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incontinence is the accidental leaking of urine. It's not a disease. It's a
symptom of a problem with a man's
Urine is made by the
kidneys and stored in a sac made of muscle, called the
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
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:
Urinary incontinence happens more often in older men than
in young men. But it's not just a normal part of aging.
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:
types of incontinence have different causes.
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, narcotics, or nonprescription cold and
diet medicines can also affect your symptoms.
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.
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
If you have symptoms of urinary incontinence, don't be
embarrassed to tell your doctor. Most people with incontinence can be helped or
Learning about urinary incontinence:
Living with urinary incontinence:
Health Tools help you make wise health decisions or take action to improve your health.
Urinary incontinence occurs when the bladder's sphincter muscle is not strong enough to hold back the urine. This may
Prostate treatment is a major cause of urinary incontinence in men.
The bladder contractions that cause urge incontinence can be caused by
many conditions, including:
Overflow incontinence is usually caused by blockage of the urethra from BPH or prostate cancer. Other causes include:
You can have one or more types of
incontinence. Each type may have a different cause.
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.
urge incontinence may include:
overflow incontinence may include:
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
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
urinary tract infection,
prostatitis, or constipation will most likely
disappear when the infection or condition is cured.
Many things have been
linked to an increased risk of
urinary incontinence in men.
See your doctor right away if your
urinary incontinence does not go away or you also have:
Call your doctor if:
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.
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.
Any of the following health professionals can diagnose
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.
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.
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.
that may be done to find the type and cause of your urinary incontinence
Your doctor may do a cystoscopic exam. This is a test that
allows your doctor to see inside the urinary tract.
You may need more tests if:
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
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.
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).
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.
You may reduce your chances of developing
urinary incontinence by:
You can use behavioral strategies to help control urinary incontinence. These include simple changes to your diet, lifestyle, and urinary habits.
Try one or more of these tips. They may help you gain some control over your symptoms:
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
Medicine can help with some types of urinary incontinence.
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 may be
an option for men who:
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:
Surgery works for some people and not others. It is most likely to improve incontinence when:
Things that can lead to disappointing results include:
Treatment other than surgery or
medicine may be used to treat
Behavioral therapies, including
biofeedback and pelvic muscle exercises, are used to
treat urge and stress incontinence.
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.
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
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.
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):
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.
May 6, 2013
E. Gregory Thompson, MD - Internal Medicine & Avery L. Seifert, MD - Urology
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