Male Incontinence: 14 Facts You Should Know

Men are often uninformed about the issues regarding urinary incontinence and may face challenges—physical, social, and emotional—when dealing with the diagnosis. Here's what you should know about male incontinence.

According to the National Library of Medicine (NLM), urinary incontinence affects approximately 13 million Americans. Cisgender women are twice as likely to experience urinary incontinence as cisgender men.

There are also several types of urinary incontinence, from stress incontinence to bedwetting, that could affect anyone, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Cisgender men can have incontinence due to prostate surgery or an enlarged prostate—known medically as prostatic hyperplasia. However, other causes may play a role too.

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It's More Than Post-Void Drips

Most men have mild post-void drips. However, frequent, excess leakage after urination is not normal, said William Steers, MD, former chair of the urology department and Paul Mellon professor at the University of Virginia School of Medicine, in Charlottesville.

If urinary leakage makes you uncomfortable, shows through your clothes, or causes skin irritation, it's a form of incontinence—and it could be a symptom of a more serious problem.

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It's Not Uncommon

The NLM indicated that "11% to 34% of older men report urinary incontinence" and 2% to 11% of those individuals experience incontinence on a daily basis.

Prostate removal for cancer treatment is one of the most common causes. "Most patients who come to see me about stress urinary incontinence are men who've had surgery for prostate cancer, 9 out of 10," Dr. Steers said.

If patients have stress incontinence and have not had prostate surgery, another condition—such as a neurological disorder, spinal injury, or diabetes—may be to blame, Dr. Steers added.

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Prostate Trouble Is Often To Blame

Most people with prostates experience prostate enlargement with age. It can block the urethra and cause overflow incontinence, which is the leakage of a small amount of urine, or difficulty urinating.

Prostate removal due to cancer can also damage or weaken the pelvic floor muscles and nerves around the bladder. The American Cancer Society stated that the number of individuals who will be affected by urinary incontinence after prostate surgery is unpredictable, but "older men tend to have more incontinence problems than younger men."

This is one reason healthcare providers often suggest "watchful waiting" for slow-growing prostate cancers, Dr. Steers said.

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Extra Weight Can Be a Cause

As you age, the muscles that control bladder function start to lose strength, and weight gain can put extra pressure on the bladder—which writers noted in a chapter, published in May 2022, from Weight Management—Challenges and Opportunities.

Although, when it comes to bladder control, obesity seems to affect women more than men, Dr. Steers said increasingly saw the connection in his male patients.

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Other Major Conditions Can Play a Role

In some, incontinence problems can be caused by nerve damage from diabetes, a stroke, Parkinson's disease, or multiple sclerosis.

In addition, men are more likely to be involved in car or motorcycle accidents, workplace injuries, or active-duty combat, which puts them at higher risk for spinal cord injuries that can trigger incontinence, said Nancy Muller, PhD, executive director of the National Association for Continence (NAFC).

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Incontinence Products May Help

"Fortunately, the manufactures of adult absorbent products have recognized, finally, that the male anatomy is different from female," Muller said. "Only recently have major incontinence brands come out with gender-specific adult products."

You can find absorbent or disposable underwear—ranging from briefs to boxers—as well as compression pouches that support the urethra, in most pharmacies.

For severe incontinence episodes, consider an external collection unit (commonly called a condom catheter). This fits like a sheath over the penis and contains a urinary collection bag that fits inside a pair of briefs.

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Surgical Options Exist

If you have severe stress incontinence, you can consider surgery if other therapies fail.

Healthcare providers can implant an artificial rubber sphincter around the urethra. The sphincter is inflated and deflated to control urine flow. Another procedure, called the bulbourethral sling (or male sling), supports the urethra with a mesh hammock.

Urge incontinence can be treated with sacral nerve stimulation, a pacemaker-like electrical stimulator that is implanted under the skin and sends signals to the sacral nerve to control bladder activity. Healthcare providers may also recommend prostate surgery for cases of overflow incontinence caused by an enlarged prostate.

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Medications Can Help

Medications for incontinence often target the underlying cause. For example, drugs can be used to shrink an enlarged prostate or reduce symptoms of neurological disorders.

If you experience urge incontinence, also known as overactive bladder, your healthcare provider may prescribe anticholinergic or antispasmodic medications to calm the muscles in your bladder. Certain types of antidepressants are also sometimes effective for bladder problems.

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Some Medications May Make It Worse

Some common medicines, such as diuretics, antihistamines, and antidepressants, can cause urinary leakage. Your healthcare provider may also look at drugs you're already taking to determine if they are the source of the incontinence.

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Fluid Intake Matters

Watching your fluid intake could help you improve incontinence symptoms, even without medication or surgery.

"Sometimes we find that men are drinking full six-packs of beer, and if your resistance is already low, then that's going to cause a problem," Dr. Steers explained. "If you make more urine, you stress the system."

Limiting alcohol in general, as well as caffeine and carbonated beverages, can help. MedlinePlus recommended that "drinking the right amount of liquid at the right time" can be helpful as well.

Staying hydrated and drinking water when you're thirsty is always healthy, Dr. Steers said, but there's no need to aim for a certain number of glasses a day.

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Skin Problems Shouldn't Be Ignored

Chronic leakage and post-void "after-dribble" tends to cause more skin irritation in men than in women, said Muller. "They have more problems with rashes and skin fungus and often don't give enough attention to the perineal area around the scrotum."

Moisturizers and barrier creams can keep skin from becoming too dry and inflamed. Those who use absorbent pads or products should change them every few hours to prevent irritation or infection.

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Pelvic Floor Exercises Can Help

Kegel or pelvic floor exercises, in which you squeeze and hold the muscles you'd use to stop urination, aren't just for women.

Researchers of a Supportive Care in Cancer study published in January 2022 found that patients experienced a shorter recovery time following a prostatectomy when they engaged in simplified Kegel training.

The NAFC has recommended doing a set of 10 slow and 10 fast contractions, two or three times a day.

"It's just like bench presses at the gym," Muller said. "Doing too much too soon can actually damage the muscles, so you can't rush into it."

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Societal Challenges Exist

Men can face unique physical and emotional challenges with incontinence. "For starters, women are used to wearing pads several days of the month," Dr. Steers said, "whereas a man is not socially attuned to wearing anything down there. Just the idea can be really embarrassing to them."

It may also be hard to avoid situations where leakage is common, Dr. Steers added.

You might have a job that entail heavy lifting, for example, or friends might expect you to participate in sports like golf and tennis, which can put pressure on the bladder.

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Online Resources

There are resources for male incontinence, like the Mixed Incontinence section of the NAFC's site.

Those who've had prostate surgery may benefit from a prostate cancer support group, which can help address a range of emotional and physical and issues. Local support groups can be found in places such as on the ZERO website.

If ever you have concerns about urinary incontinence, discussing them with your healthcare provider can be beneficial to determine what treatment plan will be best for you.

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