Understanding Urinary Incontinence in Men Part One: Incontinence and Prostate Treatment

Background
Male urinary incontinence (“incontinence” for the purposes of this article) is the accidental leakage of urine that most men may experience as a result of prostate problems. It’s important to understand that while it presents itself more as men age, it is not an inevitable part of aging. Additionally men can experience nerve damage that can leads to incontinence.

Male Urinary Incontinence and the Prostate
What is the prostate? The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation.

The prostate gland commonly becomes enlarged as a man ages. As the prostate enlarges, it may squeeze the urethra. The bladder wall thickens and becomes irritated causing the bladder to begin to contract even when it contains only small amounts of urine resulting in more frequent urination.

This condition rarely presents itself, according to the National Institutes of Health, before age 40, but more than half of men in their sixties and up to 90 percent in their seventies and eighties have some symptoms. While the symptoms vary, the most common are:

1. Changes or problems with urination, such as a hesitant, interrupted, weak stream;
2. Urgency and leaking or dribbling;
3. More frequent urination, especially at night; and urge incontinence (leakage of large amounts of urine at unexpected times, including during sleep)

Problems with urination do not necessarily signal blockage caused by an enlarged prostate. Other changes associated with aging can cause urination problems.

Male Urinary Incontinence and Prostate Treatment
In some cases, patients will undergo surgery to remove the entire prostate gland; this may be recommended to treat prostate cancer. The surgery may lead to erection problems and incontinence, although new nerve-sparing procedures in the abdominal approach (along with lathroscopic surgical methods) may reduce the incidence of these side effects.

Another therapy, radiation, uses an x-ray machine to deliver radiation to the prostate gland. While this treatment is not painful, it can cause of bladder control as well as fatigue, skin redness and irritation, and other physical side effects.

An experimental therapy called HIFU (High Frequency Focused Ultrasound) exists that hasn’t yet bee been approved by the FDA but it holds promise based upon results in other regions of the world such as Europe, China, Japan, Caribbean, Mexico, Canada, and Latin America. Briefly, this procedure utilizes ultrasound that is highly focused into a small area, creating an intense heat of 176-212° F (which is lethal to prostate cancer tissue). Since ultrasound is non-ionizing (as opposed to ionizing in radiation), tissue in the entry and exit path of the HIFU beam is not injured.

No single treatment works for everyone. Treatment will depend on the type and severity of the problem, each patient's lifestyle, and their preferences, starting with the simpler treatment options.