In men, incontinence is often caused by problems with the prostate. This walnut-sized organ, located just below the bladder, produces the milky fluid that combines with sperm to produce semen.
One of the first things a doctor will do when a man complains of incontinence is check for prostate problems. This is usually done with a rectal exam to evaluate the size of your prostate (the prostate can be felt by inserting a finger in the rectum). In some cases, your doctor may also ask for a PSA test. This simple blood test measures the amount of prostate-specific antigen (PSA) - a substance naurally produced by the prostate - in the blood. Elevated levels of PSA could be a sign of an enlarged prostate, prostate cancer or prostatitis.
Men whose incontinence is caused by an enlarged prostate may benefit from drugs used to treat BPH. Medications available in Canada include:
Alpha-blockers: These drugs relax the smooth muscle of the prostate and the opening of the bladder, reducing the urge to urinate and allowing urine to flow normally. Available medications: silodosin (Rapaflo®), tamsulosin (Flomax-CR®), alfuzosin (Xatral®), terazosin (Hytrin®) and doxazosin (Cardura®)
5-alpha reductase inhibitors: These medications block the production of the male hormone DHT, which is believed to be responsible for prostate enlargement. These types of drugs are most useful for men with more severe BPH. Available medications: finasteride (Proscar®), dutasteride (Avodart®)
Surgical procedures for male incontinence often centre on correcting prostate problems or reversing the damage caused by prostate cancer treatments. Recently, sling procedures for men have also been developed. Here are some of the most common procedures.
Transurethral resection of the prostate (TURP): is a treatment for benign prostatic hyperplasia (BPH), a condition that may cause incontinence (usually urge incontinence). In this procedure, a small portion of the prostate is cut away using a wire heated with electrical current that’s threaded up the penis, through the urethra.
Artificial urinary sphincter: Men who have had a radical prostatectomy for prostate cancer may suffer from incontinence, because the urinary sphincter can be damaged during the surgery. To correct this, a fluid-filled ring that keeps the urethra shut is implanted around the urethra, acting as an artificial urinary sphincter. A valve that causes the ring to deflate is implanted under the skin: when you need to go to the bathroom, you press it to allow urine to flow through.
Male sling procedures: Though they have been performed in women for years (see above), sling procedures for men are relatively new. As in women, a strip of synthetic tissue supports the urethra, keeping pressure on it to prevent leakage. Initial studies have shown a good success rate (80% improvement) but there isn’t much data yet and the procedure is still under study.
ProAct®: Another option for post-prostatectomy relief from stress incontinence is an inflatable implant inserted near the bladder neck in a minimally invasive procedure and controlled through a port placed under the skin. The balloon lifts the bladder neck to improve continence.
Before and After Radical Prostate Surgery is a research-based, comprehensive, and comprehensible resource on prostate surgery in Canada.
Aimed at men with concerns about prostate surgery and their partners, this invaluable guide includes chapters on preparing for prostate surgery, the surgery itself, recovery in hospital and at home, a list of recommended resources, and special sections to record personal notes and important contact information.
Before and After Radical Prostate Surgery by Virgina Vandall-Walker