In childhood, girls begin to control the bladder earlier. Children's nocturnal enuresis is a problem characteristic of boys. Already in adulthood, everything changes exactly the opposite. Due to the anatomical features and the burden associated with bearing a child, women are more susceptible to the development of urinary incontinence. Nevertheless, many men are also suffering from the inability to some extent to control the leakage of urine. And the negative trend increases with aging.
What is urinary incontinence in men?
Urinary incontinence, or incontinence, in men is called involuntary leakage of urine due to loss of control over sphincters of the bladder. Incontinence can be minor, in the form of drops on linen, or severe when large amounts of urine flow simultaneously. The inability to retain urine is not a disease, but rather a symptom of another condition. To understand the essence of the problem, you must have a general idea of the drainage system of our body.
The number of people with incontinence increases with age. This is especially true for men. In the elderly, the likelihood of urine leakage increases dramatically in comparison with the young.
The urinary tract is designed to remove excess fluid and the spent chemicals dissolved in it, which are actually waste products. In order for the urinary system to function as expected, all the constituent parts must work smoothly, obeying certain signals of the brain and spinal cord.
The urinary and reproductive systems in men are closely related
The kidneys are a paired urinary organ that is not controlled by the human mind and works around the clock, daily purifying from 115 to 140 liters of blood and producing up to two liters of urine. The filtered fluid gradually flows into the bladder through two long muscle tubes - the ureters.
The urinary bladder, which serves as a reservoir of urine, is located in the pelvic area. This is a hollow muscular organ in the shape of a ball with a capacity of up to 0.5 l, which is able to expand during filling and contract after emptying. In the bladder, fluid is stored until a person finds the right time and place to urinate.
Emptying the bladder is normally subject to the will of the person, but the need itself is determined by the rate of urine production. The muscular wall of the bladder (detrusor) remains relaxed while the organ is filled with urine. When the tank is full, signals sent to the brain tell the person to quickly find the toilet. Urination occurs through the urethra located at the bottom of the bladder.
According to statistics, 11 to 34% of older men suffer from some form of urinary incontinence.
Three muscle groups provide reliable retention of urine in the bladder between visits to the toilet:
- urethral muscles (urethra)
- muscles of the neck of the bladder, or internal sphincter - this is the area of transition of the bladder into the urethra,
- the muscles of the pelvic floor, or the external sphincter, are the muscles that maintain the correct position of the pelvic organs, in particular, the bladder and intestines.
For urination to occur, the brain signals the detrusor about the need for contraction to remove urine to the outside, and the sphincter is instructed to relax.
It is important to mention that the urinary and reproductive systems in men are closely intertwined and close to the urethra in the area of the bladder neck there is an important organ of a man - the prostate gland, which resembles a walnut in shape and size.
Reasons and factors
Urinary incontinence in men occurs when the transmission of impulses from the brain to the bubble is impaired or the sphincters do not close tight enough, and sometimes both causes are present simultaneously. Detrusor contraction may be excessive or, conversely, insufficient, which can be caused by defects in the muscle tissue itself or in the nerve pathways and centers that control this process - the so-called neurogenic bladder. As a result, the function of one or more sphincters is impaired.
Factors that increase the likelihood of developing incontinence include:
- birth defects - disorders of the urinary tract,
- malignant neoplasm of the prostate - the effect of radiation therapy for prostate cancer can cause temporary or permanent involuntary leakage of urine.
The inability to hold urine is not a disease, but rather a consequence of some root cause. Conditions that may be associated with male incontinence include:
- benign proliferation of prostate tissue - a hypertrophied (enlarged) prostate compresses the urethra, and the muscle wall of the bladder gradually thickens in response and loses the function of full reduction,
Age-related overgrowth of prostate tissue creates a chronic obstruction to normal outflow of urine.
Types and symptoms of incontinence
Depending on the causes and symptomatic features, incontinence is divided into these types:
- urgent (imperative),
- overflow leak,
- temporary (transitory).
The severity of incontinence does not depend on its type, but is determined by the amount of spontaneously leaking urine over a four-hour period of time:
- insignificant (drip) - up to 50 ml,
- light - 50-100 ml,
- moderate severity - 100-200 ml,
- heavy - 200-300 ml,
- extremely heavy - more than 300 ml.
The degree of urinary incontinence is determined depending on the amount of spontaneously leaking urine in 3-4 hours
Imperative incontinence involves involuntary urination due to urgent urges that a man is not able to restrain. Extraordinary urges are the result of pathological nerve impulses sent by the brain. In this case, the fullness of the bladder does not play a decisive role, as it should be normal.
The triggering mechanism for uncontrolled urine output may be a drunk glass of liquid, contemplation or sounds of running water, staying in the cold (even for a short time, for example, being inside the refrigerator department in a supermarket). Stress or certain drinks, taking certain medications, or general ill health can increase urgent incontinence.
The appearance of urges during urgent urination does not depend on the fullness of the bladder
The transmission of nerve impulses can suffer as a result of neurological diseases, as well as injuries to the head or back. These include:
- damage to the skull or spinal cord,
- senile dementia (like Alzheimer's and others) is a neurodegenerative disorder that affects the parts of the brain,
- Parkinson’s disease - the progressive destruction of neurons that produce the dopamine neurotransmitter (a substance by which an impulse is transmitted from a nerve cell to muscle tissue),
- multiple sclerosis - a disease that destroys the myelin sheath of nerve fibers, which interferes with the transmission of brain signals to other tissues and organs,
- stroke - an acute violation of cerebral circulation as a result of blockage or rupture of an artery of the brain, leading to the loss of brain functions.
A condition where excess nerve impulses cause the bladder to involuntarily and repeatedly contract is called an overactive bladder. As a result, a person loses the ability to control the place and time of going to the toilet.
Stress incontinence refers to the leakage of urine during actions that increase intra-abdominal pressure, acting on the detrusor, for example, when coughing, sneezing or physical stress. The inability to control urination manifests itself as a result of certain conditions:
- after prostate surgery,
- as a result of a neurological injury affecting the brain,
- after urinary tract damage,
- in old age.
Other types of incontinence
- Functional incontinence. Functional incontinence may occur in people with physical disabilities or mental disabilities, as well as other external obstacles. So, a man with senile dementia may not remember the need to visit the toilet. A person in a wheelchair is not always able to get to the restroom.
- Incontinence due to overflow. This type of pathology occurs when the bladder is not systematically emptied completely. Obstruction in the normal outflow of urine or weak walls of the bladder can cause this. Stones or swelling are common causes of blockage in the outflow of urine, and diabetic damage to nerve fibers disrupts the functioning of the muscular wall of the bladder. The patient may feel frequent urge to urinate, but instead of the normal act of urination, a small amount of urine is released or its involuntary leak.
- Reflex incontinence. It is a leakage of urine in the absence of urges, often due to injuries or tumors of the spinal cord just above the lower back.
- Temporary incontinence. A side effect of certain medications or certain diseases and conditions can cause a temporary loss of control of urination. The causes of temporary incontinence include:
- an infection of the urinary system, which can irritate the bladder, provoking intense urination,
- abuse of alcohol or caffeinated drinks - can have a pronounced diuretic effect,
- tearing cough - can greatly increase intra-abdominal pressure, affecting the detrusor,
- solid feces in the rectum - compress the nearby urinary tract,
- taking medications to normalize blood pressure, the mechanism of action of which is based on the diuretic effect,
- a temporary decrease in mental activity that does not allow a person to serve himself,
- temporary restriction of mobility.
