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Family Health Magazine
GROWING OLDER

Urinary Incontinence
Help and advice for men

George is 76 years old. He had a stroke two months ago. Since then he gets sudden, strong urges to urinate. This happens often – even several times a night. He often leaks urine on the way to the bathroom.

Peter was recently diagnosed with prostate cancer. Two weeks ago, he had surgery to remove the small gland (the prostate) that sat just below his bladder. A catheter tube drained urine following the surgery. This tube has just been removed. Now, urine often leaks out when Peter moves around. This is very upsetting.

Mike is 55 years old. Over the past two or three years he has noticed that his urine stream has slowed down. He now gets up twice to go to the bathroom at night and about 10 times during the day. Sometimes urine dribbles into his boxers afterward.

Men can lose control over urination for a variety of reasons. The condition is medically known as urinary incontinence. Talking to a health professional about it can help, as most cases can be controlled or cured.

There are two types of incontinence: urge incontinence and stress incontinence.

Urge incontinence is a sudden and strong need to urinate that makes urine come out before a toilet is reached. Those with urge incontinence often visit the bathroom frequently in the daytime, and several times at night. In this case the bladder muscle is overactive, squeezing out urine at the wrong moment.

Stress incontinence involves leaking small amounts of urine when pressure inside the abdomen increases and pushes down on the bladder. It is most common with activities such as coughing, sneezing, laughing, walking, lifting, jumping, or playing sports. Men can experience it if the urethral sphincter muscle, which closes off the outlet from the bladder, becomes damaged.

How common is incontinence in men?

• About one in 33 men younger than 60, and one in six men over 60, are affected by incontinence.
  
• About half of those admitted to hospital following a stroke are incontinent. One year after the stroke, only one in six still have this problem.
  
• After a radical prostatectomy (surgery for prostate cancer, where the whole prostate is removed), most men are incontinent for a short time. However, they regain bladder control and have no problems within six to 12 months. A few men, about one in 20, have a long-term incontinence problem.
  
• Three out of four men over 70 have a problem with an enlarged prostate (not due to cancer) that can block the flow of urine. Some have a small part of the prostate removed to improve urine flow. This type of prostate surgery hardly ever causes incontinence.

George

George has had urge incontinence since his stroke. It has improved slightly in the last week or two. What might help him?

First, he should make an appointment with a health care professional, such as a family doctor, nurse continence advisor or physiotherapist. Before the appointment, he should keep a bladder diary for three days that lists:

• the amounts and types of fluid he drinks
  
• when and how much he urinates
  
• when and how much urine is leaked
  
• what is happening – such as a strong urge striking on the way to the bathroom, or leakage when he rises from a chair.

This bladder diary and a list of medications should accompany George to his appointment. Once there, he should be checked for bladder infection, as this can make leakage worse.

How can George improve his control?

• Follow good bladder habits (see sidebar below).
  
• Start exercising – pelvic muscle exercises and bladder training can help urge incontinence (see Exercises sidebar). After several weeks of doing these regularly, George should see improvement. A nurse, nurse continence advisor, or physiotherapist can help.
  

Bladder training for people with urge incontinence

Bladder training is a way of teaching the bladder to behave normally again. The goal is to improve bladder control, increase the amount of urine the bladder can hold, and decrease the both the urge and leakage.

• When you feel an urgent need to visit the bathroom, it may help to sit down and do something else to try to take your mind off wanting to go.
  
• Do your pelvic floor exercises – this strengthens your inner muscles and gives you confidence to hold on.
  
• Use the same exercises to relax the bladder and decrease the strong urge to urinate. Do five to 10 quick squeezes.
  
• When you do go to the bathroom, walk, do not run.
  
• Do not go to the bathroom ‘just in case.’
  
• Try to gradually increase the time between bathroom visits.
  
• Taking a medicine to relax the bladder may help in retraining it.
  
• Monitor medications – George may want to talk to his doctor about whether the medications he is taking may affect his bladder. For instance, a diuretic or water pill could make leakage worse. As well, new medicines might help with leakage by relaxing the bladder.
  
• Wear good protection – Many good pads and other products are especially designed for men. They may be needed while leakage is being treated. There are male pouches and stick-on pads for small to medium leakage, or pull-up pants for heavier leakage. They can be found in grocery stores, drug stores or health care supply stores.
• For very heavy leakage, external catheters that look like condoms can be used. (These do not have a tube that goes into the bladder.) They attach to a leg bag that can be worn inside the pants.
• Washable pads can protect furniture and beds.
• Remember to take good care of the skin around the leakage area. Use an appropriate cleanser and moisturizer, and wear pads designed for urine leakage, rather than cloths or tissue.

Peter

Peter’s prostate surgery damaged his sphincter muscle. Now, he needs advice on how to manage his stress incontinence.

• His family doctor refers him to a nurse continence advisor, who teaches him to do pelvic muscle exercises (see Exercises sidebar). Now that his catheter has been removed, he can start these exercises. (Doing pelvic muscle exercises four to six weeks prior to surgery can help make them part of a man’s routine.)
  
• The nurse also teaches him about good bladder habits (see sidebar) and shows him protective products that he can use until the leakage stops.
  
• Three months after surgery, there is less leakage. However, Peter finds that pads are not enough while he is golfing. The nurse suggests that he can use a penis clamp while he is playing. These clamps are recommended for short periods only, not all day.

Mike

Mike sees his doctor about his bladder problems. The doctor does a rectal examination and tells him that his prostate is enlarged. Other tests show no signs of cancer. His symptoms suggest that his enlarged prostate is blocking the outlet from the bladder.

• The doctor may prescribe medicine to shrink or relax the prostate or bladder.
  
• If this does not work in six months, prostate surgery may be necessary. This type is less severe than the surgery done for prostate cancer. It is not likely to cause incontinence.
  
• The urethra is the tube that connects the bladder to the outside of the body. Mike can reduce the dribbling by ‘milking’ the urethra along the base of the penis (behind the scrotum) after the urine stream stops, to get the last drops out.

George, Peter and Mike have different bladder problems. While some solutions are the same, others are individual. Any changes in bladder habits, urine stream, or leaking should be mentioned to your family physician. Many people can help, and much can be done.