Male urinary incontinence

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Highly Advanced Male Urinary Incontinence Treatment
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Incontinence is the accidental leakage of urine. The act of urination
goes out of one’s control in such a condition. Bladder control
develops earlier in females than in males. Men and women both are
affected by this condition. As age advances men become more
vulnerable to this condition due to prostate enlargement but this
may not be a rule.
Bladder Control and Bladder Dysfunction
The functioning of the bladder is controlled at the local level by a
micturition reflex and by the spinal cord and the brain at the higher
level. The brain has centers that tell the individual if it is the right
place and time to urinate. These centers are affected in conditions
like Stroke, Parkinsonism, Alzheimer’s and Brain tumor because of
which the person may urinate immediately after he gets the urge.
The person may pass urine in bed, in a gathering etc. This is a type
of urge incontinence.

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At times the person may suffer from spinal cord injury. The spinal
cord has nerves that carry sensation of bladder fullness from the
bladder to the brain. As soon as the brain senses bladder fullness, it
instructs the individual to go to the washroom to relieve him. Till
such a place is found the brain sends signals through other nerves
to keep the bladder opening closed. But in cases of spinal cord
injury, this connection between the brain and bladder is lost as the
spinal cord nerves are cut. In this case the person gets the urgency
to void urine and he does it immediately. This is also a type of urge
incontinence. Also in spinal cord injury the bladder gets spastic or
overactive. A little bit of urine causes reflex contraction of bladder
resulting in its contraction and expulsion of small amounts of urine
with increased frequency. This is known as overactive bladder.
In conditions such as diabetes mellitus or other nerve diseases, the bladder muscles
become weak and nerves causing the bladder contraction are diseased. As a result
even after the bladder is full, there is no reflex contraction and emptying of bladder
and the bladder keeps filling up till it overflows. This is known as overflow incontinence
or dribbling.

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Another variety is the stress incontinence which is found
more commonly. The neck of the bladder has a ring of
muscle called the sphincter. This sphincter is usually fully
contracted to keep the bladder mouth closed. This muscular
ring is supported by pelvic muscles. When the pelvic floor
muscles get weakened, this ring also gets weak. As a result
the mouth of the bladder in not totally closed at all times. So
in instances where there is an increase in abdominal
pressure as in laughing, coughing, sneezing, lifting weights
etc., there is leakage if urine as the bladder is compressed.
Enlarged prostate puts pressure on the bladder causing
premature outflow of urine that cannot be voluntarily
controlled.

Diagnosis
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The condition can be diagnosed by various methods. Digital rectal examination
can help to see whether the prostate is enlarged. The abdominal and pelvic
Ultrasonography can identify any external factors that may be compressing the
bladder. Urodynamics can help to identify stress incontinence. Maintaining a diary
on number of times you need to go to the washroom to relieve yourself is also a
good indicator of incontinence.

Treatment for Male Urinary Incontinence
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Incontinence is curable. The methods and the time taken for cure will vary from
person to person.
• Behavioral modification : involves bladder training and timed voiding.
Adjusting the time of fluid intake before bedtime or before going for a car trip or
party can help avoid accidents during sleep or parties. Also timed voiding
involves emptying of bladder after regular intervals. This technique is suitable for
people with mechanical compression of bladder or overflow incontinence.
• Kegel exercise : involves strengthening of the pelvic floor muscles which help
to keep the sphincter muscles tight which in turn keep the bladder outlet closed
during strenuous activities. Pull in the pelvic muscles and hold for a count of 3.
Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10
repeats. This is possible with the help of biofeedback also. This helps people with
stress incontinence.

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• Medications : certain medications help to relax the bladder and surrounding
muscles to allow full emptying (Alpha blockers). Some medicines help to reduce
the level of hormone that enlarges the prostate, which in turn helps to reduce the
mechanical pressure on the bladder and eases urine flow (5-alpha reductase
inhibitors). Antispasmodics relieve the bladder muscle spasm thus preventing
sudden bladder contractions.
• Artificial Sphincter : Some male patients can eliminate urine leakage with an
artificial sphincter. It is an implanted device that keeps the urethra closed until
the person is ready to urinate. This device can help people who have
incontinence because of weak sphincter muscles or because of nerve damage
that interferes with sphincter muscle function. It does not solve incontinence
caused by uncontrolled bladder contractions.

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Surgery to place the artificial sphincter requires general or spinal anaesthesia. The
device has three parts: a cuff that fits around the urethra, a small balloon reservoir
placed in the abdomen, and a pump placed in the scrotum. The cuff is filled with liquid
that makes it fit tightly around the urethra to prevent urine from leaking. When it is
time to urinate, you squeeze the pump with your fingers to deflate the cuff so that the
liquid moves to the balloon reservoir and urine can flow through the urethra. When
your bladder is empty, the cuff automatically refills in the next 2 to 5 minutes to keep
the urethra tightly closed.
• Male Sling : Surgery can improve some types of urinary incontinence in men. In a
sling procedure, the surgeon creates a support for the urethra by wrapping a strip of
material around the urethra and attaching the ends of the strip to the pelvic bone. The
sling keeps constant pressure on the urethra so that it does not open until the patient
consciously releases the urine.
• Urinary Diversion : If the bladder must be removed or all bladder function is lost
because of nerve damage, you may consider surgery to create a urinary diversion. In
this procedure, the surgeon creates a reservoir by removing a piece of the small
intestine and directing the ureters to the reservoir. The surgeon also creates a stoma,
an opening on the lower abdomen where the urine can be drained through a catheter
or into a bag.

Treatment for Female Urinary Incontinence
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• Behavioral modification : involves bladder training and timed voiding.
Adjusting the time of fluid intake before bedtime or before going for a car trip or
party can help avoid accidents during sleep or parties. Also timed voiding involves
emptying of bladder after regular intervals. This technique is suitable for people
with mechanical compression of bladder or overflow incontinence.
• Kegel exercise : involves strengthening of the pelvic floor muscles which help
to keep the sphincter muscles tight which in turn keep the bladder outlet closed
during strenuous activities. Pull in the pelvic muscles and hold for a count of 3.
Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10
repeats. This is possible with the help of biofeedback also. This helps people with
stress incontinence.
• Medications : certain medications help to relax the bladder and surrounding
muscles to allow full emptying (Alpha blockers). Anticholinergics relieve the
bladder muscle spasm thus preventing sudden bladder contractions.

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Male urinary incontinence

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Male urinary incontinence