Article written by Dr Henry, Sphere Health partner

The different types of male incontinence

If men are less likely than women to be victims of incontinence, it is thanks to their anatomy. Men have a longer urethra, the initial portion of which is surrounded by the prostate gland. The man also benefits from a striated and powerful sphincter which is in contact with the lower part of the urethra, which reduces the risks of incontinence. In addition, men do not suffer from the deterioration of the perineum caused by pregnancy.

There are different types of urinary incontinence in men. Each disorder is recognized through very specific symptoms.

Overflow incontinence

It is the most common type of incontinence in men. This incontinence is secondary to a chronic obstruction of the bladder. The bladder will then have difficulty emptying, it will distend and remain almost full at all times. When the capacity of the bladder is exceeded, urinary leaks will appear without the patient being able to control the phenomenon. This incontinence is most often due to an obstruction by benign prostatic hyperplasia (adenoma) of the prostate. The abnormal development of the prostate gland can cause compression of the urethra, and thus cause a problem with the emptying of the bladder, which will tend to distend and remain full.

Stress incontinence 

It causes the sudden emission of urine during physical exertion. It can occur when the patient laughs, coughs, runs, walks, sneezes or makes any other effort that solicits the abdominal muscles. It is more common in women, but can also affect men.

In men, stress incontinence is almost exclusively secondary to surgery (most often the total removal of the prostate following cancer: radical prostatectomy).

During surgery, the muscle responsible for continence: the striated sphincter can be damaged. It is then no longer able to contain the urine in the bladder during the rise in abdominal pressure occurring during exertion and urine leaks appear.

Incontinence by “urgency”

It is also called urge incontinence or by bladder instability or urination urgency and occurs when the patient feels the urgent need to urinate without suffering from leakage. Here, the urge to urinate is urgent and irrepressible, even when the bladder is not full. Certain everyday events or situations can lead to this type of incontinence, such as the key in the lock or the passage of hands under cold water.

The causes of this type of incontinence are all the diseases that can create inflammation of the bladder and therefore involuntary contractions:

• The urinary tract infections or prostatitis : these are the most common. The incontinence is then transient and will quickly disappear with appropriate antibiotic treatment.
• THEadenoma of prostate may also be responsible for urge incontinence. During the development of prostate adenoma certain nerve fibers will develop and may cause involuntary contractions of the bladder.
• The tumor lesions of the bladder or bladder polyps that require specific management.
• Some neurological diseases (multiple sclerosis, parkinson’s disease) can cause an overactive bladder and emergency leaks.

Mixed incontinence

It concerns about 10% to 30% of patients, combines the symptoms of stress incontinence and urge incontinence. It is possible that one of these two forms of incontinence is more dominant and deserves to be treated as a priority. It is the doctor who during a consultation will decide the most appropriate treatment.

Functional incontinence

It mainly affects the elderly. It occurs when the cause has nothing to do with bladder function. The patient cannot restrain himself without the condition of his bladder being the cause.

Some patients have neurological disorders and in some cases may experience incontinence. This is neurogenic incontinence. In this case, the problem does not come from a physical dysfunction as we can imagine in the case of stress incontinence, but from a dysfunction of the nervous system as in Alzheimer’s disease for example.

Men are therefore not immune to urinary incontinence although they are less affected than women. It is important to be able to talk about it without taboos to your doctor as soon as possible. Depending on the causes and the type of incontinence identified, there are many suitable treatments and care. The healthcare professional can recommend rehabilitation, drug treatment or even surgical treatment. For drug therapy, the patient with an overactive bladder will be prescribed anticholinergic drugs, for example, which can be combined with pelvic and perineal rehabilitation.

It should not be forgotten that any dysfunction at the level of the urinary system can lead to a degradation, in particular at the level of the kidneys, hence the need to carry out a general assessment. Urinary incontinence should not handicap the person who is affected by it since solutions exist (rehabilitation in the for example in the case of stress incontinence and effective medical or surgical treatments). To do this only one step, talk to your doctor or specialist.