Male Urinary Incontinence

Male Urinary Incontinence

Urinary Incontinence may be called as the unintended outflow of urine. Both men and women suffer due to this problem at various stages of their life. But elderly women are more likely to have Urinary Incontinence than men because of their structural differences in the pelvic area and the modifications occurred during pregnancy and delivery. On the other hand most of the men also endure from Urinary Incontinence and its incidence is high with aged men rather than the younger ones or adults

Urinary Incontinence is a manageable medical problem and the treatment options will be decided by your consultant after thorough examination. It may be divided into three kinds,

• Anxiety or Stress related Incontinence:

When a man coughs, sneezes or lifts he may have spontaneous urine loss, this is due to the strain given at the lower abdomen area which in turn affects the urinary bladder to do so.

• Urge related Incontinence:

Sometimes urine leakage occurs suddenly due to irresistible urge to pass urine and it cannot be stopped in anyways.

• Brim Over Incontinence:

In few cases there may be even leaking out of urine which is associated with frequent urination in little amount.
 

Reason for Urinary Incontinence in Men:

The urinary system in human beings works on the coordination of nerves and muscles and hence forth any trouble in it would cause Incontinence.

If nerves are damaged due to any diseases urinary problems occur. A nerve disorder can occur at any age and at any point of time.

• Persons who suffer from diabetes for longer period have damage on their nerves which impinge on the urinary system.
• Nerve disorders such as Parkinson’s disease, Stroke and Multiple Sclerosis can cause serious problem in the urinary system.
• “Hyper active” bladder is a syndrome where the bladder leaks out the urine at unexpected time. It occurs due to the problems in the nerves or may be without any reason.
• An injury in spinal cord affects the signal that controls the urinary bladder.

Prostate Problems:

A prostate is a male reproductive gland which looks like a walnut located below the urinary bladder surrounding the urethra.

Benign Prostatic Hyperplasia: The enlargement or swelling up of the prostate gland is called as Benign Prostatic Hyperplasia (BPH). It occurs in men who are above 40 yrs and the signs of this condition are Urge to urinate or leaking of urine, disturbed or weak flow, increased frequency to pass urine especially at nights and Incontinence.

Radical Prostatectomy: It is a procedure where the entire or part of the prostate gland is excised because of the prostate tumor. Due to this surgery, post complications such as Urinary Continence or Erectile dysfunction may occur.

External Beam Radiation: It is one of the treatment options for prostate malignancy and it can lead to Urinary Continence either in short or long term.
 

Diagnosis:

A complete medical history of your health will be taken by your doctor. He would get information about the quantity of water you drink in a day, consumption of alcohol or caffeine, etc and also about the medicines you are taking.

• Physical Examination: The doctor examines physically for the enlargement of the prostate by inserting the gloved finger into the rectum and sensing the gland. In order to check on the nerves the doctor may question about the numbness or pricking sensation in the particular area.
• EEG/EMG: Electro myelogram is done at the lower abdomen to find out the neural and muscular activity that grounds the loss of bladder control. Electro encephalogram is done to assess the damage of nerves in the brain.
• Ultrasound: Ultrasound is done to get a clear view of the prostate gland so that diagnosis can be made in a accurate way. In this process, a transducer which works on the sound waves is used to obtain the picture of the Prostate Gland. Both Abdominal and Trans Rectal ultrasound is done to confirm Urinary Incontinence.
• Uro dynamic Testing: This test aims at the ability of the Urinary bladder to store urine and empty it firmly and totally to find out your sphincter control method.

 Treatment:

The treatment for Urinary Continence will be decided on your complexity of the problem and lifestyle. It may be a simpler option of performing exercise to intricate surgical interventions.

Behavioral Treatment:

You will be advised to limit your fluid intake per day or planning regular spree to bathroom, it is called as “Timed Voiding” or “Bladder Training”. Once you have   strong bladder control, the time period of your between trips can be lengthened.“Kegel Excercises” are taught to strengthen the muscles at your pelvic region and this helps in greater control of your urinary bladder.

Kegel Exercise:

The identification of right muscles is the beginning step to perform the exercise. Just imagine that you are making yourself to stop passing the gas. When you sense a pulling up feeling, those are the correct muscles for pelvic exercises. Mean while you should not compress the other muscles at the same time and also not to stiffen leg, buttocks or stomach muscles. You should make sure that only the pelvic muscles are compressed and relieved. You need to do this for up to three counts and wait for another three counts. This has to be done for three sets of ten repeats by lying down on the floor in the correct position. Once you are well trained, you can continue the exercise by sitting or standing. The basic mechanism in Kegel exercise is working against the gravity, which gives more strength. This has to be done three times a day and by performing it regularly one can see drastic improvement after three to six weeks.
 

Medications:

Medicines control the urinary bladder in many ways,

• It disrupts the nerve signals which make the urinary bladder to contract at wrong time.
• Few medicines make to produce the urine at a slower rate.
• Other medicines make the urinary bladder to relax or restrict the prostate.

Based on this, your consultant may prescribe Alpha blockers, 5 alpha reductase inhibitors, Imipramine or Antispasmodics.  

Surgery for Male Urinary Incontinence:

Surgery is opted for men who have Urinary Continence because of neural damage due to Spine injury or Radical prostatectomy.

Artificial Sphincter:

This procedure is performed under Spinal or general anesthesia. Implanted instruments are inserted in to the scrotum. It has a cuff that fits urethra, a balloon like reservoir is kept in the abdomen and the pump is placed in the scrotum. Usually some amount of fluid is filled in the cuff so that it holds the urethra exactly and prevents the urine leakage. When you need to urinate, you have to compress the pump with hands to deflate the cuff. By doing this the balloon collects the liquid and the urine will start flowing in the urethra. Once your bladder is empty, automatically the cuff gets refilled within five minutes so that the urethra is kept at position.

Male Sling:

In this procedure, the urethra is covered by a band of materials and these bands are attached to the Pelvic bones. This way constant pressure is applied to the urethra so that urine will not be released unconsciously.

Diversion of Urine:
When the Urinary bladder loses its full control or in a position to be removed completely this technique is performed. Your surgeon would create a reservoir by using a small part of intestine and the urine is directed to it. He also makes an opening at the lower end so that urine will be drained into the catheter or into a bag.