- Mixed incontinence: incontinence, which includes signs of two or more kinds at the same time.
Diagnosing incontinence in men is relatively simple. Finding out its root cause may take longer.
A doctor specializing in problems with urination - a urologist - will begin by taking a look at the medical history. Then he will ask the patient to list the symptoms, features of eating habits and current medications. The patient should be ready in advance to answer the following questions:
- What and how much does he usually drink per day?
- How many times does urination occur and what is the volume of fluid that comes out?
- How often does an involuntary leak of urine happen?
- Is strong urge to the toilet preceding the leak?
- What actions usually cause bouts of incontinence (cough, exercise)?
- How long do the symptoms last?
A number of symptoms that indicate a problem with the prostate will also interest the doctor, for example:
- weak or interrupted urine flow,
- feeling of incomplete emptying of the bubble,
- spatter or drip of urine,
- recurring urinary tract infections
- painful urination.
Then the urologist conducts a physical examination, paying attention to possible signs of diseases, including neurological ones, which can cause incontinence. Often, the necessary diagnostic procedure is rectal palpation, during which the doctor in rubber gloves, using a special lubricant, feels the patient's rectum and prostate. The method allows you to evaluate the size and shape of the prostate gland, as well as to exclude the presence of neoplasms in the intestine or prostate, which can interfere with the outflow of urine. If necessary, a sample of prostate secretion can be taken during the procedure for further examination for infection.
Finger rectal examination allows you to evaluate the size of the prostate gland through the intestinal wall
The diagnosis can often be made on the basis of symptoms and physical examination, but sometimes additional studies are needed, they may include:
- Clinical analysis of urine - to assess general health and identify possible signs of infection, as an increased number of white blood cells will indicate.
- Bacterial culture of urine. A patient's urine sample is placed in a test tube with a substance that stimulates the growth of microorganisms. After about three days, the laboratory assistant sows the grown bacteria cultures, among which there may be pathogenic ones, indicating the presence of infection. In this case, the doctor selects the best option for antibacterial treatment aimed at a specific variety of pathogens identified through analysis.
- A clinical, or chemical, blood test. It is performed if there is a suspicion of impaired renal function or electrolyte imbalance in the body. Additionally, an analysis can be recommended for the level of protein produced by cells of the prostate gland, a prostate-specific antigen. An increase in this indicator may indicate a malignant neoplasm of the prostate.
- Urodynamic research. A set of procedures aimed at studying the ability of the bubble to retain fluid, as well as smoothly and completely empty. To do this, using special instruments, measure the speed of the urine flow, the presence of urine residue after urination, the nature of the stream, etc.
Urodynamic research is carried out using specialized equipment on an outpatient basis.
Therapy of urgent (imperative) and stress incontinence
Treatment for urgent or stress mild incontinence includes methods such as:
- lifestyle adjustment (rejection of bad habits, normalization of body weight),
- bladder retraining,
- strengthening the pelvic floor muscles through exercise,
- suppression of urgent urges.
If the measures taken did not bring the expected result, then apply:
- drug therapy
- electrical nerve stimulation,
- filler injections
- surgical methods.
Lifestyle adjustments to regain bladder control may include:
- Changes in the usual diet. A man should begin to control the quantity and quality of drinks consumed. It is recommended to refuse or significantly limit carbonated and caffeinated drinks (coffee, tea), which have an irritating effect on the bladder. Alcohol should be excluded, since it has a pronounced diuretic effect. The attending physician helps the patient calculate the daily fluid rate based on individual characteristics: the degree of physical activity, the climate in the place of residence, as well as the general state of health.If there is nocturnal enuresis, the doctor will advise you to refrain from taking fluid for several hours before going to bed.
- Regular exercise and weight loss. Exercise helps keep your muscles toned and body weight under control.
- Monitoring timely bowel movements. Chronic constipation negatively affects the condition of the urinary tract, creating both mechanical pressure and the risks of developing a urinary tract infection (through the penetration of pathogenic bacteria from the intestines through the lymphatic system).
- To give up smoking. This bad habit often causes chronic anguished coughing, which regularly increases intra-abdominal pressure. In addition, tobacco acts as an irritant to the bladder, often causing cancer on the walls of the organ.
- Bladder retraining. The doctor will offer the patient a specific schedule for visiting the restroom, accustoming the bladder to empty at intervals of, for example, 2 hours. Gradually increasing the interval between visits to the toilet, you can train your bladder, increasing its stress resistance.
- Pelvic floor muscle training. The basic principle of exercises to strengthen the diaphragm of the pelvis - Kegel exercises - is to consciously contract and relax the muscles responsible for urinating. The exercises are simple and suitable for doing at home without the need for additional shells or equipment. They can be performed at any time, with the exception of the process of urination.
- Suppressing the urgent need to urinate. There are special relaxing and distracting deep breathing techniques that help to switch attention and not concentrate on the desire to go to the toilet.
Drug therapy may include groups of drugs, the action of which is primarily aimed at removing excess detrusor spasm and restoring the size of the prostate gland:
- Alpha blockers. They are used for the growth of prostate tissue and blockage of the bladder neck. These drugs relax the smooth muscles of the prostate and detrusor, normalizing the outflow of urine:
- 5-alpha reductase inhibitors. Prevent the production of the male hormone dihydrotestosterone, which provokes the growth of the prostate:
- Antimuscarins, or a group of drugs that reduce the tone of smooth muscles. These medications prevent unnecessary cramping of the bladder muscles. They are released in tablet form, as well as in the form of a solution for injection and a patch:
- Tricyclic antidepressants. They affect mainly the central nervous system, eliminating excess nerve impulses:
- Beta3-adrenergic agonists. Suppress involuntary contractions of the bladder:
- Botulinum toxin type A. Botox is used as a therapy for incontinence of neurological origin, for example, due to damage to the spinal cord or for multiple sclerosis. Botox injection is done on an outpatient basis under local anesthesia. As a result, the capacity of the bubble increases, and excessive contractions disappear. The course of treatment is repeated after 10 months.
For the treatment of incontinence, injections of collagen fillers can be used to thicken the tissues and more densely close the opening through which the leak occurs. Manipulation is performed using local anesthesia. A cystoscope is inserted into the urethra - a tubular instrument through which a needle is then inserted to inject the filler. The procedure is repeated as necessary, since the drugs used dissolve over time.
Electrical nerve stimulation
Another treatment option is to use pulsed currents to correct bladder reflexes to prevent too frequent urination and other incontinence symptoms. Correction is carried out by one of two types of electrical stimulation:
- Percutaneous stimulation of the tibial nerve. The procedure is performed weekly and consists of a transdermal injection of a stimulant into the tibial nerve at the ankle under local anesthesia. Stimulation prevents the hyperactivity of the bladder, blocking the transmission of nerve impulses.
Percutaneous tibial nerve stimulation is a minimally invasive procedure that requires regular outpatient
Subcutaneous sacral nerve stimulator - a device implanted under the skin that periodically sends nerve impulses to the area of the bladder and its sphincters
Treatment for severe incontinence is surgical. Any type of surgery is performed under local or general anesthesia. The patient leaves the hospital the same day or the next. Depending on the volume of involuntary urine flowing out, patients are offered one of the following types of intervention:
- Implantation of a sling (special loop or mesh). The choice for those patients who are able to stop the flow of urine, do not suffer from bedwetting and, on average, use up to 3-4 urological pads per day. The procedure is considered simple, takes from 20 to 60 minutes and consists in implanting a sling through a small incision in the perineum. Sling provides a rise and compression of the urethra. This additional support guarantees improved urinary control.
