The Men's Room: Frequently Asked Questions
Male Stress Urinary Incontinence (SI)
What is "stress" urinary incontinence?
SUI in men is the involuntary loss of urine caused by pressure on the bladder during activities such as heavy lifting, exercise, sneezing, coughing and in some cases during sexual activity. This most commonly occurs following prostate surgery.
What causes SUI in men?
SUI is caused by a weakness in the pelvic floor most commonly following surgical removal of the prostate gland, either for an enlarged gland (trans-urethral resection of prostate, TURP) or for prostate cancer (radical prostatectomy), or radiation treatment. The prostate gland is located at the base of the bladder and surrounds the urethra, which is the pipe from the bladder along the penis. Here a ring of muscles called a sphincter close like a camera-shutter where the bladder and urethra join. In addition, there are supporting pelvic floor muscles that voluntarily close and stop urinary flow. These mechanisms together allow bladder control.. However, following. prostate surgery, if the bladder closing sphincter is removed or damaged, or the nerves controlling them are damaged, these muscles can become too weak to control urinary flow, this can result in leakage particularly when increased pressure on the bladder occurs.
What surgical options are available for SUI in men?
- Artificial urinary sphincter - A fluid-filled ring that keeps the urethra shut is implanted around the urethra and acts as a sphincter. A valve that causes the ring to deflate is implanted in the scrotum: when you need to go to the bathroom, you press it to allow urine to flow through.
- Male sling procedures - a strip of mesh tape inserted to support the urethra, keeping pressure on the urethra to prevent leakage.
- ProActTM - an inflatable implant inserted near the bladder neck, a minimally invasive procedure and controlled through a port placed under the skin.
What pharmaceutical treatments are available for SUI in men?
There are no medications approved for use in Canada for SUI.
What is the prevalence of SUI in men following prostate surgery?
Prevalence of any type of UI is difficult to determine given reluctance to report and discuss the condition. Different data collection methods also make the information difficult to interpret. The most current prevalence information (ICS) provided in 2019 shows:
- Post transurethral prostatectomy (TURP) for benign (non-cancerous) prostatic disease incontinence rates are between 0.5% and 3%.
- Post radical prostatectomy prevalence rates for cancer, incontinence varies depending on the definition used and the duration of follow-up. However, the long-term incidence ranges between 4% and 8%.
What factors increase a man’s risk of developing SUI or making the condition worse?
- Bladder problems before surgery.
- Advanced age.
- Previous radiation therapy.
- Previous TURP.
- Urethral trauma – e.g. A catheter pulled accidentally.
- Lifestyle factors e.g. Aging, obesity, and frequent coughing, such as due to lung disease and smoking.
How do men cope with SUI?
Many men with SUI do not seek professional help leading to social isolation and depression. They will try to cope with, or hide, their condition by wearing dark clothing to hide leakages.
When will I be dry again?
Within 2-6 months, leakage should be less common. In some cases, leakage may last longer. You may find the treatment options and resources highlighted below helpful.
What is the prevalence of SUI in men following prostate surgery?
Seek advice from a urologist, nurse or physiotherapist for further guidance.
Conservative measures include:
- Different reusable, disposable products and undergarments.
- Condom catheter.
- Weight loss and smoking cessation.
- Avoiding constipation – straining with bowel movements.
- Drinking plenty of fluids.
- Pelvic Muscle Exercises - Kegel Exercises. These are more effective if performed before prostate surgery.
- Biofeedback to help to identify the right muscles
- Electrical Stimulation: - A probe placed on the pelvic floor muscles that delivers a low-grade electrical current, causing the muscles to contract.
- Urethral Bulking Agents: - injected into the tissue that surrounds the urethra to build up the tissue around the sphincter.
- Urethral Inserts for Men with Incontinence - 2020. Inserted into the urethra to prevent or reduce bladder leakage. Inserts are removed before passing urine and reinserted afterwards.
- Penile Compression Devices or clamps are placed around the penis to compress the urethra.
Are there other resources available?
Before and After Radical Prostate Surgery by Virgina Vandall-Walker is a research-based, comprehensive, and comprehensible resource on prostate surgery in Canada. 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.
Please click on ‘The Source Guide’ or Continence Fact Sheets under the ‘Resources’ tab for more details.
