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For women living with multiple sclerosis, stress urinary incontinence is a troublesome side effect. Multiple sclerosis is a debilitating autoimmune disease that affects the brain and spinal cord. It occurs more often in women than men, usually between the ages of 20 and 40. Nerve damage in the brain or spinal cord often leads to bladder problems like stress urinary incontinence, frequent need to urinate, and a strong urge to do so.

A study conducted by the Cleveland Clinic Glickman Urological Institute was published in the June 2012 issue of International Neurourology Journal found that nearly 56% of women with multiple sclerosis suffered from stress urinary incontinence, greatly impacting their quality of life. This data was collected via questionnaires handed out to 143 women who had multiple sclerosis.

Stress urinary incontinence is the most common type of incontinence, and occurs when a person leaks urine while sneezing, coughing, laughing, or exercising. It typically affects women more often than men, thanks to risk factors like childbirth and obesity.

Although stress urinary incontinence (SUI) is traditionally thought of as a female problem, it is actually not uncommon to come across a man who suffers from male stress incontinence.

The mechanism behind the stress incontinence in both sexes is the same: a weakness in the ring of muscles surrounding the opening of the bladder. When the pressure in the pelvis around the bladder increases, due to straining, this ring of muscles, called the sphincter, gives way and lets a variable amount of urine leak.

What Causes Male Stress Incontinence?

The commonest cause of male stress incontinence is damage of the sphincter muscles during the removal of the prostate, a male gland which wraps around the tube carrying the urine from the bladder to the outside.

The prostate gland is removed either because it enlarges and compresses the flow of urine, or because it has a malignant tumor in it. Procedures aimed to treat benign prostatic enlargement are many such as TRUP (Trans Urethral resection of Prostate) and prostatectomy (removal of prostate). While these may cause stress incontinence, it still is a rare occurrence.

Malignant tumors (cancers) necessitate a surgery known as radical prostatectomy, where the whole of the prostate is removed along with some neighboring tissue (the seminal vesicles). Radical prostatectomy is commonly followed by male stress incontinence. In fact, as much as 90% of patients complain developing incontinence after radical prostatectomy. The good news is, most of these complaints will be only temporarily.

Can Male Stress Incontinence Be Treated?
Pelvic floor muscle exercises are the mainstay of treatment in male stress incontinence. These exercises, also known as Kegel’s exercises, are aimed at strengthening the bladder’s sphincter and therefore allowing it to seal off the bladder better.

Male stress incontinence, like its female counterpart,  can be greatly improved through strengthening the sphincter muscles: the ring-like fibers looping around the exit of the urinary bladder.

Sphincter muscles are part of a group called the pelvic floor muscles. Strengthening the pelvic floor reflects positively on the strength of the sphincter and greatly improves stress incontinence.  It is estimated that anywhere between five and twenty five percent of men who suffer from post-prostatectomy stress incontinence (stress incontinence after prostate surgery) will show marked improvement within four to six weeks after the procedure.

Dealing with Male Stress Incontinence
Suffering from male stress incontinence does not have to reduce the quality of your life. There are a variety of measures you can adopt in order to live life fully, unhindered by the occasional leaks you suffer from:

  • Visit your doctor and talk to them about your symptoms. They are the best judge on whether or not you need to alter your lifestyle or medication regimen to reduce he urinary leaks.
  • Be diligent with your pelvic floor exercises, even if at first you see no improvement.  These usually take effect in six to eight months time.
  • Do wear protective incontinence products designed to absorb the leaked urine and save you from embarrassment. You may start with cup shaped pads specific to fit the male’s body and move on to more absorbent products if you feel you need more protection.
  • If you are reluctant or feel embarrassed about shopping for incontinence pads you can get them online and have them discreetly delivered to your door step.

In many instances patients suffer from a constellation of urinary symptoms that they may escape their notice. Frequent urination problems are sometimes caused by an underlying disease pathology affecting the nervous system as a part of the whole body. Diseases such as diabetes mellitus and other causes of peripheral neuropathies are commonly associated with frequent urination problems.

For starters, diabetes, especially the poorly controlled or undiagnosed variety, causes an increase in urine volume, which is often associated with frequent urination problems. In children, it may translate to loss of previously acquired bladder control, especially at night. The new onset of urinary incontinence in many cases alerts the physician to an abnormally increased urine volume when the patient is a child. Because the urine is also rich in glucose, it may act like a culture media favouring growth of bacteria leading to urinary tract infections. Repeated lower urinary tract infections, namely cystitis or an inflammation of the bladder, is sometimes the first clue hinting towards the diagnosis of diabetes in many patients.

Urinary tract infections, in and of themselves, cause frequent urination problems, which include burning micturition, pubic pain, the presence of blood in urine (hematuria) or voiding cloudy urine (pyuria). One of the most common symptoms of urinary tract infection is an involuntary urine leakage following a sudden, severe urge to urinate. This condition is known as urge incontinence, which is caused by an overactive or irritated bladder. Urge incontinence may occur in association with other conditions such as Parkinsons, Alzheimer’s and other neurological problems because of the associated disturbed nervous control over the bladder voiding. In such patients, the frequent urinary problems and complaints are accompanied by other major neurological symptoms and signs which are easily detected through history taking and physical examination.

Another potential cause for frequent urinary problems in males is prostate gland disease. The tube which carries the urine from the bladder to the outside, called the urethra, passes through the prostate. The prostatic urethra may be compressed by an enlarged prostatic gland leading to difficulty starting urination, a weak urine stream, straining while urinating in order to bypass the obstruction and an inability to completely empty the bladder. Men suffering from benign prostatic enlargement commonly suffer from dribbling of urine after micturition ends, increased frequency of night time urine, a stream of urine that starts and stops repeatedly during micturition, and an increased risk for urinary tract infections.

It is therefore obvious that frequent urination problems may be the presentation for other, more general diseases, not necessarily diseases of the bladder or the pelvic floor. Also, it is interesting to note that stress incontinence is the most likely type of incontinence to cause frequent urination problems caused by a bladder or sphincter malfunction. Physicians evaluate patients with frequent urination problems using an integrative approach, which examines all the bodily systems in search of a cause. The doctor usually investigates by taking a thorough health history and detailed physical examination supplemented by laboratory tests as needed.

Disclaimer: All material published on the Incontinence.co.uk web site is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. The information is not intended to replace medical advice offered by your doctor or health professional. Readers should always discuss health matters and review the information carefully with their doctor or health care professional. Extended Disclaimer
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