Male Urinary Incontinence: Symptoms, Diagnosis, and Treatment

Urinary incontinence is a condition that is more common in women than men, and its prevalence generally increases with age, although it may also affect young people. Urinary incontinence is common in men and many of them feel ashamed to even discuss this with their doctor. Therefore, sometimes they leave the problem of urinary incontinence without treatment and spend the rest of their lives with this condition.

In most cases, urinary incontinence in men can be resolved with pelvic floor muscle exercises or medical treatment!

Correct diagnosis of the cause and type of urinary incontinence in men can have a great impact on the treatment method and the speed of its recovery. Of course, the treatment methods are different based on the health protocol and health system of each country.

Causes of urinary incontinence in men

• Hormonal disorders

• Weakness of the pelvic floor muscles

• Pelvic surgery

• Infections

• Neurological, brain diseases

• benign prostatic hyperplasia and prostate surgery

Obesity, a history of incontinence in the family and increasing age increase the possibility of urinary incontinence.

Diagnosis of urinary incontinence

The severity, type and cause of urinary incontinence will be diagnosed by a male urologist by receiving information from the patient's records (history), various examinations such as pelvic muscle examination and prostate examination, tests and experiments.

Take a history

To evaluate the type of urinary incontinence, the doctor first takes a medical history including the following:

• History of illness, previous surgery or drug history

• Smoking, alcohol and coffee consumption and their consumption

• History of constipation and defecation problems

The urologist needs to ask various questions about the impact of this problem on the person's life. For example, the following items are essential for evaluation:

• How often do you go to the toilet?

• How many times do you wake up at night to urinate?

• How much urine leaks and when more often (with coughing, sneezing and straining or going to the bathroom late)?

• Can you hold your urine if you feel like urinating?

examination

In the examination, they first ask you to cough or sneeze with a full bladder. They may even need to examine the strength of the pelvic muscles. Prostate examination is generally necessary for men, and internal vaginal examination is also necessary for women.

Diagnostic tests

• Complete urine test and urine culture

• Ultrasound to determine the amount of residual urine

• bladder tape

• Cystoscopy

What is a bladder strip?

Bladder tape is a test in which the patient urinates in a container and through a series of connections of the device to the patient, checking the flow of urine, the strength of the bladder muscles, sphincter (urinary valve) and evaluating the pressure and ability to urinate will be measured and recorded.

What is cystoscopy?

It is a test that is generally less used in the investigation of urinary incontinence, except in cases of blood in the urine or when the type of incontinence is unclear according to the history.

Treatment of urinary incontinence

There are different methods for treatment depending on the type and severity of incontinence, and there is not always a single solution that can be used for all people; As a result, avoid taking different medications before you know the cause of urinary incontinence.

Generally, different methods are used first to choose the most suitable treatment. Sometimes conservative measures and lack of serious treatment change a person's condition and quality of life; Such as lifestyle changes, pelvic floor muscle exercises. Surgical methods are also used when the above changes are not successful.

home treatment

Fortunately, in many cases, the home treatment of urinary incontinence is effective and there will be no need to use drugs or other methods. The home remedies for this condition are as follows:

1. Exercise: with the help of some exercises, it is possible to strengthen the pelvic floor muscles, whichis one of the most important methods of treating incontinence; These exercises are known as Kegel exercises.

2. Stress management: By using breathing exercises, listening to soothing music, walking, reading books, yoga and meditation,you can control your stress to a great extent, which will be effective in treating urinary incontinence.

3. Herbal medicines: the use of medicines such as licorice root, which has anti-inflammatory properties, can helpreduce bladder inflammation. Also, the use of milk thistle can be effective in improving bladder control.

Drug treatment

The most common medicine for urinary incontinence in men is called anticholinergic, and such medicines can solve the emergency and emergency of urination. Depending on the type of incontinence, the drugs desmopressin and duloxetine may be appropriate.

Types of urinary incontinence

Stress incontinence

It happens during certain activities such as coughing, sneezing, laughing, exercising or lifting heavy objects such as picking up a basket of fruits. Stress incontinence is usually the result of weakening or damage to the muscles used to prevent urination, such as the pelvic floor muscles and urethral sphincter.

Urinary incontinence emergency

It happens when a person suddenly needs to urinate and cannot resist it. In this case, the bladder muscles contract involuntarily and the person will urinate without wanting to. Emergency incontinence is usually the result of overactivity of the detrusor muscles that control the bladder, and weakness in these muscles in times of stress-emergency causes this type of incontinence.

Urinary incontinence after prostate surgery

Prostate surgery increases the chance of stress incontinence and the inability to control urine due to the fact that after the surgery,the prostate, which has put extra pressure on the urinary tract, is removed, and eventually the resistance of the duct is reduced.

Mixed incontinence

It is when you have stress and emergency incontinence symptoms at the same time. For example, if you cough or sneeze, you may leak urine and experience a strong urge to urinate.

Overflow incontinence

This type, also called chronic urinary retention, is when the bladder cannot be completely emptied during urination. This disorder causes the bladder to swell more than its usual size.

If you have overflow incontinence, you may often dribble. It may also feel like your bladder is never completely empty and that you can't empty it even if you try.

Overflow incontinence is often caused by a blockage in the bladder that prevents it from emptying completely. Complete incontinence may be due to a problem with the bladder from birth, a spinal cord injury, or a small tunnel, such as a hole, that can develop between the bladder and an adjacent area (fistula).

