Tag Archives: male urinary incontinence

Urinary Incontinence in Men (continued)


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Treatment for UI in men
Treatment depends on the type of incontinence and severity of symptoms. For some people, simple lifestyle changes may be sufficient, for others, medication would be necessary. Finally some men may require surgery to treat the condition.

1. Lifestyle changes
– Limit fluid intake at certain times of the day (such as before going to bed or before a long trip). However, note should be taken to increase fiber content in your meals to prevent constipation.
– Cut down on caffeine, alcohol, keep a healthy weight.
– Try pelvic floor muscle exercises such as Kegel exercises. This is to strengthen the muscles that support your bladder.
– Timed voiding or bladder training therapy : plan regular trips to the bathroom at set times of the day, gradually increase the interval between trips as you gain control.

2. Medication
Depending on the cause of incontinence the following types of drugs maybe prescribed:
– Alpha-blockers and/or 5-alpha reductase inhibitors: for treatment of enlarged prostate (BPH). Click on the link to read more about BPH and mechanism of action of these drugs.
– Imipramine, antispasmodics : these act on nerves to block bladder spasms in overactive bladder.

3. Surgery
Surgical procedures include:
– Implantation of artificial sphincter: this is performed when weak sphincter is the source of problem.
– Man sling : implementation of an artificial support for the urethra. This is usually recommended for those who have had their prostate gland previously removed.
– Urinary diversion: bypass of the bladder and urethra altogether. In this procedure, a reservoir is made to collect urine directly from the ureters and urine is emptied through an opening in the abdominal wall into a bag. This is performed when other methods fail.
– other procedures (non-surgical and surgical) for treatment of enlarged prostate, see the main article on prostate hypertrophy for more details.

Transurethral microwave thermotherapy
Fig. 1 : Transurethral microwave thermotherapy (TUMT) for treatment of enlarged prostate (BPH) incontinence in male. A catheter containing a microwave antenna is inserted through the urethra, a balloon is inflated at the end to keep the catheter in place. The antenna is heating the tissue of the prostate to destroy it. Cooled water is circulating in the wall of the catheter to keep the surface of the urethra safe from heating. See the main article about BPH for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Urinary Incontinence in Men

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Urinary incontinence (UI) is involuntary leakage of urine. Urine is produced in the kidneys and stored in urinary bladder. Urination is the process of emptying the bladder through the urethra that connects the urinary bladder to the external urethral orifice. There are two sphincters (valves) that keep the urethra closed to prevent leak: internal urethral sphincter located at the neck of the bladder, and external urethral sphincter located below the prostate gland and is supported by the pelvic floor muscles (See Fig. 1).

Click here to see an animation of male urinary system on Alila Medical Media website where the video is also available for licensing.

Urinary system in male, labeled.
Fig.1: Anatomy of male urinary organs. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

 

When the bladder is full, stretch receptors in the wall of the bladder send a signal to the spinal cord and the brain. At times when it’s not appropriate to urinate, the brain sends back an inhibitory signal to keep the sphincters closed and prevent voiding. When you wish to urinate, this inhibition is removed, the spinal cord instructs the muscle of the bladder (detrusor muscle) to contract and the sphincters to open to let the urine out (Fig. 2).

Click here to see an animation of micturition (urination) control  on Alila Medical Media website where the video is also available for licensing.

Neural control of micturition, labeled.
Fig.2: Neural control of urine voiding. Sensory nerve sends the signal from the full bladder to the nervous system; motor nerve brings instruction from the nervous system to the muscles. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Causes of urinary incontinence

– Problems with the nervous system: stroke, multiple sclerosis, Pakinson’ s disease and spinal cord injuries may affect the neural control loop illustrated in Fig.2 and cause incontinence.
– Weakness of sphincters, or lack of support from underneath muscles (muscles of the pelvic floor) making the sphincters weak so they can not close properly.
– Blocked or narrowed urethra, weakness of bladder muscles: bladder can not empty, urine builds up and leaks.

Types of urinary incontinence in men and typical cause of each type

1. Stress incontinence: urine leakage while sneezing, coughing, laughing or any activity that creates abdominal pressure on the bladder. This usually occurs because the muscles or tissues underneath the bladder are weakened and can no longer support it. In men, this typically happens after the prostate gland is removed for reasons such as prostate cancer.
2. Urge incontinence: need to void that can not be deferred, inability to hold. This is commonly caused by overactive bladder, a condition in which muscles in the wall of the bladder contract in an uncontrollable manner. The reason why this happens is unclear but it’s likely to involve problems in the nervous system.
3. Overflow incontinence:  constant dribbling of urine. This happens when the bladder does not empty properly while voiding making it almost always full and urine overflows. This is due to weak detrusor muscle in the bladder wall or a blocked/narrowed urethra. In men, the major cause for this type of incontinence is a condition called enlarged prostate or benign prostate hyperplasia (BPH) . Click on the link to read more about this condition.

