Urinary incontinence (UI), also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. Bladder control develops earlier in females than in males. Men and women both are affected by this condition. As age advances men become more vulnerable to this condition due to prostate enlargement but this may not be a rule.
The functioning of the bladder is controlled at the local level by a micturition reflex and by the spinal cord and the brain at the higher level. The brain has centers that tell the individual if it is the right place and time to urinate. These centers are affected in conditions like Stroke, Parkinsonism, Alzheimer’s and Brain tumor because of which the person may urinate immediately after he gets the urge. The person may pass urine in bed, in a gathering etc. This is a type of urge incontinence.
At times the person may suffer from spinal cord injury. The spinal cord has nerves that carry sensation of bladder fullness from the bladder to the brain. As soon as the brain senses bladder fullness, it instructs the individual to go to the washroom to relieve him. Till such a place is found the brain sends signals through other nerves to keep the bladder opening closed. But in cases of spinal cord injury, this connection between the brain and bladder is lost as the spinal cord nerves are cut. In this case the person gets the urgency to void urine and he does it immediately. This is also a type of urge incontinence. Also in spinal cord injury the bladder gets spastic or overactive. A little bit of urine causes reflex contraction of bladder resulting in its contraction and expulsion of small amounts of urine with increased frequency. This is known as overactive bladder.
In conditions such as diabetes mellitus or other nerve diseases, the bladder muscles become weak and nerves causing the bladder contraction are diseased. As a result even after the bladder is full, there is no reflex contraction and emptying of bladder and the bladder keeps filling up till it overflows. This is known as overflow incontinence or dribbling.
Another variety is the stress incontinence which is found more commonly. The neck of the bladder has a ring of muscle called the sphincter. This sphincter is usually fully contracted to keep the bladder mouth closed. This muscular ring is supported by pelvic muscles. When the pelvic floor muscles get weakened, this ring also gets weak. As a result the mouth of the bladder in not totally closed at all times. So in instances where there is an increase in abdominal pressure as in laughing, coughing, sneezing, lifting weights etc., there is leakage if urine as the bladder is compressed. Enlarged prostate puts pressure on the bladder causing premature outflow of urine that cannot be voluntarily controlled.
Diagnosis
The condition can be diagnosed by various methods. Digital rectal examination can help to see whether the prostate is enlarged. The abdominal and pelvic Ultrasonography can identify any external factors that may be compressing the bladder. Urodynamics can help to identify stress incontinence. Maintaining a diary on number of times you need to go to the washroom to relieve yourself is also a good indicator of incontinence.
Treatment for Male Urinary Incontinence
Incontinence is curable. The methods and the time taken for cure will vary from person to person.
Behavioral modification : involves bladder training and timed voiding. Adjusting the time of fluid intake before bedtime or before going for a car trip or party can help avoid accidents during sleep or parties. Also timed voiding involves emptying of bladder after regular intervals. This technique is suitable for people with mechanical compression of bladder or overflow incontinence.
Kegel exercise : involves strengthening of the pelvic floor muscles which help to keep the sphincter muscles tight which in turn keep the bladder outlet closed during strenuous activities. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10 repeats. This is possible with the help of biofeedback also. This helps people with stress incontinence.
Medications : certain medications help to relax the bladder and surrounding muscles to allow full emptying (Alpha blockers). Some medicines help to reduce the level of hormone that enlarges the prostate, which in turn helps to reduce the mechanical pressure on the bladder and eases urine flow (5-alpha reductase inhibitors). Antispasmodics relieve the bladder muscle spasm thus preventing sudden bladder contractions.
Surgery :
Artificial Sphincter : Some male patients can eliminate urine leakage with an artificial sphincter. It is an implanted device that keeps the urethra closed until the person is ready to urinate. This device can help people who have incontinence because of weak sphincter muscles or because of nerve damage that interferes with sphincter muscle function. It does not solve incontinence caused by uncontrolled bladder contractions.
Surgery to place the artificial sphincter requires general or spinal anaesthesia. The device has three parts: a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum. The cuff is filled with liquid that makes it fit tightly around the urethra to prevent urine from leaking. When it is time to urinate, you squeeze the pump with your fingers to deflate the cuff so that the liquid moves to the balloon reservoir and urine can flow through the urethra. When your bladder is empty, the cuff automatically refills in the next 2 to 5 minutes to keep the urethra tightly closed.
Male Sling : Surgery can improve some types of urinary incontinence in men. In a sling procedure, the surgeon creates a support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the strip to the pelvic bone. The sling keeps constant pressure on the urethra so that it does not open until the patient consciously releases the urine.
Urinary Diversion : If the bladder must be removed or all bladder function is lost because of nerve damage, you may consider surgery to create a urinary diversion. In this procedure, the surgeon creates a reservoir by removing a piece of the small intestine and directing the ureters to the reservoir. The surgeon also creates a stoma, an opening on the lower abdomen where the urine can be drained through a catheter or into a bag.
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