012). Urinary incontinence and pelvic prolapse: Epidemiology and pathophysiology. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 1871-1895. Philadelphia: Saunders.
  • Herschorn S (2012). Injection therapy for urinary incontinence. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2168-2185. Philadelphia: Saunders.
  • Naumann M, et al. (2008). Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1707-1714.
  • Resnick, NM (2012). Incontinence. In L Goldman, A Shafer, eds., Goldman’s Cecil Medicine, 24th ed., pp. 110-114. Philadelphia: Saunders.
  • Silva LA, et al. (2011). Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database of Systematic Reviews (4).
  • Wadie BS (2010). Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. Journal of Urology, 184(6): 2446-2451.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Avery L. Seifert, MD – Urology

Current as ofMay 5, 2017