Incontinence Sling Implantation is the surgical installation of a urethral support mesh
Implantation of an artificial bladder sphincter - a method for the treatment of severe urinary incontinence
Treatment for other types of incontinence
For functional incontinence, the use of protective hygiene items, urological pads or diapers, which can be purchased at pharmacies, medical stores or supermarkets, is recommended.
Overflow incontinence is treated depending on the cause of its occurrence. In the case when the culprit is the presence of an obstruction in the urinary tract (tumor, stone), then a surgical operation is required to remove the blockage. If an obstacle was not found, then the use of a urological catheter for the purpose of emptying the bladder is indicated. A catheter is a thin, flexible tube that is inserted through the urethra to drain urine. The device can be used continuously (urine is drained into a special tank attached to the man’s thigh) or as needed.
In order to eliminate temporary incontinence, its cause should be eliminated, for example, to replace or reduce the dose of a medicine that causes urine leakage. If the loss of bladder control is associated with an infection, then a course of antibiotics is prescribed.
Forecast and possible complications
At least 80–90% of men who have experienced a loss of control over urination significantly improve their condition as a result of complex therapy. Timely contacting a specialist and a joint search for the optimal combination of approaches provide a favorable outcome. Sometimes it’s enough to only moderately reduce the amount of drinks, regularly perform Kegel exercises, using urological pads and sanitary towels as a safety net.
Complications of chronic incontinence in men include:
- rash, diaper rash, ulceration and their infection due to chronically wet skin, as well as the constant use of pads or diapers,
- infection of the urinary system due to constant stagnation of urine or the use of a urological catheter,
- negative psycho-emotional state of a man in connection with constant stress in the social environment.
Many men with incontinence are not likely to be embarrassed to fully enjoy active activities, including various sports, causing emotional stress. At the same time, a sedentary lifestyle increases the likelihood of developing other health problems, such as weight gain and diabetes.
Urinary incontinence cannot be guaranteed to be prevented. Risk factors, such as age and neurological conditions, are completely uncontrollable. However, you can lead a lifestyle that will reduce the likelihood of developing problems with urine retention. Preventive measures include:
- the presence in the diet of a large number of fruits and vegetables - fiber prevents constipation, and the predominance of plant foods provides normalization of weight,
- strengthening the pelvic floor muscles with regular Kegel exercises.
Kegel Exercise Recommendations
Thanks to five minutes of Kegel exercises three times a day, in many cases you can avoid the problem or improve your condition after 4-6 weeks. To increase their effectiveness, listen to the recommendations of doctors:
- To start doing the exercises, you first need to feel the necessary muscles (pelvic floor muscles). Imagine that you are trying to keep the exit of gases from the intestines and squeeze the muscles that you use for this. Other muscles, such as the abdomen, buttocks or thighs, should not be contracted at the same time. The tension of the extra muscles will put unnecessary pressure on the detrusor.
- Tighten the pelvic muscles for about three seconds, then you need to relax.
- It is recommended to perform 2-3 similar approaches of 10 repetitions per day.
- It is better to start exercises in a horizontal position. As your muscles strengthen, you can move on to sitting or standing positions.
Perhaps the problem of male urination control is much more common than statistics show. Men are not inclined to consult a urologist about urinary incontinence due to embarrassment. Nevertheless, a visit to a specialist is the first step to fixing the problem. Treatment will restore control of the bladder and maintain quality of life.
What is urinary incontinence
Urinary incontinence is diagnosed in the case when its secretion cannot be felt, controlled, or stopped by force of will.
Pathology can manifest itself in several forms:
- Enuresis - uncontrolled urination during sleep. The symptom is characteristic mainly for children and adolescents, in adult men it is fixed in 1% of cases.
- Incontinence - this term refers to various forms of involuntary urination in the medical literature.
- Leakage after urination - the allocation of a few residual drops from the urethra.
The flow of urine is controlled by the muscular ring around the urethra - the sphincter. When the bladder is full, receptors on its walls are triggered, a signal for compression is sent to the sphincter along the nerve paths. Normally, it remains tense until complete urination is achieved, provided by the voltage of the detrusor (muscle expelling urine).
Uncontrolled urine output occurs in the following cases:
- Bladder muscles are damaged or too weak.
- Sphincter compression occurs at the wrong time (abnormal reaction of nerve receptors).
- Paradoxical incontinence (overflow incontinence). The bladder is too crowded for too long, the walls lose their tone, the receptors do not work.
Urination is impaired if there is an obstruction in the urethra, which interferes with the normal outflow of urine, as a result of which it seeps arbitrarily. This usually happens with prostate adenoma.
Types and causes of urinary incontinence in men
Depending on origin secrete true and false urination. In the latter case, involuntary urination can be caused by the following reasons:
- Urethral malformation, splitting of its wall (epispadias),
- A malformation of the bladder, in which its front wall is absent (extrophy),
- Erosion of the mouth of the ureter,
- Post-traumatic fistula (opening) or other defects of the bladder or ureter.
True incontinence develops in the absence of pronounced anatomical defects.
Depending on the circumstances in which incontinence occurs, the following types are distinguished:
- Stressful - incontinence, provoked by an increase in intra-abdominal pressure during coughing, laughing, physical exertion. Urination without any urge in this case is due to weakened pelvic ligaments. The reason is the lack of collagen, the amount of which is usually reduced in smokers (they do not absorb the lion's share of vitamin C, which is necessary for the strength of collagen fibers). Stress incontinence can occur when the neck of the bladder is too mobile, the sphincter is insolvent, due to tissue damage during surgery.
- Urgent - incontinence, provoked by a sharp and so unexpected urge that there is no way to restrain urine. Sphincter muscles are hyperactive and inadequately respond to receptor signals. This is the so-called OAB syndrome (overactive bladder). The cause may be irritation of its walls with infections, stones, a complication of neurological pathologies, brain diseases. The frequency of such sudden urges does not depend on the amount of fluid consumed, and urine in some cases may not be allocated at all.
- Mixed - incontinence, combining the symptoms of urgent and stress.
By the duration of the presence of symptoms, transient and chronic incontinence are distinguished. The latter can occur due to constant alcohol intoxication or mechanical damage to tissues in patients with diabetes mellitus (nerve endings are damaged).
Against the background of severe stress, hypothermia, intoxication, acute cystitis, transient (temporary) incontinence may occur. Uncontrolled urination can provoke some drugs: alpha-blockers, calcium antagonists, diuretics, antidepressants.
Drip urinary incontinence occurs in almost all men during the first 2-4 weeks after surgery on the prostate, if the neck of the bladder is affected in the process. The smooth muscle fibers that make it are intertwined with the fibers of the prostate gland, so when they are damaged, the whole mechanism suffers. Neurovascular bundles are also often affected.
The most common manipulation is TUR - removal of adenomatous growths through the urethra (more about the progress of TUR surgery of the prostate adenoma). After surgery, slight incontinence is usually observed for several days.
After prostate removal, some form of urinary incontinence occurs in 87% of men. In order to minimize the risk of developing this symptom, doctors need to maintain the anatomical relationship between the muscles of the pelvic floor and the sphincter system.
