Overview of Male Incontinence
Urinary incontinence (UI) is the inability to control the loss of urine. During childhood, bladder control usually develops sooner in girls than in boys, and bedwetting (nocturnal enuresis) is more common in boys. Due to differences in anatomy and changes caused by pregnancy and childbirth, urinary incontinence is about twice as common in adult women as in adult men.
Male urinary incontinence can result from a number of factors. In many cases, benign prostatic hyperplasia (BPH, enlarged prostate) contributes to the condition. Male incontinence can be acute (i.e., come on suddenly) and temporary (transient), or chronic (long lasting). The condition can be congenital (i.e., present at birth) or acquired (i.e., develop as a result of injury or disease).
Male Urinary Tract Anatomy
The male urinary tract is made up of the kidneys, the ureters, the bladder, and the urethra. The kidneys are bean-shaped organs that are located below the ribs near the middle of the back. Kidneys remove toxic (uremic) waste products from the blood and form urine, maintain a balance of substances in the blood, and produce a hormone (erythropoietin) that triggers the production of red blood cells in the bone marrow.
The ureters are fibromuscular tubes that carry urine from the kidneys to the bladder, which is the hollow, muscular organ that stores urine. When the volume of urine in the bladder reaches a certain capacity, the brain sends impulses that cause muscles (e.g., internal sphincter, detrusor muscles) to relax and expel the urine. As the bladder contracts, it expels urine out of the body through the urethra (tube that passes urine from the bladder out of the body).
In men, the urethra is roughly 8 to 9 inches long. It extends from the bladder to the end of the penis and is composed of three parts: prostatic, membranous, and spongy. The prostatic urethra passes through the prostate gland and is made up of fibrous tissue, muscle fibers, and tiny glandular openings that connect to the prostate. The membranous urethra is located between triangular ligaments (bands of connective tissue) in the pelvis and the spongy urethra extends through the penis to the glans (tip of the penis).
The prostate is a walnut-sized gland that is located beneath the bladder and in front of the rectum. It is surrounded by a capsule of fibrous tissue called the prostate capsule. Prostate tissue produces prostate specific antigen (PSA) and prostatic acid phosphatase, an enzyme found in seminal fluid (the milky substance that combines with sperm to form semen).
There are several types of urinary incontinence. The most common forms are stress, urge, mixed, and overflow. Overflow incontinence, which causes small amounts of urine to leak continuously, is common in men who have benign prostatic hyperplasia (BPH, enlarged prostate).
Stress incontinence causes urine loss during activities that put pressure on the abdomen (e.g., coughing, sneezing, laughing, exercising). Urge incontinence results in sudden, uncontrollable loss of urine and frequent urination (e.g., every 2 hours). Mixed incontinence causes symptoms of both stress and urge urinary incontinence.
Incidence and Prevalence of Male Incontinence
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), male urinary incontinence affects approximately 17% of men over the age of 60. Incontinence occurs more often in women than men. The condition affects as many as 25 million adult men and women in the United States and 200 million people worldwide.