The two most common forms of male incontinence are stress urinary incontinence (SUI) and overactive bladder (OAB) with concomitant urge urinary incontinence (UUI).
Refers to incontinence of urine that is associated when downward pressure “stress” is applied to the pelvic floor and bladder area causing leakage of urine.
- The main pathophysiology behind SUI in men relates to the underlying dysfunction of the urethral sphincter complex and/or change in the urethral angle.
- This is often a complication following prostate surgery, such as radical prostatectomy or transurethral resection of the prostate (TURP). Other causes of male SUI are;
- iatrogenic sphincter injury (eg sphincterotomy in spinal patients)
- Neurological conditions or trauma to the pelvic floor (eg pelvic trauma in a motor vehicle accident).
- The exact incidence of SUI may vary depending on the underlying pathology, definition of SUI and source of data (eg physician versus patient report)
Bladder weakness, or urinary incontinence, is experienced by many men following prostate surgery (prostatectomy or TURP). This is a common problem and often men find this the biggest challenge they have to cope with during the recovery process. Most men regain their bladder control over time and are fully recovered within 6 to 12 months.
However, it is important to get professional advice to help cope with bladder weakness during this time. ( Reference CFA)
This refers to the loss of a small amount of urine after emptying the bladder. It can be annoying and embarrassing and occurs when the urethra (the tube which carries urine from the bladder to the penis) is not completely emptied. This occurs when the muscles surrounding the urethra do not contract properly, which in turn prevents the bladder from fully emptying.
URGE Incontinence or: Detrusor overactivity
The bladder muscle that contracts or spasms out of the person’s control usually at low bladder volumes and with little warning
The loss of urine is preceded by a sudden and severe desire to pass urine with loss of urine typically occurring on the way to the toilet.
Triggers for urine loss include arriving at the front door, running water, hand washing, cold weather.
Amount of urine loss is variable, ranging from a few drops to flooding
Other common causes:
- Bladder diseases such as tumours or stones.
- Constipation, enlarged prostate that presses on the bladder or urethra and restricting urine flow.
- Often related to diseases such as MS and Parkinsons
- Urge incontinence can be a sign of infection so excluding this as a cause
- Treatment of underlying diseases processes eg: MS and Parkinsons
This occurs when the person is in chronic urinary retention where the bladder is not emptying fully and the leakage is due to an over-distended bladder. Occurs in the setting of bladder outlet obstruction (eg due to prostatic enlargement in men, poor bladder muscle function, or nerve damage to the bladder
Usually associated with a reduced sensation of bladder fullness and a feeling of incomplete bladder emptying. Does not tend to occur unless bladder emptying is very poor with large volumes of urine left behind in the bladder after urination
Some of the other reasons for this are
- Damage to the nerves that control the bladder, urethral sphincter or pelvic floor muscles
- Diabetes, Multiple Sclerosis, Stroke or Parkinson's disease ( these diseases can interfere with the sensations of a full bladder and emptying)
Involuntary loss of urine caused by physical (e.g. poor mobility) or mental (e.g. dementia) limitations that result in an inability to toilet normally.
If the issue interferes with the decision-making process, ability to toilet quickly or independently, or the environment in some way prevents the person from accessing the toilet when required
Overactive Bladder (OAB)
OAB is defined as the urgent desire to urinate (with or without urge urinary incontinence) which is usually associated with frequent urination as well as excessive urination at night.
OAB is a clinical syndrome usually accompanied by frequency and nocturia. Other neurological conditions, such as Parkinson’s disease, multiple sclerosis or stroke, may cause loss of inhibitory neurons, resulting in neurogenic voiding dysfunction.
- About 1/3 of people who suffer from OAB experience urinary incontinence, known as “OAB wet”, with the remaining 2/3 of people having “OAB dry”.
- It is important to ensure that other conditions causing irritation to the bladder lining are not mistaken for OAB, e.g. urinary tract infections, bladder stones, and bladder tumors
The risk factors for UUI include:
- Neurological conditions
- Various inflammatory processes of the bladder
- Bladder outlet dysfunction
- Physiological aging, and psychosocial stressors
- The condition may be idiopathic in nature. Meaning the cause is unknown.
Although it is accepted that OAB occurs more commonly in women, the true prevalence of OAB in men remains largely unknown. This is because most storage symptoms are frequently attributed to an enlarged prostate. Enlarged prostate and ensuing bladder outlet obstruction can result in bladder adaptations and abnormal bladder contraction (ie detrusor overactivity). It is also important to exclude other conditions that can simulate OAB-like symptoms, such as UTI, bladder stones and carcinoma in situ.
Aging increases the prevalence of UUI and SUI, and the two can often co-exist, leading to mixed incontinence.