Stress urinary incontinence drug

If stress incontinence does not improve significantly with lifestyle changes or exercise, surgery is usually recommended as the next step. However, if you are not eligible for surgery, you may benefit from an antidepressant called duloxetine. This drug can help increase the muscle tone of the urethra, to help keep it closed

. You should take duloxetine twice a day and be checked after 2 to 4 weeks to see if the medicine is working or if there are any side effects.

Side effects of duloxetine include the following

• nausea

• dry mouth

• extreme fatigue (fatigue)

• constipation

Medicines for emergency incontinence

Antimuscarinic drugs

If bladder training doesn't work for your urge incontinence, your GP may prescribe a medicine called an antimuscarinic.

Antimuscarinic drugs are also prescribed in case of overactive bladder syndrome, which may be accompanied by frequent urination or occur with urinary incontinence.

The most common types of antimuscarinic drugs used to treat urinary incontinence are:

• Oxybutynin

• Toltrodine

• Darifnacin

These drugs are usually taken as oral tablets 2 or 3 times a day. You usually start at a low dose to minimize possible side effects.

Nocturnal medicine

Nocturnal enuresis is a low-dose prescription of a drug called desmopressin that is used to treat nocturnal enuresis, which is the frequent need to urinate during the night by helping to reduce the amount of urine produced in the kidneys.

Surgical method in stress incontinence

Colposuspension: In colposuspension, an incision is made in the lower area (abdomen) and includes removing the bladder neck andsewing it up in this position. In women, the use of colposuspension can prevent involuntary leakage of stress incontinence.

This is done in two ways:

1. Open colposponson: where the surgery is done through a large incision.

2. Laparoscopic colposuspension is performed through one or more small incisions using small surgical instruments.

It is possible that after colposuspension surgery, difficulty in completely emptying the bladder during urination, urinary tract infections (UTI) that cause recurrence of the disease, and discomfort during sexual intercourse may occur.

Sling surgery

It involves making an incision in your lower abdomen (abdomen) and vagina, so a hook can be placed around the bladder neck to support it and prevent urine leakage. In men, this surgery involves cutting between the testicles and the anus to place a sling around part of the urethral bulb (the enlarged end of the urethra).

The hook can be one of the following:

• Tissue taken from another part of your body (autologous sling)

• Tissue donated from another person (slinging allograft)

• Tissue taken from an animal (xenograft tissue), such as tissue from a cow or pig

The most commonly reported problem associated with sling use is bladder emptying during urination. A small number of people who perform this operation will suffer from emergency incontinence again, which can be counted as a side effect of surgery.

Surgery and emergency incontinence procedures

Botulinum toxin injection

Botulinum toxin A (Botox) can be injected into both sides of the bladder to treat urinary incontinence and overactive bladder syndrome. This medicine can sometimes help relieve these problems by relaxing the bladder. The effect of this method can last several months and the injections can be repeated if there is a positive response.

Although your incontinence symptoms may improve after the injection, you may have difficulty emptying your bladder completely. If this happens, a thin, flexible tube called a catheter will be inserted into the urethra to drain urine from the bladder. Botulinum toxin A is not currently approved to treat urinary incontinence or overactive bladder syndrome, so you should be aware of any risks before deciding to undergo this treatment.

Posterior tibial nerve stimulation

The dorsal tibial nerve is transferred from your foot to your ankle and includes nerve fibers that innervate your bladder and pelvic floor from the same nerve location.. A very thin needle is inserted through the skin of your ankle and a mild electrical current is sent through it, causing the foot to tingle and move. You may need 12 stimulation sessions, each lasting about 30 minutes, spaced 1 week apart.

Reinforcement cystoplasty

In rare cases, a procedure known as booster cystoplasty may be recommended to treat urinary incontinence. This surgery involves enlarging your bladder by adding a piece of tissue from the intestine to the bladder wall. After an augmented cystoplasty, you may not be able to urinate normally and may need to use a catheter.

For this reason, augmentation cystoplasty is considered only if the use of a catheter is desired. Difficulty urinating can also mean that people who have augmentation cystoplasty can get urinary tract infections (UTIs), which can cause incontinence to keep coming back.

Urinary deviation

Urine diversion is a procedure in which the tubes leading from the kidneys to the bladder (ureters) are directed out of the body. The urine then collects in a bag, without draining into your bladder. Urinary diversion should only be performed if other treatments have failed or are not appropriate. This procedure can cause several complications, such as bladder infection, and sometimes more surgery is needed to correct the problems.

How to live with urinary incontinence

• Lifestyle changes that can generally increase the quality of life.

• It's best to make sure you always know where the nearest toilet is.

• Never feel embarrassed to ask for the address of a public toilet.

• Empty your bladder every two hours, especially before bed.

• There are a variety of products to absorb urine that leaks, such as incontinence condoms and pads

• When using diapers or pads, try to always keep the groin area dry and clean; This will help to reduce the irritation or irritation of the skin and also control the smell of urine.

• Men can also use condoms for urinary incontinence.

Urinary incontinence control at work

• Avoid excessive consumption of liquids and caffeinated drinks such as coffee and tea.

• As soon as you feel your bladder is full, go to the bathroom to empty it and try to empty your bladder every two hours.

• Try to wear dark clothes and have at least one extra dress at your workplace.

• During rest hours, try to do pelvic floor exercises regularly.

Use of a catheter

Sometimes catheterization is necessary to prevent urine leakage. The patient may be taught to use a catheter every few hours to empty the bladder, and sometimes the catheter is placed inside the bladder for a long time (two to three weeks).

Having a catheter does not mean that a person cannot be sexually active. Both men and women can have sex with a catheter. Men can bend it down and fold it and pull the condom over it to have sex. Women can also fix the tube on their groin using an adhesive tape and have sex easily.