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Male urinary incontinence is the involuntary loss of urine and can occur for various reasons, especially after certain prostate surgeries. Treatment is tailored to the type and severity of incontinence and includes traditional options, pelvic floor rehabilitation, and, in selected cases, surgical procedures.
Male urinary incontinence is defined as the involuntary loss of urine . Although more common in women, many men also experience this problem, affecting their quality of life and emotional well-being. Incontinence can vary in severity, from minor leaks to a continuous loss of bladder control.
There are several possible causes of male urinary incontinence, such as prostate problems, nerve damage, sphincter muscle weakness, or urinary tract infections.
The main symptom of urinary incontinence, whatever its cause, is urine leakage. Sometimes, depending on the cause, it may be accompanied by other symptoms.
This condition usually worsens when urination is forced, either by drinking water or through treatment with diuretics.
In men, stress urinary incontinence is often caused by urological surgeries or procedures, such as prostate or bladder surgery. These include transurethral resection of the prostate (TURP), radical prostatectomy, and prostate radiation therapy, among others. These procedures can damage the urinary sphincter, leading to incompetence. Some men experience urinary incontinence after one of these procedures, which usually improves over time.
In other cases, it may be due to denervation of the urinary sphincter—the closing mechanism—caused by neurological diseases such as diabetes, multiple sclerosis, or polyneuropathy of any cause. In this situation, the symptom is usually urine leakage during certain activities or exertions. It is very common for the severity of the incontinence to increase in parallel with the underlying neurological disease.
Urge urinary incontinence typically appears in men over 50. It can be due to age-related bladder deterioration or prostate problems. Although the mechanism is complex and multifactorial, benign prostatic hyperplasia (BPH) can cause obstruction, and the bladder responds by increasing voiding pressure through hypertrophy of the detrusor muscle (bladder muscle). This is associated with increased fibrosis, decreased distensibility, and the appearance of storage symptoms such as urinary urgency. While this is very common with BPH , it can also occur in other conditions such as bladder tumors, urethral strictures, or bladder neck contraction, among others.
Some foods high in caffeine, spicy foods, or alcohol can worsen it. It's surprising how much improvement some men experience when they eliminate these substances from their diet.
Similarly, some medications can hinder bladder emptying and worsen the clinical picture. For example, some sympathomimetic drugs can alter the urinary sphincter and impair bladder emptying. Paradoxically, this can lead to urge urinary incontinence.
When incontinence is mixed, the cause is usually an obstructive problem (benign prostatic hyperplasia, prostate cancer, urethral stricture) that overloads the bladder, often associated with urge incontinence after surgery or a urological procedure. It will be necessary to identify the predominant component of the condition.
The only cause of overflow incontinence is urinary retention. In most cases, this is due to prostatic obstruction or urethral stricture. Some medications (sympathomimetics or beta-2 agonists) can trigger urinary retention and, secondarily, overflow incontinence. Typically, these are men with long-standing prostate symptoms that have gradually worsened over time and who present with urinary incontinence that is difficult to define, with more of a stress than an urge component, but which is difficult to categorize.
Physical examination usually gives us a clue by identifying a urinary bladder full of urine, painful to the touch and whose pressure, when examined, triggers an episode of incontinence.
During an initial clinical consultation, the doctor will ask the person when they experience urine leakage to determine whether it is primarily stress incontinence (stress urinary incontinence) or urge incontinence (the inability to rush to the bathroom). Many patients present with a combination of both stress and urge incontinence. In such cases, it is necessary to identify the predominant component.
Occasionally, we encounter overflow incontinence in men aged 60-70 who have obstructive problems (prostate hyperplasia, urethral stricture). In this situation, it can be diagnosed partly based on the clinical presentation (which is usually more similar to stress incontinence) but especially due to the presence of chronic urinary retention.
It is important to collect data using standardized measures, which will help us better understand what is happening to each man and to determine the severity of the problem. For this purpose, we use questionnaires and a diary given to the patient to record the situations in which they experience urinary incontinence and the amount of urine lost. This will help us assess the impact of these losses.
To assess the severity of urinary incontinence, more or less precise quantitative measures are used, such as the number of times urine incontinence requires changing each day or the number of pads or absorbent products used. Alternatively, for a more accurate estimate of leakage, the PAD test can be used. This involves wearing one or more absorbent products for a day and weighing them to determine the grams of urine lost (1 gram equals 1 milliliter) and, therefore, the severity of the leakage. However, the assessment of urinary incontinence severity is often based on the impact it has on the patient's quality of life.
Following this conversation, there are generally two levels of diagnosis:
Initially, tests will be performed to determine the cause of the incontinence and its severity in order to objectively assess the amount of leakage. To determine the cause, diagnostic tests such as renal and prostate ultrasound, blood tests including PSA and renal function tests, and urine cytology are used. On the other hand, to assess its severity, diaper tests (PAD) are performed.
Secondly, depending on the results of the initial tests, further examinations may be performed to try to understand the origin of the condition in greater depth . These tests include urethrocystoscopy, urodynamics, and pelvic magnetic resonance imaging.
Normally, all these tests are performed to rule out any other condition, but with a good medical history and some questionnaires we can arrive at an accurate diagnosis.
Treatment depends on the underlying cause and the severity of the symptoms.
Treatment for male stress urinary incontinence:
Treatment for male urge urinary incontinence:
Treatment of mixed male urinary incontinence:
As a general principle, the component the patient identifies as predominant should be treated first. If this is insufficient, the less common component should then be addressed. Treating this type of incontinence is highly complex and often requires specialized units.
Treatment of male overflow urinary incontinence:
The initial treatment involves inserting a urinary catheter to relieve pressure on the bladder. Following this, we investigate the cause of the problem and any resulting complications.
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
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