When the prostate is removed, the posterior urethra is always damaged and its sensitivity is reduced, as a result of which the urine retention mechanism is disturbed. The prostatic part of the urethra must be reconstructed. The newly formed structures are functionally insolvent, and therefore urinary incontinence (usually stressful) develops. The urgent form occurs due to damage to the nerves of the bladder, which are in close contact with the seminal vesicles, so they try to save them during the operation (if they are not affected by the tumor).
After prostatectomy, the restoration of urination mechanisms occurs after about 6 months. In older men, the period may be delayed due to age-related changes in the detrusor. Recovery steps:
- A month later, lying down should be no incontinence.
- After 3 months in the afternoon, during normal activity, urination should be normal. 54% of patients no longer need urological pads.
- After 6-12 months, uncontrolled excretion of urine should not be even with physical exertion. Urological pads are not already used by 93% of patients.
Restoration of urination can last for 2 years.
Extremely nocturnal chronic urinary incontinence in adult men is extremely rare. Usually this is a transient form of the disorder, developing due to external factors:
- Bust with alcohol,
- Severe stress
- Sleep disturbances
- Too deep sleep (profundosomnia).
Enuresis in adult men can be triggered by infectious irritation of the genitourinary tract. During the day, urination is controlled.
In older men after 70-80 years, incontinence is recorded more often than in young men. It is caused by a violation of nervous regulation, weakening and sagging of the muscles of the pelvic floor. Age-related incontinence usually develops gradually, begins with drip leakage.
This pathology is not part of natural aging, you do not need to put up with this condition. For a man of any age, you can choose an adequate therapy.
After a stroke
Stroke - damage to certain areas of the brain due to acute oxygen starvation. Nerve cells die, and the organs they control lose their functionality. Urinary incontinence is a common consequence of this disease - observed in 2/3 of patients admitted to the hospital. After a year of rehabilitation, the symptom remains in 15% of patients.
A stroke can cause bladder paralysis. The patient is completely unable to urinate in a controlled manner, since there is no feeling of fullness, and the muscles are uncontrollable. Another option for urinating after a stroke is a hyperreactive bladder. The patient goes to the toilet more than 8 times a day (mainly at night), sometimes the urge is uncontrollable.
Incontinence appears in several forms:
- With urgent urges, a man does not have time to run to the toilet,
- With a crowded bladder, the patient pushes, but urine does not flow out with a steady stream, but is allocated dropwise,
- With stress incontinence, urine is excreted in small portions during coughing, laughing, and a sudden change in posture.
Additional symptoms depend on the form of incontinence and associated pathologies (adenoma, cystitis).
Conservative methods include medication, physiotherapy, and special exercises to develop the correct stereotype of urination.
Medications are especially effective for urgent incontinence. Their task is to reduce the contractile function of the bladder and increase its functional capacity. With urgent incontinence, antidepressants and antispasmodics are prescribed.
Most often, patients are prescribed Oxybutin, which relaxes the detrusor and suppresses contractile impulses from the nervous system. The course of treatment usually does not exceed 3 months. The drug has a cumulative effect. In inflammatory incontinence after removal of the catheter, "Spazmeks", "Urotol" are prescribed.
Physiotherapeutic methods include biofeedback exercises, electrical and magnetic stimulation, and mud therapy.
Incontinence patients must first eliminate the triggering factors: alcohol, carbonated sugary drinks and coffee, spicy food. Excess weight exacerbates the patient’s condition, so doctors strongly recommend reducing it.In order not to create excess pressure on the bladder, you need to monitor the timely bowel movement. Quitting smoking will reduce the symptoms of incontinence by 1.5-2 times.
Kegel Exercises for Men with Incontinence
Pelvic floor muscle strengthening exercises (stopping a stream of urine, muscle tension around the anus) recommended for senile and postoperative incontinence. There are several programs based on the Kegel system. The main condition for success is regularity.
We will write about programs in our future articles, wait for updates.
Doctors warn that it is important not to overdo it, otherwise acute urinary retention due to spasm is possible.
The following treatments can be used as adjunctive treatments for incontinence:
- A decoction of dill or plantain seeds.
- Sage tincture.
- A decoction of onion peels.
To prevent infectious processes in the urinary tract, drink broths of lingonberry leaf, half a half, chamomile.
In difficult cases, stress leakage incontinence is treated by installing an artificial bladder sphincter (for example, model AMS-800), which consists of an inflatable cuff, a reservoir and a pump. There is water in the cuff, due to which it compresses the ureter. When you need to urinate, just click on the pump in the scrotum, after which the water will flow into the tank, the cuff will deflate and clear the passage. After urination, it will fill again.
Causes of urinary incontinence in men
The causes of male incontinence are very diverse, they can be grouped as follows:
- Lesions of the central nervous system (CNS):
- due to diseases (stroke, Parkinson's disease, multiple sclerosis, circulatory disorders in the brain),
- traumatic origin (congenital malformations of the central nervous system, damage to the brain or spinal cord),
- with chronic intoxication (diabetic, alcoholic, narcotic, etc.).
- Postoperative urinary incontinence due to surgical manipulations on the pelvic organs, bladder, urethra, prostate gland, especially in case of unsuccessful operations.
- Age-related disorders of local blood supply, neurohumoral regulation of physiological functions.
- Dysfunction of the bladder, urethra, ureters of neurogenic origin.
- Tumors of the urinary system and pelvic organs, including cancer and benign prostatic hyperplasia (adenoma) (BPH).
- Infectious diseases of the urinary tract (prostatitis, cystitis, urethritis).
- The prolapse (ptosis) or displacement of the internal organs of the abdominal cavity and pelvis, exerting pressure on the bladder and prostate, which occurs when the muscles and connective tissues are weakened, excessive physical exertion, a sedentary lifestyle, or chronic constipation.
- Urolithiasis and kidney stones.
- External remote radiation therapy in the treatment of prostate cancer.
- Chronic stress or mental illness.
- Side effects of drug therapy (due to the use of antidepressants, tranquilizers, diuretics, antihistamines and decongestants that affect muscle tone, etc.).
- Anomalies in the development of the genitourinary system (congenital malformations) and genetic causes.
Urgent (imperative) urinary incontinence (Urge Incontinence)
It is characterized by sudden, strong and unbearable urge to urinate, which is very difficult or impossible to overcome, putting off going to the toilet at a later time. Even a small filling of the bladder provokes a spasm, as a result of which urine is lost.It is characteristic that limited fluid intake does not produce a positive effect, the additional risk factors for this type of incontinence may be the sound of pouring water, as well as touching the jet. With urgent incontinence, the need to use the toilet arises no more than 2 hours later, and this interval is maintained day and night. The suddenness and strength of the urge is such that the person suffering from this ailment often does not have time to empty the bladder in a timely manner and loses urine on the way, for example, from the bed to the toilet. But there are some cases where the "imperative" urge to urinate is not accompanied by the release of urine.
Blame hyperactivity of the bladder, which can be caused both by neurogenic causes, as well as infections of the genitourinary system, and tumors. Age is an additional aggravating factor in the development of urgent urinary incontinence in men. Epidemiological studies conducted in different countries of the world have shown that imperative (urgent) incontinence is the second most common urinary incontinence among men - 14% (V. A. Mikassian, H. P. Dralzetal., 2003).
Mixed (combined) urinary incontinence (Combined Incontinence)
As the name implies, such urinary incontinence in men involves a combination of 2 or more types of incontinence, most often urgent and stressful, the symptoms of which can be expressed to varying degrees.
