As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. “Thousands of years ago, it was not as much of an issue,” observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. “There were lots of trees, and you could just find one and go.”
But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Often your doctor can suggest helpful strategies and possibly medication to improve urinary control.
How urinary incontinence works in men
Urinary incontinence means the accidental or involuntary loss of urine from the bladder. Many cases involve slight “dribbling.” The most common types are urge incontinence and stress incontinence. The usual causes of urge incontinence in men are involuntary contractions of the bladder muscles (overactive bladder). This is sometimes related to long-term blockage from an enlarged prostate. “You feel the urge to go but you start leaking before you make it,” Dr. Das says. “It could be a few drips, or it could be a larger amount if you can’t find the bathroom in time.” Many men notice that certain triggers set off their urge incontinence, such as hearing running water, entering a cold room, rising after sitting, or even just inserting the key in your home’s door lock.
Stress incontinence refers to urine leakage that occurs when coughing, sneezing, lifting a heavy object, or other activity. In men, this is usually caused by problems in the rings of muscle, or sphincters, that squeeze closed to seal off the bladder.
“If they are weak or damaged, then coughing, sneezing, running, or jumping can cause leakage,” Dr. Das says. In men, the most common cause of stress incontinence is sphincter damage after prostate surgery. Radiation treatment for prostate cancer can also cause it. The doctor will ask questions to figure out what may be causing the problem and how severe it is. You may be asked to go home and keep a voiding diary, which is a careful record of how often you need to urinate and the circumstances or triggers that lead to leakage.
Here’s what you can do
Depending on the nature of the problem, the following behavior changes and strategies can help:
Avoid beverage triggers. In some men, the bladder becomes very sensitive to certain beverages. Obvious solution: drink less of whatever sets off the urges, whether it’s coffee, tea, soft drinks, or alcohol.
Go on a schedule. Putting yourself on a regular preventive schedule for urinating can also take the pressure off. A typical schedule is to urinate every two to four hours.
Lose weight, if needed. Being overweight can put extra pressure on the bladder and urinary system and make things worse. Losing some weight may reduce urinary urgency.
Use guarding moves. For both urge and stress incontinence, it can help to strategically tighten up the pelvic floor muscles with a regimen of Kegel exercises (these are not just for women). A urologist can instruct you on how to do these properly or refer you to a physical therapist for brief training. For stress incontinence, doing a Kegel exercise helps contain urine when you sneeze or cough. For urge incontinence, it retrains the brain to weaken sudden, strong urinary impulses. “It sends a message to the brain that it’s not the right time to go,” Dr. Das says. “If done on a consistent basis, it’s often helpful for a certain percentage of men.”
There is no FDA-approved medication for treating stress incontinence. A variety of options are now available for urge incontinence, however. These medications target the overactive bladder muscles. “The bladder can hold more urine, and you have more time to get to the bathroom,” Dr. Das says.
But urge incontinence drugs must be used with caution, since they can have many side effects. You need just enough in your system but not too much, or it could prevent you from urinating at all. This event, called urinary retention, is a medical emergency and requires immediate medical care. If the underlying problem is an overgrown prostate gland — also known as benign prostatic hyperplasia, or BPH — the standard drugs for that condition can help with urgency.