Incontinence in Men and Women

What are the symptoms of Incontinence?

The main symptom of incontinence is the accidental release of urine.

• Stress incontinence: Urine leaks when coughing, laughing, exercising, or sudden movements.
• Urge incontinence: An immediate need to urinate, even small amounts. Patients urinate frequently and have trouble reaching the toilet in time.
• Overflow incontinence: Despite a constant urge to urinate, urine just dribbles continuously.

What causes Incontinence?

Muscle weakness in the bladder or pelvic floor, or problems in the nerves that control urination, cause incontinence. In general, it occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull.

Other contributors to incontinence include:

• Certain medications
• Chronic coughing
• Cognitive impairment
• Congenital problems
• Diabetes
• Frequent constipation
• Neurologic disease such as stroke, Parkinson’s disease, multiple sclerosis, or a spinal cord injury
• Obesity
• Prior pelvic surgery and/or radiation
• Smoking
• Urinary tract infections

For women, these additional causes are common: pregnancy, pelvic floor trauma after vaginal birth, and menopause.

Men may become incontinent as a result of prostate removal. If the nerves or the sphincter muscle have been damaged, the urethra won’t close enough to keep urine from leaking.

How is Incontinence diagnosed?

A urologist will perform a detailed history and physical exam, so it is helpful if you keep a diary for a few days beforehand to record times of urination, the amount of urine, leakage, and foods and beverages consumed. Your doctor may also perform one or more of these tests:

• Stress test: You’ll be asked to relax, and then cough hard as your physician watches for urine loss.
• Postvoid residual volume: Measures the amount of urine left in the bladder after urination.
• Urinalysis: An examination of the composition of your urine.
• Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
• Urodynamics: A technique that measures the pressure in the bladder and urine flow.

For men, further testing may be needed to determine that the bladder is emptying and that there is not a blockage from the prostate or scar tissue (if prior surgery has been done).

How is Incontinence treated?

Lifestyle changes, including modifications to the diet and Kegel (pelvic squeezing) exercises for men and women can help manage incontinence. Other treatment options include:

• Medications: Anticholinergics (which block neurotransmitters) can help suppress involuntary contractions by the muscle surrounding the bladder. Other medications include beta-3 agonists (mirabegron), and alpha-adrenergic (nerve-stimulating) drugs.
• Posterior Tibial Nerve Stimulation (PTNS): A periodic stimulation of the posterior tibial nerve (near the ankle) as regular, outpatient therapy.
• Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.
• Sacral nerve stimulation: A pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone to calm the nerves that control bladder function. This usually treats urge incontinence.
• Urethral or mid-urethral slings: Mesh tape placed under the urethra acts like a hammock to keep the urethra in its normal position. The tape provides support for a sagging urethra, so it remains closed during a cough or vigorous or sudden movement. At times, non-mesh or autologous fascia options can be used.
• Artificial urinary sphincter: A device is inserted to encircle and close the urethra, acting as a replacement muscle.

Additional options for women:

• Injection therapy: Injecting synthetic compounds around the urethra bulks up and improves the function of the urethral sphincter and compress the urethra near the bladder outlet.
• Tension-free vaginal tape (TVT): Mesh tape placed under the urethra acts like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed during a cough or vigorous or sudden movement.

Additional options for men:

• Prostate surgery: Removal of tissue in the prostate gland or maneuvering the prostate itself may alleviate pressure on the urethra and allow the bladder to empty.