Male Incontinence

It is estimated that 3.4 million men (5% of men aged 19-44, 11.2% of men aged 45 to 64, 21% of men aged 65 and older) in the United States currently experience urinary incontinence. As you may know, urinary incontinence makes life difficult both physically and emotionally, but this is especially true for men. While often related to prostate problems, urinary incontinence in men has a variety of causes and can also be brought on by medical conditions such as diabetes, Parkinson’s disease, multiple sclerosis, and by pelvic surgical procedures including radical prostatectomy.

Continence care is a crucial aspect of managing incontinence. Aeroflow Urology can supply incontinence products through insurance, keeping you dry and saving you money. Aeroflow offers ultra absorbent, high quality incontinence supplies (adult diapers, protective underwear, etc.) and catheter products through insurance at up to no cost to you. With the right incontinence products, your quality of life can increase immensely.

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What Are the Most Common Causes of Incontinence in Men?

There are a variety of different reasons that men may be experiencing symptoms of urinary incontinence. It is important to be aware that there will be different side effects due to the cause of the incontinence and the specific type of incontinence that is affecting the urinary system. 

Prostate concerns. When a male has an enlarged prostate, the flow of urine is diminished causing a weak, slower urinary stream along with frequent urination. Incomplete emptying of the bladder may occur and lead to overflow or urge incontinence. If men have prostate surgery to have their prostates removed secondary to prostate cancer, this removes a supporting structure to the bladder and urethra, which can lead to stress urinary incontinence.

Neurological conditions. When the nerves to the bladder become compromised, this can also lead to urinary incontinence in men. Neurological conditions that may cause incontinence include diabetes, Parkinson’s disease, multiple sclerosis, spinal cord injuries, dementia / Alzheimer’s, herniated discs, and strokes.

Constipation. Chronic constipation can lead to hard impacted stool in the rectum, which can press on the bladder and displace volume in the pelvis. This can lead to urge incontinence in men.

Waist circumference. Increased abdominal girth and waist circumference leads to increased abdominal pressure pushing on the bladder and pelvic floor muscles, which can lead to stress incontinence in men. Increased physical activity can help to combat weight gain and comorbidities such as obesity. 

Diet. Certain foods and beverages can cause irritation to the lining of the bladder, which can in turn lead to symptoms of urge incontinence. Citrus foods, spicy foods, caffeine, alcohol, and dehydration can all lead to bladder lining irritation contributing to urge incontinence.

Smoking. Smokers tend to have a chronic cough that leads to an indirect cause of urine leakage, mainly because of the frequency and abnormal violence involved in each cough which can lead to uncontrolled urinating.

How Can Working from Home or Sitting for Long Periods of Time Lead to Incontinence Symptoms?

Sitting for prolonged periods of time can weaken the pelvic floor muscles and thereby lead to bladder control problems. We have seen this more with people working from home more frequently and more jobs becoming desk jobs. Your pelvic floor muscles engage as you go from a sitting to standing position, supporting the bladder and the urethra so that you don’t leak urine. With prolonged sitting, those muscles do not engage as often and therefore weaken over time. We recommend standing up and walking around at least every 30 minutes if you have to be sitting for longer periods of time. Standing desks are also a great alternative if you have one available.

The Connection Between Biking and Incontinence Symptoms

Avid athletes, like hard-core cyclists, tend to have high-tone pelvic floor muscles. We know that high-tone pelvic floor muscles can lead to over-supporting the urethra and bladder, which can lead to urge incontinence. Another cause of incontinence for cyclists includes damage to the pelvic nerves that control the pelvic floor muscles and the detrusor or bladder muscles. Sitting on cycling seats applies direct pressure to the pudendal nerve, which runs just under the ischial tuberosities or your sits bones. That pressure compromises the pudendal nerve, causing numbness, lack of sensation. This causes loss of control to the pelvic floor muscles, bladder, and even genitals. This can lead to not being able to control when you need to empty your bladder or even recognize when you need to void. This then can even lead to your genitals not being able to perform with adequate stimulation.

We know that it is important during training to schedule long rides to enhance your stamina and strengthen your body. However, it is also important to listen to your body and rest. We recommend avoiding scheduling long rides back-to-back, and remember to stretch during rides and races. Even adding extra cushion / padding to your bike seat can help decrease the amount of pressure applied to your pelvic nerves.

Urge incontinence in Men vs. Stress Incontinence in Men

There are two primary types of urinary incontinence that are seen in males. It is important to note that a urologist will be able to properly diagnose the type of incontinence you are experiencing, so your treatment plan can be specialized to your symptoms. 

Stress incontinence is what happens when outside pressure, usually abdominal pressure, gets applied to the bladder. This pressure overcomes the muscles holding the bladder and urethra shut. This type of incontinence typically occurs when sneezing, laughing, coughing, or lifting heavy objects. This type of incontinence is rarer in men than women. However, it can still occur in men. Men typically experience stress incontinence after prostatectomy (removal of the prostate secondary to prostate cancer) or those with chronic cough secondary to long-term smoking.

Urge incontinence, which is the more common type of urinary incontinence in men, occurs when the sudden urge to void overcomes the autonomic physiological response (also referred to as overactive bladder or OAB). This can happen when pelvic nerve damage occurs from pelvic or abdominal surgeries. It can also occur after spinal cord injuries (including herniated discs), and it is often seen in neurologic diseases such as Parkinsons, multiple sclerosis, and comorbidities, such as diabetes, that can damage nerve signals to the bladder. Bladder irritants such as citrus foods, spicy foods, caffeine, and dehydration can contribute to urge incontinence, as well.

Other types of incontinence include overflow incontinence, functional incontinence, and mixed incontinence. Mixed incontinence occurs when an individual has more than one type of urinary incontinence.

Treatment Options for Men with Incontinence

Pelvic floor retraining is a great way to improve urinary incontinence in men. It is highly recommended that the pelvic floor retraining be under the guidance of a pelvic floor physical therapist. Pelvic floor PTs are able to determine if you have high-tone pelvic floor muscles or muscle dysfunctions that are leading to your incontinence. They will be able to assess and evaluate your pelvic floor muscles, pelvis, abdominals, and lower back to ensure proper functioning.

If there are discrepancies, they are able to provide strengthening and / or lengthening exercises. Avoiding bladder irritants such as citrus, spicy foods, caffeine, excessive alcohol, and additional sugar intake can also help improve urinary incontinence. Avoiding constipation and ensuring hydration with adequate water intake is beneficial, as well. Regular exercise, 30 minutes a day, including stretching, can significantly improve pelvic floor muscle and bladder strength. Voiding (emptying your bladder) every 2-3 hours is also helpful to not allow your bladder to fill too full, causing urgency and potentially incontinence. Bladder training can also be a helpful process in treating incontinence. It is important to discuss your incontinence with your healthcare provider to allow for adequate treatment options for your unique symptoms and needs.

Dr. Aleece Fosnight

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, NCMP, IF is a Medical Advisor and Writer for Aeroflow Urology and a board-certified physician assistant specializing in sexual medicine, women’s health, and urology. In 2019, she opened up her own private practice, the Fosnight Center for Sexual Health, and implemented the sexual health grand rounds curriculum at her local hospital and residency program.

Aleece is also the founder of the Fosnight Foundation, a non-profit organization dedicated to the education and training of professionals in the sexual health field and providing funding for access to healthcare services in her local community.

Information provided on the Aeroflow Urology blog is not intended as a substitute to medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.