Contrary to popular belief, urinary incontinence does not only affect women and can also affect men. This disease is characterized by any involuntary leakage of urine that causes discomfort to the person and is the daily burden of nearly 2 million men.

Because of the difference between the male and female excretory systems, incontinence can vary from patient to patient. Despite popular belief, there are different types of urinary incontinence that manifest and are treated differently. Focus!

Causes in humans

In many cases, involuntary urine loss in men is the result of medical treatment or surgery. Surgical procedures such as prostatectomy can damage the sphincter tissue and cause temporary or persistent leakage.

Certain conditions such as benign prostatic hyperplasia (enlargement of the prostate gland) can be implicated in male urinary incontinence. Other conditions such as degenerative diseases (multiple sclerosis, Parkinson's disease, etc.) or diabetes are sometimes linked to bladder weakness.

Diseases affecting the prostate, bladder or urethra (severe constipation, hypoactive or overactive bladder) are also the cause of male urinary incontinence. Similarly, medication such as diuretics can affect sphincter function. It should be noted that poor lifestyle habits (obesity, poor diet, etc.) are also risk factors.

Types of incontinence in men

Male bladder weakness manifests itself in different ways. As a result, there are different types of male urinary incontinence.

• Stress incontinence

  When the patient has stress incontinence, urine leakage occurs when the intra-abdominal pressure changes. This occurs during movement from light to heavy physical activity. Leakage from this type of incontinence occurs when the man coughs, laughs, sneezes, walks or simply changes position.

  This type of incontinence is commonly seen when the sphincter muscles are affected or weakened after prostate cancer surgery. However, it can disappear within three months after surgery.

• Emergency incontinence

  Urge incontinence is characterized by a sudden urge to urinate. This symptom is the translation of a bladder hyperactivity and an untimely contraction of the bladder which causes urinary leakage. The pressure on the sphincter becomes so great that the leakage occurs at the same time or immediately after the contraction of the bladder muscle.

• Mixed incontinence

  Mixed incontinence is characterized by symptoms of both stress and urge incontinence. When it occurs, it is common for one type to be dominant and require priority medical care.

• Overflow incontinence

  Overflow incontinence is the most common form of incontinence in men. Overflow incontinence is the overflow of urine into the bladder caused by an obstruction to the normal flow of urine (such as an enlarged prostate). The bladder's storage capacity is exceeded and urine is regularly passed out drop by drop.

• The late drops

  Apart from the main types of incontinence, there are a few other urinary disorders that have an equally negative impact on the lives of sufferers. Delayed drops are the last drops of urine that are not completely evacuated during urination. Some time after urination, these drops can escape in a more or less important quantity after having been retained.

  This urinary problem can affect men of all ages and is often caused by a weak urine stream. Despite their innocuous appearance at first glance, lagging drops must be treated by a doctor, otherwise complications may arise.

• The terminal drops

  Also known as dribbling, end-drops are a gradual and rather slow completion of urination. In this case of urinary disorders, the flow of urine at the end of the micturition is done by drip, which makes the process much longer. In everyday life, this is a disorder that can quickly become a nuisance for those who suffer from it.

The exercises

When a man's incontinence is caused by a sphincter problem, it is possible to use specialized medicine such as physiotherapy. The specialist may suggest exercises to rehabilitate the pelvic floor muscles and bladder muscles.

In this way, he or she will be able to better assess muscle function and its involvement in urinary problems. Once this step is completed, the rehabilitation physician will offer an active exercise program tailored to the patient with urinary problems.

It is possible to find a physical therapy professional who offers programs for patients who have just undergone risky surgery. In some cases, exercises to be performed at home with the help of a perineal self-education device are included in the program.

The work is not as effective as that done with the doctor, but it allows you to progress at a good pace. In more than half of the cases of stress incontinence, the practice of these rehabilitation exercises allows us to observe an improvement in the health of the men concerned.

When to consult?

