Stress Incontinence in Men

Have you ever sneezed, coughed or laughed only to feel the sensation of urine leakage?

If so, you may be experiencing stress urinary incontinence, the involuntary loss or leakage of urine that occurs during physical activity such as exercise, laughing, coughing and sneezing. The “stress” is added pressure on your bladder. Oftentimes, weakened pelvic muscles allow urine to leak when a cough, sneeze or other action puts pressure on the bladder.

Stress incontinence is a common side effect of prostate cancer surgery, specifically radical prostatectomy (complete removal of the prostate). 

In fact, urinary incontinence is a problem to some degree for most men following prostate surgery and radical prostatectomy. 

According to the National Association for Continence, "studies have indicated that as many as 90% of men report leakage in the first few weeks following surgery after removal of the catheter."

 

Why Does Stress Incontinence Occur Following Radical Prostatectomy?

The prostate gland aids the urethral sphincter in bladder control by providing support for the bladder neck. When the prostate is removed, so is the support, which sometimes causes urine to leak when pressure is put onto the bladder. Added pressure can be in the form of exercise, lifting and even sneezing, coughing, laughing and sex.

 

Diagnosing Stress Incontinence

It's important to discuss your urinary incontinence symptoms with your doctor who understands that bladder control problems interfere with your quality of life. Your doctor will begin by performing a physical exam and taking a medical history in order to diagnose your bladder control issue. He or she may also order additional diagnostics tests including:

  • Urinalysis
  • Blood work
  • A bladder diary – your physician may ask you to keep a record of what you drink, your urine output, when leakage occurs and what you were doing (coughing, laughing, exercising, etc.) when urine leakage occurred.

Specialized tests may also be performed to get a clear idea of the cause of your stress incontinence including:

  • Pelvic ultrasound: This test checks for structural abnormalities of the lower urinary tract and can assess for bladder abnoralties.

  • Post void residual test (PVR): Determines how well you empty your bladder by measuring residual urine after voiding. Measuring residual urine may aid your doctor in determining if there is a blockage or nerve or muscle problem.

  • Cystoscopy: A small camera called a cystoscope is inserted into the urethra to inspect the urethra, prostate and bladder for any visual abnormalities. This procedure can be performed in your doctor’s office or ambulatory surgery center under topical local anesthesia.

  • Urinary stress test – Looks for leaking urine when you cough, laugh or put other types of pressure on your bladder.

  • Cystogram – A special X-ray of your bladder taken while filling and evacuating.

  • Urodynamic tests – Diagnostic tests that evaluate the function of the bladder and urethra and include Uroflow, cystometrogram, EMG, pressure flow study, or videourodynamics.

  • Urinalysis and urine culture, which checks urine for the presence of infection or abnormalities. 

Treatment for Stress Incontinence

First Line Treatments

  • Physical Therapy - Physical therapy strengthens the pelvic floor muscles. Pelvic floor muscle exercises can help prevent urine leakage by strengthening the pelvic floor and sphincter muscles. 

  • Pelvic rehabilitation - Following a radical prostatectomy, rehabilitating the pelvic floor muscles can help stop urine leakage.

  • Fluid and diet management - Changing the amount of fluid intake during the day, as well as  avoiding common dietary irritants such as caffeine and tomato-based foods, may help bladder function.

  • Healthy lifestyle changes - Losing excess weight and quitting smoking (which leads to chronic cough) can help eliminate some pressure on your bladder.

 Surgical Treatment Options

  • Male urethral sling - For men who have not responded to behavioral therapy, a synthetic mesh sling surgically implanted to provide support to the urethra may help restore continence. Many men have success with the sling and see improvement in leakage following the surgery. Like any surgical procedure, the male sling does have its risks. Speak to your doctor to learn about the benefits and risks.  

  • Artificial Urinary Sphincter - The artificial urinary sphincter is an implantable device equipped with an inflatable cuff that fits around the urethra. This cuff replaces the natural sphincter that has been compromised and prevents urine leakage associated with stress urinary incontinence. Learn more about the artificial urinary sphincter here

  • Urethral bulking - Urethral bulking involves the injection of a special material called a bulking agent around the urethra. The bulking agent helps build up the thickness of the urethral wall to increase the outlet resistance to lessen urine leakage. However, bulking agents in men have proven to be a less effective treatment than other surgical options.