Statistics based on recent epidemiological studies show that mixed urinary incontinence in men is approximately 32%, and the high proportion of this type of incontinence compared to other types of uncontrolled urine excretion is due to the frequency of manifestations of stress and urgent incontinence, often found in combination (VA Mikassian HP Dralzetal. 2003).
According to statistics, the first three forms of incontinence are the most common, although there are others listed below, they together account for about 5% of all manifestations of urinary incontinence in men.
The cause of postoperative incontinence is surgery on the prostate and urethra, for example:
- radical prostatectomy (removal of the prostate in oncology),
- transvesical or posterior adenomectomy (removal of a benign tumor of the prostate),
- transurethral resection (truncation, removal) of the prostate (TUR of the prostate in cancer, benign neoplasms, chronic inflammatory processes),
- surgery for urethral stricture,
- surgery for traumatic injuries of the urethra,
- other operations and manipulations on the urethra.
Strictly speaking, postoperative urinary incontinence in men can be attributed to a special case of stressful (under stress) incontinence, which can pass on its own during the first year and a half years, but still requires conservative treatment - if it is a mild degree of uncontrolled urine excretion, and surgical - if the urologist is faced with a severe form that is not amenable to therapy with medicines, exercise therapy exercises and hardware. Surgical methods today are quite diverse, their spectrum varies from periurethral injection of volume-forming substances and special devices (minimally invasive method) to performing a sling operation and installing an artificial urethra sphincter.
Any of these types of surgery has its own indications and contraindications, so it is important to undergo a thorough examination and consult with several specialists.
This type of incontinence, also called paradoxical ischuria, is caused by blockage of the urethra against the background of prostatic hypertrophy through which the urethra passes, and various types of tumors of the canal itself. Thus, the urethra is narrowed, and by itself is a pedobubic barrier, as a result of which urine is excreted in small volumes, but often. For this reason, this form of urinary incontinence in men is often called drip incontinence. But it is important to understand that the concept of “drip incontinence” can be misleading, since the bladder is never completely empty and a certain amount of urine always remains in it, which in some cases leads to inflammatory diseases. Moreover, random urination is sometimes absent altogether. The volume of delayed urine can reach 1 liter and lead to acute cutting pain, therefore, in severe cases, they resort to the introduction of a catheter into the urethra to drain urine into an external vessel or to surgery.
With urinary incontinence in men from overflow of the bladder are observed:
- constant uncontrolled discharge of urine in small volumes throughout the day,
- frequent use of the toilet
- a feeling of heaviness, pressure on the bladder, dull pain over the bosom may be present,
- the impossibility of complete emptying,
- when urinating, urine is secreted by a weak and thin stream, which is also accompanied by a feeling of overflow.
Transient (temporary) urinary incontinence (Transient Incontinence)
Typical causes of uncontrolled urination in men of a temporary nature include infectious diseases, intestinal disorders, various intoxications, undesirable effects from taking certain medications (see above), diseases that disrupt the work of neuromuscular activity related to the regulation of urinary emptying function bladder, strong psycho-emotional experiences. When eliminating an external provoking factor, transient urinary incontinence in men passes independently.
Male Incontinence Hygiene
Urinary incontinence in men does not belong to the natural elements of the aging process, although this condition is often correlated with age. With certain forms of uncontrolled urine output, elementary physical exercises help, which should be performed regularly, but, as a rule, patients have to deal with the root causes of the problem in question. In any case, you need to learn how to live a full life. For this, men suffering from incontinence are forced to turn to urological hygiene products for the period of treatment and adhere to several recommendations.
The main hygiene products for male urinary incontinence are:
- Urological inserts (pads) of an anatomical form with drip, mild and moderate incontinence
- Elastic adjoining mesh panties for reliable fixing of loose leaves (laying)
- Disposable absorbent briefs for moderate to severe urinary incontinence
- Diapers for adults with severe and very severe incontinence
The basis of individual absorbent (absorbent) urological hygiene products is a superabsorbent that can bind liquid in a proportion of 1:50. In addition, the composition of hygiene products includes fluffy (processed by various methods) cellulose, polyethylene and polypropylene films. Combinations of these materials may be different, but must meet the conditions:
- high-quality absorption and retention of urine,
- protection against smell and leakage,
- stealth and comfort
- protecting the skin from damage (irritation), maintaining an optimal level of acid-base balance of the skin (pH 5.5),
- antibacterial protection.
Some recommendations for men with urinary incontinence:
- keep the required volume of fluid you drink (2 l) and in no case reduce it under the pretext of incontinence, since an increased concentration of urine will lead to significant irritation of the mucous membrane and skin, and the amount of fluid consumed is not related to the problem of incontinence,
- observe the usual mode of emptying the bladder, using a timer if necessary - visit the toilet at least every 2 hours,
- regularly exercise the muscles of the sphincter of the bladder according to the Kegel system,
- at home, wet laundry immediately change to dry,
- for severe and very severe incontinence, consider using special urinal systems for urine removal, including a tip on the penis (like a condom), drain tubes, a urine reservoir that is fixed on the thigh or lower leg, monitor the level of urine in the urinal, do not forget how you can wash it and disinfect it more often,
- try to wash the skin in the inguinal area twice a day, then wipe it thoroughly and lubricate it with special protective creams or liquid paraffin, vegetable oil, baby cream, dusting the skin with powder.
Male urinary incontinence, or incontinence, is a condition that creates social and hygiene problems. None of the males is safe from this pathology. However, timely diagnosis of the disease increases the chance of a speedy recovery. Contact the diagnostic centers that have existed for a long time and have won the trust of customers, this will allow you to quickly determine the course of treatment, and you can return to your usual way of life.
Types and symptoms of urinary incontinence
Doctors distinguish several forms of urinary incontinence in adult men, depending on the symptoms. The main forms of the disease:
Urgent incontinence has characteristic symptoms. With this form of incontinence, a man is bothered by frequent (about every two hours) urge to the toilet. In this case, the urinary bladder is not completely filled with urine. Despite the appearance of urges, the patient often can not restrain himself, and urine is released even before coming to the toilet. After urination, there is a feeling of incomplete emptying of the bladder, although this may not be true.
Symptoms of a stressful form look somewhat different. This is the most common form of the disease. About half of men suffering from incontinence are affected by it. Urine with a stressful form is excreted without any urge. True, this does not happen at any moment of time, but only under the condition of strong physical exertion, jumping, running, lifting weights. Sometimes even coughing, laughter, sneezing, and a change in body position can lead to the separation of urine.
But the most unpleasant mixed form of the disease. In this form, the patient suffers both urgent and stressful forms of the disease.
Enuresis in adults is rare. So called the form of urinary incontinence, when urination is completely involuntary.
In a separate category include pathology, in which there is leakage of urine after the act of urination.
Most cases of urinary incontinence in men are acquired. However, there is also a congenital form, when some defects of the genitourinary system lead to incontinence in childhood. And in the future, this disease passes to an adult man.
Why does urinary incontinence occur in men?
The mechanisms of urinary incontinence may be different.For a stressful form, this is usually a weakening or anatomical defect of the urethral sphincter, that is, the annular muscle, which opens access from the bladder to the urethra.
A special case of a stressful form is incontinence caused by operations on the genitourinary organs (prostate gland, urethra, bladder). However, this is a temporary condition that usually goes away on its own, after a year or two.
