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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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