In order to begin receiving proper care, it is crucial that those concerned go to a doctor. When should bladder weakness be considered serious enough to seek medical attention? Men with warning signs such as loss of sensation in the legs or genitals should go directly to the emergency room. Otherwise, watching the symptoms develop over a week before seeking medical attention is not dramatic.

Even in people of advanced age, it is necessary to consult, because incontinence is not a normal attribute of aging. In order to propose adequate solutions, doctors must establish a diagnosis based on a general and specific clinical examination. First, a dialogue must take place with the caregiver and be preceded by the completion of a form with medical details about the patient's health.

A urine cyto-bacteriological examination (UBE) or urinalysis is regularly required to identify possible urinary tract infections. The person to be treated may be asked to keep a voiding calendar, documenting certain details of urination over a period of time. This may include the time of day, the volume of urine expelled, but also additional observations made in relation to the urine.

The quantification of the volume of urine loss can be ensured by a pad test. This consists of weighing all the urinary protection used during the day to obtain more accurate data. These medical examinations are not systematic, but they can remove any doubt as to the mechanism and causes of the incontinence observed.

Surgical treatments

Depending on the causes identified by the physician as being at the root of male urinary incontinence, treatments can be either medical or surgical. Surgical intervention is usually chosen to correct urinary stress incontinence that occurs after prostate cancer surgery. Priority organs are targeted to address urinary problems in men:

• the sphincter muscles,
• the bladder,
• the urethra.

In cases where the patient does not tolerate oral medication therapy, intravesical botulinum toxin A injection services are an option. These injections help to calm the overactive bladder. However, the effect is only seen for six to nine months and must be repeated regularly.

In order to safeguard the patient's health as much as possible, the procedure is adapted to the patient's medical profile, but also to his or her medical history. Most surgical treatments are quick and painless for those who undergo them.

• The sub-urethral strips

  Male suburethral sling surgery can be considered for bladder weakness persisting more than 9 months after prostate removal. Unlike transurethral resection of the prostate (TURP), the return to continence is immediate after urinary tape placement.

  Complications are rare, but difficulty in urinating (dysuria) may occur, requiring the bladder catheter to be worn for longer periods of time or even a new procedure. In addition, the use of urinary strips does not eliminate all leaks. In practice, 50% of sling wearers complain of continued leakage, but experience a marked improvement in stress incontinence-related leakage.

• The sphincter implant

  The treatment of severe incontinence in men is achieved through the installation of a urinary artificial sphincter. This choice is recommended in cases of severe urinary leakage exceeding 400 milliliters per 24 hours.

  Unlike the female sphincter, the male artificial sphincter consists of an inflatable sleeve that surrounds the urethra. It is controlled by a button attached to a pump housed in a pouch. An overhanging reservoir is inserted under the abdominal wall and supplies the system with a sterile liquid that inflates the sleeve and thus compresses the urethra. Both hands are needed to operate the pump.

  Ultimately, patients fitted with an artificial sphincter appear to have an excellent urinary satisfaction rate (90%). Manufacturers advise patients who choose this method to avoid certain sports to avoid damaging the on-board equipment or the surrounding tissue. However, this option seems to have a number of drawbacks:

  • risk of infection,
  • risk of urethral erosion,
  • problems related to the handling of the material in case of consciousness disorders,
  • loss of autonomy,
  • material wear.

  Complications can also be mechanical: failure due to pump blockage, fluid leakage from the system, occlusion failure with persistent urinary incontinence, etc. In addition to surgery, treatment of prostate hypertrophy can be done with medication.

If conventional therapies are not effective in reducing urine loss, there are solutions such as OPTILUME, an innovative treatment for urinary stenosis. Several years after the surgery that caused the incontinence, the patient can expect to receive one of the above mentioned treatments.

In Marois clinics across Canada, many specialists in urology and various treatments for male urinary incontinence are open to receive anyone who suffers from it. They offer a warm welcome and, above all, a treatment program that is entirely customized to provide satisfaction and relief.