For the urgent form, the main reason is an increased tone or cramping of the detrusor of the bladder (the muscle that pushes urine out). This pathology can occur as a result of prostatic hyperplasia, which presses on the bladder, increasing its tone and decreasing volume. Urine fills the bladder faster, therefore, urge to urinate more often.
The urgent form most often develops as a result of diabetes mellitus, Parkinson's disease, stroke.
In some cases, with dysfunctions of the nervous system as a result of spinal injuries, CNS pathologies, the brain may not receive a signal about the need to empty the bladder. As a result, emptying still occurs, due to the fact that the bladder is full and the urethral sphincter can no longer restrain urine pressure.
Pathogenetic factors common to the main forms of the disease are disorders of the blood supply to the pelvic organs, prostate, muscles of the bladder and urethra, and neuropathy.
Enuresis, including nocturnal, may be due to cystitis, prostatitis, benign prostatic hyperplasia, which increases the pressure from the prostate on the bladder.
Immediate causes of urinary incontinence in men:
- stress, neurosis, psychosis, cerebrovascular accident, Alzheimer's and Parkinson's disease, multiple sclerosis, epilepsy,
- prostate diseases (adenoma, prostatitis, prostatic hyperplasia),
- inflammatory processes in the urethra and bladder,
- urinary tract injuries
- spinal cord and brain injuries,
- genitourinary surgery (bladder, prostate, urethra),
- prolapse of the pelvic organs,
- bladder stones
- abnormalities in the structure of urination.
- drug use
- chronic constipation
- sedentary lifestyle or, conversely, hard physical work,
- taking sedatives
- elderly age,
- the presence of foci of infection in the body,
- continuous use of diuretics
- chronic constipation
- work in hazardous industries.
Sometimes a situation occurs when incontinence occurs in an adult male due to untreated childhood enuresis. Congenital defects in the organs of urination can also occur.
It was previously believed that reasons such as overweight and excessive fluid intake also lead to incontinence, but now some scholars dispute these theses. Moreover, inadequate water intake can aggravate the patient's condition, as it leads to an increase in inflammatory processes on the mucous membranes of the urogenital organs.
Symptoms of the main forms of urinary incontinence
|strong sudden urge||Yes||not||Yes|
|how often urine is excreted (8 or more times per day)||Yes||not||Yes|
|urination during exercise||not||Yes||Yes|
|the amount of urine at each urination||big||small||differently|
|Can urine be retained when urged||usually not||Yes||often not|
There are several stages of urinary incontinence.
|stage||volume of urine released spontaneously in 4 hours, ml|
|drip||less than 50|
|very heavy||more than 300|
What threatens the continent?
If the disease is not treated, then this threatens the patient with problems of not only a psychological, but also a purely medical nature.The first category includes depression, neurosis, impaired social adaptation. Medical complications include:
- impaired potency and erection,
- renal failure.
What to do with urinary incontinence in men?
It is necessary to treat this pathology until it has passed into more severe forms. In addition, it should be remembered that incontinence is often the first symptom of such serious diseases as prostatitis, adenoma, and tumors of the genitourinary system.
An urologist is involved in the treatment of incontinence, however, the patient can also be referred to a psychotherapist and a neuropathologist in identifying the psychogenic or neurogenic nature of the disease.
- surgical methods
- medical methods
- physical exercise,
- lifestyle changes, giving up bad habits,
First of all, conservative methods are tried - drugs, physiotherapy, diet, Kegel exercises. And only with the low effectiveness of these funds can we talk about surgical intervention.
With the disease, a person should also change his lifestyle. It is necessary to minimize the use of alcohol. But smoking is better to quit altogether. Regular exercise, sports, and good rest are also needed.
Psychotherapy is used for those patients in whom neurosis and stress are one of the causes of incontinence. And in many cases, the disease itself leads a person into a state of deep depression, which does not contribute to the effectiveness of therapeutic efforts. The task of the therapist is also to help restore the patient's normal social activity.
Transient urinary incontinence in men: treatment
Transient urinary incontinence develops under the influence of adverse factors, however, when the exposure to these factors ceases, it passes. Transient incontinence may occur under the influence of alcohol poisoning, diuretics, acute cystitis. Therefore, this condition does not require treatment. It is enough to eliminate the provoking factor. In particular, if the cause is cystitis, it is necessary to cure this disease with anti-inflammatory drugs and antibiotics.
Medicines for the treatment
The main types of drugs used in the treatment of incontinence:
- alpha blockers
- 5-alpha reductase blockers.
The most commonly used drugs are in case of urgent form of incontinence. With a stressful form of the disease, medications are not as effective as surgery.
M-anticholinergics and antispasmodics (oxybutynin, tolteradin, darifenacin) affect the muscle of the bladder. The first group of drugs acts on the m-cholinergic receptors of the bladder, and the second - directly on its muscles. The result in both cases is similar - the muscles of the bladder relax, its volume increases. Urge to urinate less frequently.
Means from the class of antidepressants (imipramine, duloxetine) are used for the neurogenic or psychogenic nature of incontinence. They affect the nerve endings of urination. As a result, spasm of the bladder is reduced. As auxiliary agents, sedatives, tranquilizers can be prescribed.
Antibiotics (ampicillin, fluoroquinolones) are prescribed if incontinence is associated with inflammatory processes in the urethra and bladder caused by a bacterial infection.
Alpha-blockers (tamsulosin, alfuzosin, terazosin, doxazosin) are prescribed for incontinence caused by prostatic hyperplasia, as well as for adenoma. They act on alpha-type adrenergic receptors and have a relaxing effect on the prostate muscles.
5-alpha reductase blockers (dutasteride, finasteride) are also prescribed if hyperplasia or prostate adenoma is diagnosed. This group of drugs inhibits the production of dihydrotestosterone, since it is this hormone that is often responsible for prostatic hyperplasia.
Often, a doctor may prescribe several groups of drugs at once, for example, anticholinergic and alpha-blockers, anticholinergic and antispasmodics. In mild forms, anti-inflammatory herbal remedies are used.
Botox or collagen-based injections are used to loosen the pelvic floor muscles. However, this method is effective only for several months, then a relapse of the disease occurs.
Surgical operations are performed if conservative methods have not justified themselves or if the pathology has reached a severe stage. Some operations can be performed under local anesthesia, others under general. Surgery can help most patients (70-80% of cases). Symptoms of the disease after surgery often disappear, and in other cases, there is a decrease in the severity of symptoms.
The main types of operations are the installation of slings or an artificial sphincter. If the cause of incontinence lies in the tumor of the bladder, then it must be removed. Instead, a new bladder is made from part of the intestine.
The most common sling operations. The essence of the operation is to support the urethra and the neck of the bladder in such a position that urine leakage would be impossible. For this purpose, a synthetic tape (sling) is inserted under the urethra through an incision in the perineum, which is attached from above to the pubic bone using titanium screws. Slings are made of polyester and have a silicone coating. There are other types of sling systems (self-locking, functional retrourethral). Sling-type surgeries are popular in stress-type incontinence.
To combat the disease, folk remedies are also used - decoctions of dill, wormwood, onion husks, sage, plantain, parsley infusion. Decoctions and infusions reduce spasms in the bladder, relieve inflammation, so they are more suitable for the treatment of urgent forms of the disease, for cases when urinary tract infections and prostatitis accompany infections. Folk remedies act as an addition to traditional therapy. Only fresh decoctions of herbs are suitable for treatment.
