The doctor is in

Causes of Urinary Incontinence in Men: Am I Alone?

Jay Simhan, MD, FACS
Vice Chairman, Department of Urology
Einstein Healthcare Network

You are not alone. My patients often ask me if they are the only ones that suffer from urinary leakage. Urinary leakage, also known medically as “urinary incontinence,” is actually quite common with many millions of men in the United States alone diagnosed with this debilitating condition. A wide variety of things may cause urinary incontinence such as prior medical conditions, infection, cancer treatments, medications, and even certain types of food!

Although patients that leak urine automatically qualify for a diagnosis of urinary incontinence – this condition itself can often be broken down into distinct types of urinary leakage. Urge incontinence and stress urinary incontinence (SUI) are two different types of urinary leakage that patients might suffer from. Diagnosing the incontinence — the cause of leaking urine — is the first step to a solution.

What is urge incontinence? What causes overactive bladder?

Urge incontinence is popularly known as a serious form of “overactive bladder” or OAB. Patients that have this condition can relate to a sensation of needing to urinate with significant urgency or feeling the need to go to the bathroom frequently. Those that do not make it to a bathroom in enough time due to such bladder spasms that cause urine to leak qualify for a diagnosis of urge incontinence. There are many possible causes of overactive bladder or urge incontinence. Specifically, there are a variety of factors that can lead to the development of urge incontinence including urinary tract infection, inflammation, neurologic conditions (such as stroke or multiple sclerosis), and benign prostatic hyperplasia (BPH). All of these conditions could cause development of urinary urgency with leakage due to changes in the bladder’s ability to contract appropriately and squeeze the urine out of the body. Simply put, patients with overactive bladder can often be diagnosed with a poorly contracting bladder that does not fill and empty properly. As a result, urge incontinence is often due to a problem with bladder control. This type of incontinence is caused by problems with the bladder. Patients often describe a sensation of needing to go to the bathroom often along with significant urinary urgency. Those with poor bladder control often suffer poorly with urinary incontinence. Although men can certainly acquire this diagnosis as they get older due to developing larger prostates from BPH, most people that develop urge incontinence are women.

There are a variety of factors that can lead to the development of urge incontinence including urinary tract infection, inflammation and benign prostatic hyperplasia (BPH).

What causes stress urinary incontinence? What is stress incontinence?

Stress incontinence in men, on the other hand, represents a completely different type of urinary leakage that is commonly caused by prostate surgery or prostate cancer treatment. Patients with stress urinary incontinence (SUI) notice leakage when they are coughing, lifting heavy objects, and/or performing strenuous activities. Stress urinary incontinence may be experienced following treatment for prostate cancer. Patients can suffer from SUI or stress urinary incontinence, this second type of urine leakage, after prostate cancer treatment –   prostatectomy (surgical removal of the prostate gland) or radiation treatment. Often, a weakened urinary sphincter muscle that sits beneath the prostate causes stress urinary incontinence – and treatment of this condition depends on the degree of incontinence. Although patients may believe that incontinence may happen only with surgery, many patients can experience stress urinary leakage or incontinence from a weakened sphincter muscle following radiation treatment as well. For many, stress incontinence causes significant bother and a decrease in quality of life as patients might not be able to perform some of their work duties or enjoy hobbies.

Patients can experience stress urinary leakage or incontinence from a weakened sphincter muscle following radiation treatment.

Patients that suffer from urge or stress incontinence often face significant embarrassment due to their condition. Many patients go through numerous pads or diapers due to the leakage of urine and report an extremely poor quality of life. I am proud to have a practice that in large part is dedicated to management of urinary incontinence, with a predominant focus of stress urinary incontinence. Patients can suffer with any form of incontinence with the causes of incontinence varying along with severity. Whether mild or severe – there are often numerous medical or surgical treatments available to significantly improve one’s quality of life.

Jay Simhan, MD, FACS
Associate Professor of Urology
Temple Health / Fox Chase Cancer Center