What Causes Male Stress Incontinence?
It is estimated that 22.6 million men are affected by severe incontinence. Although stress incontinence accounts for only 12.5% of these men, it can still be a life-changing and traumatic condition that you should understand how to manage.
A sphincter is a circular muscle that controls the flow of urine out of the bladder. When the sphincter is damaged, the sphincter cannot squeeze and close off the urethra effectively. This results in individuals with stress incontinence leaking when putting pressure on their bladder. In men, the biggest cause of damage to the sphincter muscle results from surgery for Prostate removal. The surgical removal of the Prostate causes disruption of either the anatomic continence mechanism or the nerves that influence controlled urination. This is due to either damage to the urinary sphincter that leads to incontinence or the removal of physical support which creates functional problems for the sphincter when the prostate gland is removed. When pressure is placed on the bladder, the impaired sphincter then allows a steady stream of urine to pass. Urologist Dr Steers claims, “most men who come to see me about stress incontinence are men who’ve had surgery for Prostate cancer, 9 out of 10”. In addition to this, Prostate enlargement can also cause stress incontinence in men, as it can block the urethra and cause urine leakage when pressure is placed on the pelvic floor muscles.
As in any other form of incontinence, obesity is also a huge risk factor for developing stress incontinence. The pelvic floor muscles support most of your body weight. In people with obesity, the pelvic floor muscles have the job of supporting excess abdominal fat in addition to the pelvic organs. Just like in the later stages of pregnancy in women, excessive weight in men and women can lead to chronic strain. This can lead to the pelvic floor muscles weakening and causing incontinence when they are put under pressure. It is estimated that each 5 unit increase in body mass index is associated with an incontinence prevalence risk of up to 50%. Evidence even suggests that individuals who have been obese from a young age more than double their risk for having stress incontinence. As you age, the muscles that control bladder function start to lose strength, and weight gain can put extra pressure on the bladder.
Diseases such as Diabetes and Multiple Sclerosis are also risk factors as they can affect your nerves and thus your ability to control the muscles that open and close your bladder. Frequent urination is often a consequence, which can develop into stress incontinence. Diabetes can damage autonomic afferent nerves, leaving motor function intact but impairing the sensation of bladder fullness. Diabetes can ultimately affect your ability to control the muscles that open and close your bladder. Frequent urination when the bladder is put under pressure is a consequence of this. Multiple Sclerosis nerve damage interrupts the transmission of signals between the brain and bladder muscles. In individuals with Multiple Sclerosis, it is spasms in the bladder that often cause stress incontinence.
Stress incontinence in men can also be caused by trauma to the muscles, congenital anomalies or sacral spinal cord lesions. You should note that stress incontinence is often a temporary problem for a number of reasons, such as consuming too much caffeine or alcohol, being constipated or having a urinary tract infection. Depression and anxiety are additional reasons for developing incontinence.
Treating your Stress Incontinence
There are a number of ways you can combat stress incontinence with the help of your Doctor and useful lifestyle changes. You can follow these tips to successfully manage male stress incontinence:
Find the Cause of your Stress Incontinence
The most important part of treating stress incontinence is finding the culprit in your incontinence. To find the underlying cause, your GP or physician will perform diagnostic tests to evaluate the exact cause of the leakage. This will typically involve a physical exam and medical history examination. You may also find that other tools such as a urine flow test, blood tests, cystoscopy and urodynamic testing will be used. Your GP or Physician can also grade the severity of your stress incontinence, diagnosing you with severe, moderate or mild stress incontinence.
Make the Appropriate Lifestyle Changes
You do not have to rely on your Doctor to help you find treatment methods for stress incontinence. There are plenty of changes at home you can make to help treat stress incontinence. These changes can be as simple as limiting fluid intake at night time and avoiding known bladder irritants such as caffeine and alcohol. It is also vital to make the necessary dietary changes to help improve your incontinence. Acidic fruits such as lemons and limes are known for worsening stress incontinence, as they irritate the lining of the bladder. Try and opt for foods that have lower PH values and are more incontinence friendly to stay free from leakages. Highly acidic vegetables can have the same effect on the bladder, therefore it is important to choose vegetables with low acidity. In addition to this, ensure you reduce the number of bladder irritants you are consuming per day, such as coffees and colas. Cigarette smoking and heavy drinking are habits that are known to worsen a man’s symptoms of incontinence. You can also practice Pelvic Floor Muscles to help strengthen your Pelvic Floor Muscles. To do this, you should squeeze in the muscles around your urine tube and back passage. You should have a lifting sensation each time you squeeze your pelvic floor muscles. Try to hold them strong and tight as you count to 8, before relaxing.
Consider Surgical Treatment
Surgery is only suitable for men who have severe symptoms of stress incontinence and find other treatment methods to be unsuccessful. Surgical intervention to improve stress incontinence is aimed at increasing sphincter outlet resistance. Specialist evaluation of the patient is primarily a clinical approach with a physical evaluation to outline the most appropriate method. A clinician can provide investigations such as radiographic imaging of the lower urinary tract, cystoscopy and urodynamic studies to provide important information. The artificial urinary sphincter currently has the longest record of satisfactory results for treating stress incontinence. Today, an artificial sphincter is most commonly placed for postprostatectomy stress incontinence. More than 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. An artificial urinary sphincter consists of three separate components whose tubing must be connected using connectors. The occlusive cuff is commonly placed at the bulbar urethra. The pressure regulator transmits pressure to the occlusive cuff, providing appropriate pressure that is sufficient for maintaining continence. The lower part of the control unit is a bulb that the patient squeezes to transfer fluid out of the compressive cuff to the PRB allowing micturition. In men, the pump is placed within a subparts pouch within the scrotum where it can be easily accessed by the patient.
A Urethral Bulking is another popular method of surgery for treating male stress incontinence. This method consists of material being injected into the urethra. This controls urination through closing a hole in the urethra or building up the thickness of the wall of the urethra. A Bulbourethral Sling is another common alternative method, in which a sling is placed beneath the urethra. It is attached to either muscle tissue or the pubic bone. The sling then compresses and raises the urethra. This gives the urethra greater resistance to pressure from the belly. Sling surgery is mainly considered as a treatment option for incontinence caused Prostate surgery. Alternatively, nerve stimulation is a method in which 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. Your GP will advise you on which method of surgery is appropriate for you.
Ask your Doctor about Pharmaceutical Treatment
There are various types of medication that have been proven to be successful in treating stress incontinence. Drugs that increase bladder outlet resistance are the ideal choice for managing male stress incontinence. The first-line medication option is phenylpropanolamine or pseudoephedrine. These drugs can be administered with the co-morbidity of hypertension.
…Do not be afraid to talk!
It is estimated that 65% of women and 30% of men sitting in a GP waiting room report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional. For men in particular, incontinence can seem an embarrassing condition that you should not talk about. However, it is important to spread the message and contact professionals to get the condition treated as quickly as possible. Your life does not have to be dictated by your stress incontinence.