Urinary incontinence in men
Fig.3: Types of urinary incontinence in men and typical cause in each case. The prostate gland (orange color) is located under the bladder where it wraps around the first part of the urethra. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

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Benign Prostatic Hyperplasia (BPH)

Below is a narrated animation about BPH and treatments. Click here to license this video on Alila Medical Media website.

Benign prostatic hyperplasia  (BPH), also called benign prostatic hypertrophy or enlarged prostate,  is a condition in which the size of the prostate gland is increased. It is considered “benign” because it’s NOT a cancer, and it does not increase the risk of cancer. However, when becomes sufficiently large, the prostate tissue may compress the urethra and block the urine flow causing a number of urination problems and urinary tract infection. BPH is very common in aging men: about 50% of men have some degree of BPH by the age of 60.

Anatomy

The prostate is a walnut-size exocrine gland of the male reproductive system. It is located just below the urinary bladder where it wraps around the first part of the urethra – prostatic urethra (see Fig. 1 and 2).
Male reproductive system median section
Fig. 1: Male reproductive and urinary organs, mid-sagittal view. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

Prostate gland produces a milky fluid that is expelled into the urethra to mix with spermatozoa during ejaculation. The fluid serves as a lubricant and nutrition for the sperms.

Click here to see an animation of male reproductive system on Alila Medical Media website where the video is also available for licensing.

Click here to see an animation of male urinary system on Alila Medical Media website where the video is also available for licensing.

In BPH, the enlarged prostate presses on the prostatic urethra making it narrower. This affects normal flow of urine (Fig. 2).

Benign prostatic hyperplasia (BPH)
Fig. 2: Normal prostate (left) and enlarged prostate (right). Same sagittal view as in Fig. 1 with other organs removed to simplify. The urethra is squeezed narrow in BPH.  Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.  

 

 

Click here to see  an animation of prostate hypertrophy on Alila Medical Media website where the video is also available for licensing.

Causes

BPH is considered a normal part of male aging as a result of hormonal changes. The rate of cell proliferation induced by androgens (male hormones) somehow exceeds the rate of programmed cell death (apoptosis) in aging prostate tissue resulting in enlargement of the prostate.
Severity of BPH (development of symptomatic BPH), however, has been associated with lifestyle. The incidence of clinically significant BPH is notably higher in men who lead a modern lifestyle compared to those who live in rural traditional settings.
About half of men with histopathologic BPH demonstrate clinically significant symptoms.

Symptoms

Obstruction of urine flow makes urine voiding difficult and incomplete. This leads to common symptoms of BPH:
– frequent urination.
– urgency : need to void that can not be deferred.
– urinary hesitation: difficulty to initiate urine stream, weak and interrupted stream.
– straining to void: need to push to completely empty the bladder.
– residual urine: constant feeling of need to void.
– dribbling
Altogether the voiding dysfunction resulted from BPH is called lower urinary tract symptoms (LUTS) – a more recent term for prostatism.

Treatment

Patients with mild symptoms and who are not bothered by their symptoms are usually advised to follow a “watch and see” approach with regular check-up and lifestyle changes such as low-fat diet, reduced consumption of alcohol and caffeine, reduced fluid intake before bedtime, avoidance of certain products and medications such as diuretics,…
1. Medication
There are two main classes of medication:
– alpha-blockers: these drugs relax smooth muscle in the prostate and by doing so relieve blockage of urine flow.
– 5-alpha reductase inhibitors: these inhibit local production of the hormone that is responsible for prostate enlargement.

2. Minimal invasive treatment
These non-surgical therapies use heat to cause cell death (necrosis) in prostate tissue. The heat is delivered in small amount and to a specific location to minimize unwanted damage. Different procedures differ mainly in the type of energy used.
– Transurethral microwave thermotherapy (TUMT): use of microwave energy delivered through a probe inside a catheter inserted into the urethra.
– Transurethral needle ablation (TUNA) : use of radio frequency energy delivered through a transurethral device with needles.
– Photoselective vaporization of the prostate (PVP): use of laser to vaporize prostate tissue.
3. Surgery
Transurethral resection of the prostate (TURP) is a surgical procedure for removal of prostate tissue through the urethra. This procedure has been around for a long time and is still considered gold standard for treatment of severe BPH. Nowadays, it is usually performed when medications and less invasive methods fail.

                                                                                                                    See all Urology topics

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