Male Urinary Incontinence

Diagnosis and Treatment for Bladder Control Issues in Men

Urinary incontinence (UI), or the unwanted loss of urinary control, affects 13 million people of all ages and sexes. It is often temporary and usually stems from an underlying medical condition. Many men are hesitant to seek help, either out of embarrassment, the belief that leakage is a normal part of aging, or a lack of awareness that effective treatments exist.

Symptoms can range from frequent or urgent urination to difficulty emptying the bladder and accidental leakage. Fear of these episodes can prevent participation in work, exercise, or social activities, significantly impacting quality of life.

Fortunately, there IS treatment, including many new medical therapies and minimally invasive surgeries. The experienced urologists at Georgia Urology are skilled in the management and treatment of all types of urinary incontinence. Our patients benefit from these life-changing procedures by being able to resume their lives without anxiety and shame.

Male urinary incontinence often differs from female patterns, and is most commonly associated with prostate conditions or procedures, particularly surgery for prostate cancer or benign prostatic hyperplasia (BPH). Understanding the underlying type of incontinence guides the selection of the most effective treatment.

Types of Incontinence

Treatment and management begin with determining the underlying cause: urologic (urinary system-related) versus non-urologic (indirectly related). Non-urologic UI could stem from infection, certain medications, stool impaction, or psychological factors, and is typically self-correcting once the root cause is addressed. Urologic causes generally fall into four categories (stress, urgency, overflow, and mixed), and each one is related to physiological dysfunction of the bladder, the urethra, or both.

  • Stress Urinary Incontinence (SUI): Leakage with physical activity, coughing, sneezing, lifting, or exercise; common in post-prostate surgery
  • Urgency Urinary Incontinence (UUI): Sudden, strong urges that cause leakage; often related to overactive bladder (OAB)
  • Overflow Incontinence: Occurs when the bladder is overly full due to obstruction (BPH, urethral stricture) or poor bladder contractility
  • Mixed Incontinence: Coexistence of stress and urgency symptoms; requires treatment targeting both mechanisms
  • Non-urologic causes: Medications, limited mobility, psychological or neurological dysfunction, infections, metabolic disease, or chronic constipation

Causes

Incontinence has many different causes. Urine normally collects in an internal sac called the bladder, and incontinence may occur when muscles that keep the bladder closed weaken or are too active. Male incontinence is most often linked to prostate or neurologic conditions.

  • Surgery for prostate cancer (radical prostatectomy)
  • Benign prostatic hyperplasia (BPH) causes bladder outlet obstruction
  • Neurologic conditions such as Parkinson’s disease or congenital abnormalities like spina bifida
  • Medications, infections (like urinary tract infections [UTIs]), or systemic illnesses affecting bladder function
  • Lifestyle factors: chronic straining or constipation, obesity, or smoking can worsen symptoms
  • Certain foods and drinks that irritate the bladder, such as caffeine, carbonated drinks, spicy foods, and acidic foods
  • Trauma such as spinal cord injury, irradiation, or other injuries to the lower urinary tract and pelvic organs
  • Pelvic floor weakening or prolapse, including prolapse of the bladder, rectum, or bowel

Symptoms

Incontinence can develop so gradually that you might not notice how much of an issue it has become. Male incontinence symptoms vary by type and their severity.

  • Leakage during physical activity (SUI)
  • Urgency with or without sudden leakage (UUI)
  • Weak urine stream, dribbling, or incomplete bladder emptying
  • A combination of stress and urgency symptoms
  • Emotional and social impacts, including embarrassment, anxiety, and activity avoidance

Diagnosis

Your urologist will review your symptoms, medical history, any previous surgeries, previous treatments for incontinence, and any medications you are taking. If you’ve had prior treatment, it’s helpful to bring relevant records or imaging to your appointment. Your evaluation will guide the choice of the most appropriate treatment or management plan, and may include any or all of the following:

  • Detailed medical history: onset, severity, triggers, prior surgeries, and impact on daily life
  • Physical exam
  • Cough stress test
  • Post-void residual measurement and uroflowmetry
  • Urodynamics or cystoscopy as indicated for complex cases

Treatment

In many cases, there are several treatment options available, and you and your urologist will work together to determine the most suitable first approach for your situation. Treatment is individualized based on the type and severity of incontinence.

  • Behavioral interventions: This can include bladder training and lifestyle adjustments.
  • Pelvic floor exercises: Male Kegels can support the surrounding musculature.
  • Medications: Anticholinergics or beta-3 agonists, for example, can help control urgency or an overactive bladder.
  • Surgical options, especially after prostatectomy:
    • e-Coin Peripheral Neurostimulator System: This generates electrical pulses to help stimulate nerves involved in bladder control in people with urgency, urinary incontinence, or a sudden urge to urinate that causes some urine to leak. Learn more about eCoin
    • Axonics® System: This method uses sacral neuromodulation to treat overactive bladder, bowel incontinence, and urinary retention by improving signaling between the brain and the bladder (or bowel). Learn more about the Axonics® System
    • Medtronic InterStim™: This system also uses sacral neuromodulation to stimulate the sacral nerves in the pelvic area that control the bladder, and it’s the only one that lets you see if it works before you and your doctor decide. Learn more about Medtronic InterStim™
    • Male Sling: A simple, highly effective treatment option that involves implanting a bio-compatible, plastic mesh hammock under the urethra to lift and support it, thus helping prevent incontinence. Learn more about Male Sling
    • Artificial Urinary Sphincter (AUS): An inflatable cuff that wraps around the urethra, connected to soft, flexible, biocompatible tubing, a control pump that sits in the scrotum, and a saline-filled balloon placed in the pelvic area. Learn more about Artificial Urinary Sphincter (AUS)
  • Periodic catheterization: This helps manage urinary retention or certain types of male incontinence when the bladder does not empty, especially for men with neurogenic bladder (such as from spinal cord injury, multiple sclerosis, or diabetes-related nerve damage), enlarged prostate, or after urologic surgeries.
  • Botox: FDA-approved for treating overactive bladder (OAB), Botox blocks the transmission of nerve impulses to the bladder muscle to calm contractions and reduce OAB symptoms.

Prognosis

Urinary incontinence in men is often manageable and treatable.

Outcomes depend on the underlying cause, type of incontinence, and timely intervention. With appropriate care, men can regain continence and improve daily life, resuming work, exercise, and social activities without fear of leakage or embarrassment.

Call Georgia Urology today to schedule an appointment to talk to an experienced urologist in one of our convenient Atlanta area locations.

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