Urinary Incontinence in
Men – What Shall we Do?
Article contributed by:
Dr Ho Siew Hong, Senior
Consultant Urologist
Gleneagles Hospital & Mt
Elizabeth Novena
Hospital
www.urologycentre.com.sg
for New Dimension -
biannual newsletter of
the
Society for Continence,
Singapore
Urinary incontinence is
the accidental released
or leakage of urine.
The amount of urine
leakage can be small,
such as a few drops or a
large amount, leading to
total soilage of the
underwear and trousers.
In either case, it
causes distress to a man
and many a time, hinders
him from participating
in many social and
sports activities.
Incontinence itself is
not a disease but a
symptom of a potential
problem in the urine
system. Urine is
made in the kidneys and
directed via two fine
tubes called the ureters
into the bladder.
The bladder acts as a
store house for urine.
It can usually hold
between 200-300cc of
urine before the
sensation of fullness
sets in. This will
trigger a contraction
response from the
bladder muscles,
resulting in urine being
pushed out of the
bladder in to the
urethra and out of our
body. There is an
automated regulator
muscle below the bladder
called the external
sphincter which will
contract to keep the
urethra locked and
closed when the bladder
is filling up.
This prevents accidental
leakage of urine.
During normal passage of
urine, the bladder
muscles will contract
and the regulator muscle
will relax resulting in
the opening of the
urethra.
Contrary to many
beliefs, urine
incontinence problems
are usually related to
the bladder and less
likely an indication of
a kidney problem.
Urine incontinence may
occur in boys and men of
all ages.
Bed Wetting – Nocturnal
Enuresis
Bed wetting or nocturnal
enuresis is involuntary
urination while asleep
after the age of which
bladder control should
have usually occurred.
It is one of the most
common childhood urology
complaints. It is
in most cases a
development delay and
not an emotional problem
or physical illness.
Most girls stay dry by
age six and most boys
stay dry by seven.
By ten years old, 95% of
the children are dry at
night.
Treatment starts with
simple life style
changes such as
decreased fluid intake
after dinner, passing
urine just before going
to bed, regulate bed
time. An alarm can
be set at two hours
after a child has fallen
asleep so that he can be
brought to toilet to
empty his bladder.
This allows training of
the bladder to sense
fullness even during
sleep so that a child
can eventually wake up
on his own whenever his
bladder is full.
If all fails, there are
medications such as
desmopressin which acts
to conserve fluids in
the body, decreasing
urine production in the
night and delaying
bladder fullness till
morning. This
medication is prescribed
by a doctor, taken just
before bedtime and
should always be coupled
with lifestyle changes
mentioned earlier.
As the boy develops
better sensation of his
bladder, this medication
can be withdrawn after
several weeks.
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Frequent Urination and
Urge Incontinence
Urge incontinence is an
urge to urinate that’s
so strong that a man
cannot reach the toilet
in time. It occurs
when the bladder muscle
contracts automatically
when it shouldn’t.
This can happen even
when a men has only a
small amount of urine in
his bladder.
Overactive bladder is a
medical term to describe
this condition. Mild
overactive bladder
results in frequent
urination in the day and
night while a more
serious variant of this
condition leads to urine
leakage. Normally,
a man passes urine 8-10
times a day and not more
than 2 times in the
night.
Overactive bladder can
be due to diet or
environmental factors.
Consumption of caffeine
containing beverages
such as coffee and tea
can worsen the symptoms
of urine frequency.
Cold weather and an
anxious situation may
also bring out these
symptoms. Simple
avoidance of such
factors can improve
overactive bladder.
The onset of overactive
bladder can occur as
early as the twenties
and continue to progress
as a man ages. It is
certainly more common in
elderly men. The
aging bladder can be
trained to hold urine
for a longer time before
releasing.
Medications in the
category of
anti-cholinergic can
help stabilize the
overactive bladder.
In mild cases,
medications with bladder
training can correct
overactive bladder over
a period of several
weeks or months.
However, in the more
serious case, especially
with urge urine leakage,
long term treatment with
these medications may be
required.
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Prostate problems in the
Aging Male
The prostate gland is
unique to man and it is
part of the male
reproduction system.
It is located below the
bladder. As a man
ages, the prostate gland
enlarges by itself and
gradually constricts the
urine tube that is
passing through it.
Most prostate glands
begin to enlarge when a
man reaches 50 years old
and more than 50% of men
will have enlarged
prostate by the age of
65. The resulting
constriction causes
poorer urine flow and
less efficient emptying
of the bladder.
As a result, the bladder
has to push harder to
expel urine. In
the long term, the
bladder muscles thicken
and this results in
secondary overactive
bladder. The
abnormally thickened
bladder muscles do not
work a coordinated
manner. It may
contract spontaneously
on its own resulting in
frequent urination and
eventually urine
leakage. The
treatment for this
situation is both
correction of the
prostate enlargement and
medications to stabilize
the bladder. Up to
90% of prostate
enlargement can be
successfully treated
with medications that
will widen the
obstructed urine tube or
medications that will
reverse the enlargement
process. These
medications are to be
taken for long term.
In 10% of patients,
these treatments are not
sufficient and the
patient may have to
undergo a minor prostate
surgery called TURP
(transurethral resection
of prostate).
Under anesthesia, a fine
tube with a camera is
inserted via the urine
opening into the penis,
following it in to the
prostate ”meat” is
scrapped away and sucked
out via the fine tube.
At the end of this
procedure, the caliber
of the urine tube within
the prostate is restored
to its original size.
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When should you see a
Doctor?
As mentioned earlier,
urine leakage is not a
disease. It is a
manifestation of an
underlying problem in
the urinary system.
A sudden onset of urine
leakage warrants a
consultation with a
family doctor for
initial assessment.
Gradual increase in
urine frequency over a
period of several years,
particularly in an
elderly man, suggests a
prostate problem which
also requires medical
evaluation.
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What would a Doctor do?
The doctor would take a
detailed history of the
urinary symptoms, paying
attention to the time of
onset, severity and any
possible precipitating
factors. In men
above 50 years old, he
will do a prostate
examination with his
finger. A urine
test for blood and
infection is also
commonly done.
Further tests such as
urine flow studies and
scans are usually
ordered by the
specialists.
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Take Home Message
Urine leakage in
middle-age men occurs
less commonly than in
middle-age ladies.
Hence, man may be less
willing to come forward
with this symptom as he
ages. Studies have
clearly shown that
younger boys and older
men have more urinary
symptoms than their
female counterparts.
Many of these conditions
are very treatable and
early diagnosis can
avert complications in
future.
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Article contributed by:
Dr Ho Siew Hong, Senior Consultant Urologist
Gleneagles Hospital & Mt Elizabeth Novena Hospital
www.urologycentre.com.sg
for New Dimension - biannual newsletter of the
Society for Continence, Singapore
Dated: April 2015
|
The
Society for
Continence,
Singapore
(SFCS) is a
non-profit
organization
that
originated
from the
dedicated
efforts of a
group of
doctors,
nurses and
rehabilitation
therapists
who
recognised
the special
needs of the
incontinent
as far back
as 1988.
The mission
of the
society is to
promote
bladder and
bowel health
and to work
towards a
community
free of the
stigma and
restrictions
of
incontinence.
The society
aims to
disseminate
information
and educate
healthcare
professionals
and the
public on
methods to
promote
urinary &
bowel
continence
and to
promote the
education,
training and
rehabilitation
of the
incontinent
and their
general
interests
and welfare. |
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