Stress Incontinence

Stress Incontinence is the termed used for uncontrolled loss of urine in men usually after surgery on the prostate gland. It is a common problem, which can cause considerable distress and embarrassment for the patient. After radical prostatectomy (laparoscopic or retropubic), the male continence mechanism and the controlling nerves are structurally damaged.

Large studies have indicated that there is a 3% to 11% overall prevalence rate of incontinence in the male population with urge incontinence being the prominent symptom reported in 40% to 80% of patients. In cases where the incontinence is due to prostate cancer surgery, options include the placement of the AMS 800 Artificial Urethral Sphincter, or the male sling procedures (AdVance and InVance).

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Stress incontinence is the involuntary leakage of small amounts of urine resulting from an increased pressure in the abdomen. Men usually don’t have stress incontinence unless they have had a procedure on their prostrate, such as a prostatectomy for cancer or a transurethral resection of the prostrate which is often performed for benign prostate disease. Mixed incontinence which is a combination of stress incontinence and urge incontinence commonly occurs in men after cancer surgery on the prostate who had some damage to the valve muscle combined with an overactive bladder.

Types of treatment

Types of treatment available are Pelvic floor training, medications to help tighten the valve muscle may be used in men with mild stress incontinence. For patients with more significant stress incontinence or when non-surgical treatments are not helpful, a “sling” that provides support to the urethra can be placed through minimally invasive techniques. Patients who are frail physically or those with mild stress incontinence probably are not good candidates for a sling, but there are options for them, too. Some men with stress incontinence may be helped by an operation in which a device is inserted behind the pubic bone and outside the urethra.

Exercises

In general, patients with mild degrees of leakage are more likely to resolve the problem with exercises as compared to those with a severe degree of leakage. Treatments may include exercises to strengthen weak muscles, biofeedback and bladder training. You may have heard of Kegel exercises and think they are mainly for women. Both men and women can benefit from doing Kegel exercises. These exercises strengthen the pelvic floor muscles that hold the urine in your bladder until you are ready to release it. Sometimes it can be hard to tell if you are doing the exercises correctly so using simple biofeedback devices at home can help you learn how.

Bladder Training

As men age, the prostate gland grows larger, squeezing the urethra and pushing the neck of the bladder out of position. With age, bladder capacity, contractility, and the ability to postpone voiding decline, and uninhibited bladder contractions become more prevalent. Some of the causes of incontinence in men include weakness of the structures supporting the bladder and blockages due to prostate problems.

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Bladder training appears to be effective in reducing the frequency of stress and urge incontinence. Urge incontinence, also called overactive bladder, is the inability to hold urine long enough to reach a toilet once the urge to urinate occurs. Bladder training, a traditional conservative treatment for urge UI, has been studied in women but, despite almost equal incidence of overactive bladder symptoms in the older age group, no studies have addressed men with urgency. Bladder training instructs patients to void at regular short intervals, usually hourly during the day, and then at progressively longer intervals of up to 3 hours over a training period of a few to a dozen weeks. Medications may be prescribed that help tighten muscles or relax the bladder. Biofeedback can complement bladder retraining and is helpful for some patients.