Incontinence (involuntary loss of urine) may be a devastating problem, resulting in embarrassment, loss of intimacy, and even social isolation.  We describe it to our patients as a “social cancer”.

Incontinence comes in several varieties but the most common are:

• Stress
• Urge
• Overflow

STRESS

This is defined as leakage associated with activity. This type of incontinence, or involuntary loss of urine, in men usually occurs after prostate surgery for cancer but occasionally may occur after other events such as injury, transurethral resection of the prostate (TURP), etc.  Typically there has been injury to the urinary sphincter muscle.  Leakage then occurs when the patient uses their abdominal muscles, for example sneezing, coughing, laughing, bending over, athletic activities, etc.

If a man is diagnosed with stress incontinence, various successful treatments are available. [link to treatment section-behaviorial tx, catheters, clamps, bulking agents, slings, sphincter]

URGE

Also known as overactive bladder, this is when the man gets an irrepressible urgency to urinate and cannot get to a bathroom in time.  Men can also get urgency without incontinence, which is the feeling of urinary urgency but the man is able to suppress it (sometimes barely!).  These are very common problems, with a wide variety of causes.  Causes include: infection, medications, prostate growth, overactivity or sensitivity of the bladder muscles, sensitivity to certain foods or substances, neurologic injury or diseases, etc.  Occasionally, urgency or urge incontinence can be the sign of a more serious underlying condition such as bladder cancer.

Urgency and urge incontinence are NOT normal and need to be evaluated.  Evaluation includes a patient’s history and examination, an analysis of the urine, and often additional testing such as cystoscopy (looking into the bladder with a very small camera, it is not a painful procedure) and/or urodynamics (an outpatient “functional” test of the bladder muscles done in clinic).

Treatment depends on the cause and the individual and may include behavioral therapy [link], medications, and/or neuromodulation. [link to section on Interstim]

OVERFLOW

This is typically a constant leakage that occurs when a patient is unable to efficiently empty their bladder.  Urine builds up and “spills” out, like a reservoir spilling over a dam. This can be due to obstruction (such as prostate or scarring in the urethra) and/or loss of bladder function or sensation.  It can be dangerous and requires investigation to make sure no other problems are occurring.  Treatments generally include catheters and/or surgery.