Treatment for Male Incontinence
Treatment for male incontinence depends on the underlying cause, the age and overall health of the patient, and the severity of the condition. In many cases, treating an existing medical condition (e.g., benign prostatic hyperplasia [BPH, enlarged prostate], urinary tract infection [UTI], diabetes) helps resolve urinary incontinence.
Treatment may include the following:
- Pads and other external devices
- Behavioral therapy (e.g., bladder training, timed voiding, biofeedback)
- Electric stimulation
- Intermittent self-catheterization (e.g., in patients who have spinal cord injuries)
External Devices to Treat Male Incontinence
Pads and protective devices (e.g., bed pads, underwear liners, disposable or reusable adult diapers, male incontinence drip collectors) may be helpful. Other external devices include penile clamps (e.g., Cunningham clamp) and compression rings, which can be used to stop urine flow. The penile clamp is a V-shaped casing with a foam cushion that fits over the penis. Compression rings fit around the penis and are inflated to prevent leakage.
Clamps and rings must be removed every 2 to 3 hours to empty the bladder and they should only be used by patients who can adjust them properly and adhere to the voiding schedule. Improper use of these devices can cause penile and urethral tissue damage, penile edema (swelling), pain, and obstruction.
Behavioral Therapy to Treat Male Incontinence
Types of behavior therapy include biofeedback and bladder retraining with timed voiding. Kegel exercises, which can strengthen pelvic floor muscles, also may be helpful. In bladder retraining, the patient keeps a voiding diary of urination and leakage and the physician analyzes the information to help the patient learn to empty the bladder before accidental urine loss occurs.
Biofeedback involves using a simple instrument to record small electrical signals that are produced when urinary muscles contract. These signals are changed into audio and/or visual signs that help patients control urination. Using this method, weak muscles can be activated on demand, tense muscles can be relaxed, and muscle activity can be coordinated.
Neuromuscular Electrical Stimulation to Treat Male Incontinence
Neuromuscular electrical stimulation (NMES) of nerves in the pelvic floor (e.g., the pudendal nerve) can be used to cause urinary muscles to contract. This treatment can be used to retrain and strengthen weak urinary muscles and improve bladder control. During treatment, a probe is inserted into the anus and current is passed through the probe at a level below the pain threshold, causing the muscles to contract. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions last approximately 20 to 30 minutes.
Medications to Treat Male Incontinence
Several types of medication can be used alone or in combination to relax involuntary bladder contractions, improve bladder function, and treat male incontinence.
Medications that may be prescribed include the following:
Anticholinergic agents (e.g., propantheline bromide [Pro-Banthine®], oxybutynin chloride [Ditropan®XL], tolterodine tartrate [DetrolLA®], darifenacin [Enablex®], trospium chloride [Sanctura®], solifenacin succinate [Vesicare®], hyoscyamine sulfate [Levbid®, Cytospaz®)], flavoxate [Urispas®])These drugs have an antispasmodic effect on urinary muscles and reduce muscle spasms.
The oxybutynin transdermal system (Oxytrol®) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly. This treatment delivers oxybutynin continuously through the skin into the bloodstream and relieves incontinence symptoms for up to 4 days.
Side effects include dry mouth, blurred vision, headache, and constipation.
Tricyclic antidepressants (TCAs; e.g., doxepin hydrochloride [Sinequan®], desipramine hydrochloride [Norpramin®], nortryptyline hydrochloride [Pamelor®], imipramine pamoate [Tofranil-PM®])These medications, which help block nerve impulses, have an antispasmodic effect and reduce urinary muscle spasms. Side effects include appetite changes, dry mouth, dizziness, and blurred vision.
Alpha-1-adrenergic blocking agents (e.g., doxazosin mesylate [Cardura®], tamulosin hydrochloride [Flomax®], terazosin hycrochloride [Hytrin®])These drugs are used to treat benign prostatic hyperplasia (BPH, enlarged prostate), which compresses the urethra and may cause incontinence. Side effects include headache, dizziness, and fatigue.
5-Alpha reductase inhibitors (e.g., finasteride [Proscar®], dutasteride [Avodart®])These medications reduce production of a male hormone (DHT), which may cause BPH and lead to urinary incontinence. Side effects of these drugs include erectile dysfunction (impotence), breast enlargement, and a low sperm count.
Surgery to Treat Male Incontinence
Three types of surgery may be used to treat urinary incontinence in men. In some cases, mild symptoms can be treated using injectable fillers (e.g., collagen, synthetic material). This treatment involves injecting the substance into the tissue surrounding the urethra near the bladder opening to reduce bladder pressure and improve the function of urinary muscles (e.g., internal sphincter).
A device called a male sling can also be used to treat moderate to severe urinary incontinence. This treatment often is performed following prostate surgery (e.g., prostatectomy) and involves surgically implanting a mesh-like material to compress the urethra and reduce urine leakage.
In older sling procedures, the mesh is held in place with surgical screws that are attached to bone in the pelvis. The transobturator sling for men is a newer type of male sling that does not require screws and can be implanted using a minimally invasive surgical technique.
Severe male incontinence that does not respond to other therapies may require an artificial urinary sphincter. This treatment involves a device that has three components that are filled with fluid (e.g., saline): a pump, a balloon reservoir, and a cuff that encircles and closes the urethra.
The cuff is connected to the pump, which is surgically implanted in the scrotum and is activated by squeezing or pressing a button. The fluid in the cuff empties into the reservoir, the urethra opens, and the bladder empties. Fluid from the reservoir returns to the cuff, which again closes the urethra. Complications from this treatment include infection, tissue breakdown, and mechanical failure of the device.
Male Incontinence Prevention
Male incontinence cannot be prevented in all cases. To help prevent urinary incontinence:
- Maintain a health weight.
- Quit smoking.
- Limit intake of bladder irritants (e.g., alcohol, caffeine).
- Exercise regularly.
- Follow your physician's advice about taking prescription and over-the-counter medications and managing existing medical conditions (e.g., benign prostatic hyperplasia [BPH, enlarged prostate], kidney disease, diabetes).