Sometimes with incontinence, most often with an urgent form and concomitant prostatitis, physiotherapeutic procedures can be prescribed for treatment. One of the most promising methods is neuromodulation. With this procedure, the pelvic muscles and muscles of the anal and urethral sphincters are affected by low frequency currents. This stimulates muscle tissue, as a result of which the neuromuscular mechanism of urination is restored.
For most patients with incontinence, doctors recommend these exercises. They are designed to strengthen the muscles of the pelvis, including the muscles that control the bladder and urethra.
Various options for Kegel exercises involve alternating compression and relaxation of the pelvic floor muscles. Thanks to this, you can learn to confidently restrain urine.
In the early days of the exercise, you can do it three times a day for several seconds. Then the duration of the exercise increases until it reaches 1-2 minutes. The regular implementation of this complex leads to remission in most patients.
The traditional complexes of physiotherapy exercises affecting the muscles of the lower body and, in particular, the abdomen are also useful for incontinence.
Diet is one of the effective means of combating incontinence. Foods consumed by humans can also affect the severity of the disease. It is necessary to exclude from the menu dishes that cause cramping and irritation of the bladder. First of all, these are salted, smoked, pickled, spicy dishes and products. Salt should also be limited, especially in the presence of acute cystitis, prostatitis, or urethritis.
In addition, strong tea, coffee and carbonated drinks are subject to restrictions. Favorably affect the state of health during incontinence, products containing a large amount of vegetable fiber - wholemeal bread, cereals, vegetables.
Drinking water is allowed only in small portions at a time. This is due to the fact that overflow of the bladder should not be allowed.
However, in addition to treatment, the hygienic aspect of the problem is important. Constant urine leakage creates physical and emotional discomfort, leads to skin irritation and an unpleasant odor. In order to avoid these inconveniences, you can use men's urological pads attached to underwear or disposable underpants.
Urological pads have the following advantages:
- absorb urine in large volumes,
- eliminate the unpleasant odor inherent in urine,
- help to avoid skin irritation,
- do not cause allergic reactions.
Ordinary urine-absorbing diapers can also be used. These devices are more suitable for the elderly and bedridden patients.
There are several types of diseases, each of which has its own treatment characteristics:
- Urgent incontinence. It is also called imperative or urgent. In this case, the man is aware of the urge, but cannot tolerate and control it. This type occurs in patients with diabetes mellitus or Parkinson's disease. Sometimes such urinary incontinence occurs after a stroke.
- Transient urinary incontinence is associated with external factors. As soon as such factors cease to affect a person, the disease disappears. The causes of its occurrence include alcohol intoxication, impaired bowel movement, cystitis in the acute stage, taking diuretics, alpha-blockers, calcium antagonists, antipsychotic and some other medications.
- Stress urinary incontinence can occur with excessive physical exertion, weight lifting, coughing, sneezing, laughing, etc.
- The mixed type is a pathology that combines the signs of a stressful and urgent state. In this case, when the bladder is full, it spontaneously empties due to a decrease in the contractility of the sphincter.
- Bedwetting in men - may be due to a variety of reasons. This type of pathology is divided into:
- Constant - when involuntary urination occurs every night.
- Relapse - in this case, incontinence does not occur every night.
The medical worker Elena Konyaeva will talk about the types and causes of the disease among men:
- Congenital - is associated with impaired development of the urinary system in children. This pathology will accompany a person in adulthood.
- Acquired incontinence can be associated with stress, infection, changes in the elasticity of the walls of the bladder, or age-related changes (more common in people over 60).
Predisposing factors contributing to the appearance of urinary incontinence in men include the presence of foci of infection in the body (chronic tonsillitis, dental caries, etc.).
Causes of the disease
A variety of factors can lead to urinary incontinence in men: from malfunctioning of internal organs to age-related changes after 50 years. The most common of them include:
- The use of drugs that have a diuretic effect and have an effect on muscle tone.
- Enuresis can occur after surgery on the prostate gland.
- Injury to the spinal cord or brain, resulting in impaired control of urination function.
- Neurological diseases (multiple sclerosis, etc.).
- Pelvic muscle weakness due to a sedentary lifestyle, chronic constipation, or prolonged physical activity.
- Infectious lesion of the bladder.
- The development of prostatitis, adenoma, or another disease of the prostate.
- Stressful or depressive state.
- Taking high doses of medications with a sedative effect.
Use of medicines
Drug therapy consists in the use of:
- Alpha blockers (Alfuzosin, Tamsulosin, Doxazosin, etc.), which are effective in case of infravesicular obstruction or prostate adenoma. The medicine has a relaxing effect on the smooth muscles of the sphincter and prostate, as a result of which the outflow of urine is normalized.
- Psychotropic drugs (Tofranil, Depsonil, Priloigan, etc.) that help muscles relax and block nerve impulses in case of spasm.
- Reductase blockers - drugs based on finasteride and dutasteride. Their use is effective if necessary to reduce the synthesis of the hormone dihydrotestosterone, which is often exceeded in patients with prostate adenoma. Such urinary incontinence pills reduce the size of the prostate, which helps to reduce the manifestations of enuresis.
Oxybutynin relaxes the smooth muscles of the bladder. In patients with a neurogenic bladder, oxybutynin increases its capacity, reduces the frequency of contractions and relaxes the detrusor, reduces the number of urinations. The price in pharmacies is from 594 rubles.
- Anticholinergics and antispasmodics (Tolterodin, Oxybutynin, etc.) that relieve nervous tension. As a result, the muscles of the bladder relax. The complex use of drugs of these two groups is more effective than their use separately.
- Tricyclic antidepressants based on imipramine. Such pills have a relaxing effect and block impulses that lead to sphincter spasm.
Surgery is considered the only solution to urinary incontinence after removal of the prostate or urinary incontinence in spinal patients. Effective methods of surgical treatment are:
- ProACT system.
- "Functional" retrourethral sling.
- Artificial urinary sphincter.
Alexei Yurievich Plekhanov, urologist-andrologist at the Andros Clinic, will tell about methods of treating the disease in men:
- Adjustable sling systems, including those that are embedded in the bone.
- Self-locking sling.
- Drainage of urine into a special urinal with a catheter.
Due to the fact that there are a huge number of ways to treat pathology, the prognosis for men in most cases is positive. Even if urinary incontinence cannot be completely eliminated, the degree of impairment can be significantly reduced.
Doctors call the artificial gold urinary sphincter the gold standard. Such an operation is expensive and requires the implementation of it only by a highly qualified specialist. However, the implant is able to act on the urethra for a long time. But, it can not always be used to treat urinary incontinence in older men due to the fact that the patient must be able to physically and mentally treat the sphincter.
Implantation of an artificial bladder sphincter
Such an implant is a cuff filled with water, which compresses the urethra, not allowing urine to stand out until the man himself wants to use the toilet.To urinate, he needs to press the button that controls the pump, as a result of which the sphincter relaxes. At the same time, fluid from the pump flows into a special tank.
After some time, the cuff is independently filled with water and exerts pressure on the urethra, holding urine in it.
With urinary incontinence, the doctor can advise the patient to engage in so-called planned urination. To do this, strictly limit the amount of fluid consumed. Drinking is allowed in small portions at a strictly agreed time. In addition, bladder emptying time is being planned.
