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The International Continence Society defines urinary incontinence as “the involuntary loss of urine that represents a hygienic or social problem to the individual.” It is a symptom, not a disease, and can be caused by many factors.
Urinary incontinence increases with age and is often underdiagnosed and underreported. According to estimates, the condition affects 50 to 84 percent of the elderly in long-term care facilities; it is twice as common in women. It is a prevalent, unpleasant, and embarrassing symptom in prostate disease and its treatment, causing unpredictable leaking of urine that can result in visible wetness and odor.
Types of Urinary Incontinence
There are four types of urinary incontinence:
- Stress incontinence: urine leakage caused by physical exertion or stress. Laughing, sneezing, coughing, or climbing stairs, for example, can cause stress incontinence.
- Urge incontinence: involuntary leakage with an urgent need to pass urine due to spasm of the bladder.
- Mixed urinary incontinence: a combination of stress and urge incontinence.
- Functional: the inability to hold urine due to reasons other than neurourologic and lower urinary tract dysfunction. Causes include delirium, psychiatric disorders, urinary infection, and impaired mobility.
Your clinician will conduct a full medical history and examination, plus a urinalysis to look for blood, glucose, and infection.
- Voiding diary: Your doctor may ask you to keep a detailed record of your urination habits, including volumes, for a few days.
- Blood tests: They may be ordered to check for kidney function, calcium levels, and glucose.
- Cough stress test: Your doctor will ask you to cough and observe for leakage. This simple technique may help confirm stress incontinence.
In general, lifestyle changes may help reduce urinary incontinence. A healthy, well-balanced diet and regular exercise may help reduce obesity (which worsens bladder control). Exercise also helps tighten the pelvic floor. And kicking the habit of smoking will in the long term reduce coughing and may also reduce stress incontinence.
- Physical therapy. Your physical therapist will help you gain control of your pelvic floor and strengthen your abdominal muscles. He or she may recommend biofeedback training to help improve the sense of bladder filling and teach you pelvic muscle exercises to do at home.
- Biofeedback training. Pelvic floor biofeedback, for example, can help men gain control and strengthen the pelvic floor muscles. Two small sensors are stuck to the skin on either side of the anus, where they detect pelvic floor tone. Feedback is given in the form of graphs or sounds on a device or computer. Biofeedback sessions usually last 30 minutes, and the average number of sessions is four, over a one-month period.
- Kegel exercises. First, pretend that you’re trying to avoid passing gas—feel the contraction in the anus. Practice contracting 10 short contractions and then increase the hold up to 10 seconds, 10 times. Repeat several times a day. Try placing notes around the house or office to remind you.
- Bulking agent injection. A bulking agent, such as collagen, is injected into the space once occupied by the diseased prostate, giving temporary relief only.
Urge incontinence is common in BPH and prostatitis. Bladder retraining is a behavioral therapy that involves slowly increasing the storage capacity of the bladder by controlling the urge to urinate.
Medications may also help; examples include oxybutynin (Ditropan), tolterodine (Detrol), and some of the tricyclic antidepressants. For post-TURP incontinence, anticholinergic drugs such as propantheline (Pro-Banthine) and dicyclomine (Bentyl) may be useful.
Medications such as alpha-blockers—including alfuzosin (Uroxatral) and tamsulosin (Flomax)—may reduce overflow by relaxing the urethral muscles, decreasing urinary retention and the tendency to leak urine.
With functional incontinence, it’s important to treat the underlying cause. In prostate disease, a urinary infection may occur after prostate biopsy or surgery, and it should be treated. Infected urine causes an unpleasant odor that’s hard to mask, and if not adequately treated, it can go on to cause a kidney infection or sepsis (blood infection).
Surgery is reserved for severe incontinence, with the aim of creating an artificial sphincter. There are several options:
- Prostate adjustable continence therapy (ProAct): In this treatment, two small fluid-filled balloons are surgically implanted near where the prostate was removed. These implants provide pressure at the bladder neck to prevent accidental urine leakage (stress incontinence) but still allow you to urinate with a normal amount of effort. If necessary, the devices can be adjusted by your doctor via a port placed underneath the skin of the scrotum. This procedure is reported to be successful in nearly 90 percent of patients.
- Artificial urinary sphincter: This device consists of a cuff that wraps around the urethra, a pump in the scrotum that delivers fluid to inflate or relax the cuff, and a balloon placed under the abdominal muscles that serves as a reservoir for the fluid. To urinate, you squeeze the pump in the scrotum to move the fluid from the cuff into the balloon and open up the urethra. After you urinate, the cuff re-inflates automatically, closing the urethra to prevent urine leakage.
- Bulbourethral sling surgery. A sling is a polypropylene or silicone mesh that lifts the urethra and helps retain urine. The surgeon makes an incision in the perineal area—between the scrotum and the rectum—and installs the sling from anchors on the pelvic bone, under and around the urethra.
Living with Urinary Incontinence
Temporary and long-term urinary incontinence are unpleasant and inconvenient, but their effects can be minimized with special pads and underwear developed to absorb wetness and reduce odor.
Some men benefit from long-term catheterization, in which a flexible tube is inserted into the penis and up into the bladder. The urine flows constantly and is collected in a bag that’s emptied intermittently. It’s useful for men who are elderly or infirm, but urinary infections are common. Suprapubic catheterization (access via abdomen) is an option for long-term catheterization.
An external collecting device might also be an option. Here, a device similar to a condom is fitted over the penis and drains into a collecting bag, which is emptied frequently.
Erectile dysfunction and urinary incontinence are inconvenient, troubling side effects of prostate disease and its treatment. The good news is that there are numerous treatment options. Your doctor should be able to help you find symptom relief and potentially a cure.
For more information about conditions that affect to prostate, purchase Prostate Diseases at UniversityHealthNews.com.