Incontinence (leakage of urine) is not just a women’s problem. Plenty of men have difficulty controlling their urine.

• 5% of men under 45 years of age have urinary incontinence.
• 10–20% of men over 75 years of age have urinary incontinence.

After the age of 65, stress incontinence decreases, while urgency and mixed urinary incontinence increases.

Types of Urinary Incontinence in Men

In men, incontinence can take various forms.

• If you have the commonest form, you have to rush to the toilet (urgency), and perhaps leak on the way (urgency incontinence). This is often worse in cold weather or if you hear the sound of running water (this is also true in women). You may notice some dribbling after you have passed urine. These problems are most common in older men. They are often partly related to a blockage at the outlet of the bladder, caused by enlargement of the prostate gland – a condition called benign prostatic hyperplasia (BPH).
• Some men have had bladder problems all their lives, such as bedwetting, urgency, urgency incontinence or having to pass urine frequently.
• Difficulty in holding urine sometimes results from a previous prostate operation, especially if you leak urine with a cough or sneeze, during exercise or standing (stress incontinence). This is common straight after the operation, but often improves within weeks. It can also occur in men who have not had a prostate operation, particularly in older men, but this is uncommon.

Why Prostate Enlargement Causes Incontinence

Enlargement of the prostate gland tends to occur with ageing. At 60 years of age, about 40% of men have enlarged prostates, but this rises to 75% by the age of 80. The reason is not known, but it is not a cancerous condition.

A normal adult prostate is about the size of a walnut and weighs 20–25 g, but it can increase to 60 g or more (a condition called BPH). As it expands, the prostate wraps itself round the neck of the bladder like a collar, restricting the outlet, and the bladder muscle has to work harder to push the urine out.

• Because of the obstruction, you notice that you have a poor stream or that starting the stream is difficult or that urine seems to flow in stops and starts.
• The strain makes the bladder muscle want to empty more often so that it often starts to contract before the bladder is full, causing urgency. Because the bladder tends to contract before it is full, you will pass urine frequently in small amounts and often have to get up in the night to urinate.
• The bladder has difficulty in emptying completely, because the outlet is restricted (like kinking a garden hose), and there is always some urine left inside. Gradually, more and more urine is left inside and, in severe cases, eventually overflows without any feeling of urgency. This is called overflow incontinence.

What You Can Do

Try to figure out if your prostate is enlarged. If you can answer yes to any of the following questions, it is quite likely that you have an enlarged prostate.

• Do you have difficulty in starting to pass urine?
• Do you think it takes you too long to pass urine?
• Do you pass urine in stops and starts?
• Do you dribble urine without full control when you have tried to stop?
• Do you have a sensation of not having emptied your bladder completely?
• Do you have to get up more than twice a night to pass urine, but only pass small amounts?

If you do think that your prostate may be enlarged, then you should arrange to see your doctor to check that this is the cause of your symptoms.

Decide whether urgency is your main symptom. If you have urgency, you could try ‘bladder retraining’. Some men find this helps, but generally it is not as effective in men as in women. Discuss the problem with your doctor, because there are various medicines that are very effective in calming an overactive bladder.

Dribbling after passing urine. If you dribble after passing urine, try running your finger along the underside of your penis to force out any remaining liquid.

Bedwetting. If you have always had bladder problems, including wetting the bed at night as an adult, look at the section on bedwetting and then discuss it with your doctor.

What Your Doctor Can Do

Prostate problems. If you think you have an enlarged prostate and the problem is really troubling you, your doctor may decide to try medication. A drug (finasteride) is available to shrink the prostate, but when you stop taking it the prostate starts to grow again. Other drugs (alpha-blockers) relax the bladder neck and the prostate itself but have side effects in some people. You may need a prostate operation to remove the enlarged prostate.

After a prostate operation. Tell your doctor about your incontinence if it has not improved within a few weeks after a prostate operation. Pelvic floor muscle exercises often help, especially if a pelvic floor specialist (physiotherapist or nurse) shows you how to do them properly. Various operations might be possible, such as insertion of a sling to support the urethra (tube from the bladder), or an implanted device to replace the inadequate neck of the bladder (artificial urinary sphincter).

Other surgery. Men with stress incontinence may be candidates for insertion of an artificial urinary sphincter (AUS). This is a surgically implanted device that involves placing a water-filled cuff around the urethra that is connected to an internal scrotal pump and reservoir near the bladder. Once a patient is ready to urinate, the pump is pressed and water is released from the cuff to the reservoir allowing the flow of urine. After several minutes the water is automatically transferred back into the cuff causing the urethra to close and preventing incontinence. A decrease in the amount of urine leakage is 80 to 80% but complications such as mechanical device failure and need for replacement at ten years is about 30–45% (BJU International 2011;107(suppl 3):7–10).

First published on: embarrassingproblems.com
Reviewed and edited by: Dr Diane Newman
Last updated: October 2020