Treatment with folk remedies
Along with conservative treatment, the doctor may recommend the use of folk remedies, which make it possible to accelerate recovery and prevent its re-occurrence. To do this, use:
- A decoction of plantain.
- A decoction of dill seeds.
Recipes of traditional medicine:
- Tincture of sage.
- A decoction of onion peels.
Use of hygiene products
The treatment for enuresis is usually quite lengthy. Therefore, so that the patient can feel comfortable at this time, the doctor may advise using pads for men with urinary incontinence. After all, few can afford to spend all the time at home, and such hygiene products will help to avoid psychological discomfort.
The photo shows a mannequin in knitted shorts with a urological pad
The advantages of urological pads include:
- Excellent absorption of even a significant amount of liquid.
- Elimination of an unpleasant smell.
- They do not cause skin irritation and allergic reactions.
For elderly patients suffering from senile urinary incontinence, which is usually observed in men after 60-70 years old, you can use an adult diaper. Such diapers are also used for bedridden patients.
Consequences of the disease
Often, men are embarrassed by this delicate problem and prefer not to contact her for medical help. But, in this case, the disorder not only does not disappear, but can also lead to the development of other, no less unpleasant consequences:
- Depressive state and increased nervousness.
- Deterioration of erection and decreased sexual function.
- Violation of adaptation in society.
- Renal failure.
To prevent this, it is important, when the first signs of incontinence appear, to seek medical help. After all, the sooner treatment is prescribed, the faster it will be possible to get rid of the problem.
Features of male incontinence
An adult often keeps everything in himself. And people are afraid to tell about intimate problems even to a doctor. As a result, the pathology progresses, and difficult complications arise. This is often the case with urinary incontinence. Anatomically, the male urinary system has a more complex structure than women, namely:
- Combined urinary and ejaculatory systems.
- The long urethra (about 20 cm.) With three departments: prostatic, perineal and free.
- The location of the prostate down from the bladder, it covers the neck of the abdominal organ and the initial section of the urethra with a ring.
Constant suppression of negative emotions, overwork at work, great responsibility leads to chronic stress. Repeated nervous breakdowns and permanent stress stimulate urinary retention. Subjective symptoms:
- frequent use of the toilet
- weak stream or drip,
- uncontrolled urine output,
- spots of urine on the underwear.
All men with urinary incontinence noted these symptoms.
Types of incontinence
Associations of urologists make up many classifications of these disorders. Each reflects the features of the problem to varying degrees.In accordance with etiological factors, the following types of urinary incontinence were distinguished:
- Stressful. It occurs with an increase in intra-abdominal pressure: coughing, laughing, sneezing and other physical exertion, without the urge to empty.
- Urgent. There is an irresistible urge to urinate, without any connection with the load.
- Mixed. A combination of signs of stress and urgent disorder.
- Nocturnal (scientific name - enuresis).
The cause of all species is a violation of normal regulation mechanisms: a disorder of nerve conduction, urethra hypermotility, weakness of the sphincter of the bladder, pathological contraction of its wall.
Many men turn to a specialist late for help. In this regard, the symptoms of incontinence become more frequent due to stability or even an increase in provoking factors:
- Bad habits: smoking, alcohol.
- Features of a lifestyle: disturbance of the biorhythm sleep / wakefulness, inactivity and, as a result, slowdown of blood circulation in the pelvic organs.
- Chronic diseases: diabetes mellitus, urolithiasis, pyelonephritis, cystitis.
- Neurological problems: multiple sclerosis, stroke.
- Inflammatory and oncological processes in the prostate gland, incontinence after prostatectomy.
Gland removal is the most common cause of enuresis in adult men. Prostatitis occurs in the majority of the male population of adulthood. An equally common pathology is prostate adenoma.
Consequences of the syndrome
In advanced situations of incontinence, the following symptoms develop: pain, hematuria, fecal incontinence. Recurrent infections occur. Enuresis in adult men leads to a violation of the daily regimen, the inability to perform work duties and exercise. There is dermatitis around the pelvic organs due to constant skin irritation of the urine.
Experts follow an algorithm for diagnosing the causes of urinary incontinence in men. First, the doctor makes an anamnesis and determines the severity of symptoms (patient filling out a questionnaire developed by the International Association of Urology).
Further, the results of a laboratory examination are clinically evaluated (general analysis, measuring the volume of residual urine, the frequency and amount of urine excreted by the Zimnitsky method, the determination of creatinine), ultrasound of the urinary system to exclude pathology from the kidneys. And the latest study aimed at identifying the underlying pathophysiological cause is urethrocystoscopy. It allows you to diagnose the condition of the urinary canal, sphincter, structural changes in the bladder, using the method, urodynamic studies are performed.
Stress urinary incontinence develops due to a decrease in the elasticity of the muscle tissue of the pelvic floor organs or tears. The following procedures are recommended for patients with such disorders:
- Sling operations (an implanted loop or mesh actively increases urethral resistance and prevents spontaneous leakage of urine).
- Implantation of a regulated system of the continent - an artificial sphincter of the bladder.
- Periurethral collagen injections. They have low performance. The effect is temporary due to the tendency of the injected volume-forming substance to resorb.
Urinary incontinence medication
It is possible to treat urinary incontinence in men at home with drugs that improve the tone of the muscles of the perineum and sphincters: Duloxetine, Imipramine, Norephedrine. When overflowing the bladder, M-anticholinergics and anticholinesterase drugs are used (Dicycloverin, Atropine, Fesoteradin).The means that regulate the hormonal background help get rid of leakage of urine, since the latter are responsible for the speed, volume and accumulation of urine. "Desmopressin" in practical studies showed a decrease in nightly desires and increased the duration of sleep.
In the initial stages of incontinence, treatment of urinary incontinence in men is performed by training the muscles of the pelvic floor. Long-term exercise (Kegel gymnastics) demonstrates high effectiveness in eliminating urinary retention. This is a home method. Initially, it existed as a folk, but with the development of preventive medicine and physiotherapy exercises, a positive effect was scientifically proven when applying Kegel exercises for both men and women.
If the symptom is not quickly resolved medically, physiotherapy will have a positive effect. This treatment is used in young and old age. The method must be selected depending on the type of urinary incontinence:
- Electrophoresis is recommended for patients with hyperreflective bladder, conduct sessions with anticholinergics ("Atropine", "Eufillin").
- Ultrasound therapy stimulates the transmission of nerve impulses, enhances blood circulation in the pelvic organs, and as a result, the work of all departments of the urinary system improves.
- Diadynamic therapy is a method for training the sphincter of the bladder.
An important condition for physiotherapy is the absence of contraindications: epilepsy, cachexia, grade 3 hypertension. It is forbidden to treat patients with a pacemaker: cardiac arrest may occur.
A long-term but effective way is to train your bladder. The bottom line is to visit the toilet after a certain time with the same frequency. For convenience, a man keeps a diary indicating the exact time of urination, the amount of urine and subjective sensations. The volume of liquid drunk is controlled (per day, not more than 30 ml per kilogram of weight). After a week or two, it is necessary to increase the time between emptying, this should be done gradually until a comfortable frequency of visiting the toilet is achieved.
Urological underwear and pads
Each pharmacy has a sufficient range of urological underwear and panty liners. They will be a good option in cases where it is impossible to visit the toilet often (conferences, concerts, travels) or situations with nervous overload are coming up. Pharmacists in pharmacies will help you choose the size and level of absorption, depending on the degree of incontinence.