Treatment Options for Male Incontinence

You don't have to live with urinary incontinence. Thousands of men each year see a urologist to get the help they need to resume a normal, active life.

During your first appointment at Virginia Mason's Pelvic Floor Center, in Seattle, we'll take a complete medical history and conduct a physical exam. You may also have a session scheduled in the Pelvic Floor Center's video urodynamics lab. Our state-of-the-art video urodynamics lab provides us with simultaneous electronic tracings of bladder activity and video imaging of the bladder in motion. Both are important to determine the cause and type of incontinence you may be experiencing. Our specialists all have particular expertise in interpreting this data.

Based on the type, severity and cause of your incontinence your care team at the Pelvic Floor Center will help you decide on the best treatment for you. For more information about the treatment options for male incontinence, call (206) 223-6772.

Urge Incontinence

Intrinsic Sphincteric Dysfunction (ISD)

Overflow Incontinence

Urge Incontinence

 
Non-surgical options

  • Lifestyle Changes
    There are a number of things you can do on your own to assist your bladder's ability to function:
    • Limit your fluid intake to under 40 ounces a day.
    • Avoid bladder irritants. These include tobacco, coffee, tea, chocolate, sodas, and acidic and spicy foods.
       
  • Physical Therapy
    Pelvic floor muscle exercises, supervised by a physical therapist, can help you isolate and train the muscles that support the pelvic floor to help reduce incontinence.
     
  • Bladder Training Techniques
    If appropriate, we can teach you bladder-retraining techniques, which enable many people to learn to delay urination and suppress urge symptoms. These can be extremely helpful in reversing frequent urination and any associated incontinence.
     
  • Neuromodulation
    Neuromodulation can be performed as a temporary procedure by stimulating the tibial nerve in the ankle, similar to acupuncture. The temporary stimulation method is applied weekly eight to 10 times and is then performed once a week in the clinic or by the patient at home.
      
  • Medications
    There are three main types of medications for treating urge incontinence. Your physician may make a recommendation best suited to your needs.
     
    • The medications to control bladder spasm and overactivity are Ditropan, Detrol, Oxytrol patch, Vesicare, Santura and Enablex. These medications help manage urge incontinence by partially blocking the bladder's ability to contract.
       
    • Medications to reduce the muscular blockage to urine outflow associated with an enlarged prostate are the Alpha-blockers Flomax, Uroxatral, Hytrin and Cardura. Alpha-blockers relax the bladder neck and prostate tissue allowing improved urine flow.
       
    • Medications to block hormonal stimulation to the prostate and lead to prostate size reduction are the 5-Alpha Reductase Inhibitors Proscar and Avodart. These medications reduce the size of the prostate and can help relieve obstruction if present. As with alpha-blockers, this helps urine flow and improves urge incontinence.

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Surgical Options

  • Botox Treatment
    Although approved for other uses, Botox is not yet FDA approved for urological purposes. The same substance that is injected by plastic surgeons and dermatologists to smooth wrinkles can block nerve transmission in the bladder and correct urge incontinence. Treatment entails multiple small injections into the floor of the bladder through a small needle under local or regional anesthesia. The results are immediate and last six to nine months in most patients. The Botox medication itself is fairly expensive, and because it is not FDA approved for use in urologic conditions it is considered experimental therapy, and is not paid for by any insurance companies.
     
  • Neuromodulation
    One of the newest and most promising treatments for urge urinary incontinence is neuromodulation, which can be thought of as a "pacemaker" for the bladder. This treatment device is used in patients with urge incontinence when other therapies have not been effective.
     
    The FDA approved a surgical method of neuromodulation, InterStimTM in 1998. It involves placing permanent electrodes near the bladder nerves as they exit the spinal cord. These nerves are stimulated continuously by a small device placed under the skin in the patient's back. At the Pelvic Floor Center at Virginia Mason, we are seeing encouraging results in patients who are well suited for this procedure.
     
  • Bladder Augmentation (Augmentation Cystoplasty)
    Bladder augmentation is a surgical treatment to increase the storage capacity of the bladder. It involves taking a section of the small intestine and attaching it to the bladder, creating a larger, low-pressure addition to the bladder and preventing leakage. This treatment is reserved for people who have not responded to other medical therapies or neuromodulation. Patients who have bladder augmentation usually require lifelong, intermittent catheterization four times per day to drain the bladder.

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Intrinsic Sphincteric Dysfunction (ISD) Incontinence

Non-surgical Options: ISD
Used in conjunction with the lifestyle recommendations above, incontinence aids can be helpful for men with ISD who are not candidates for surgery.

  • Male Pads — Pads continue to be improved and refined. The newer gel-type pads absorb wetness and have a dry layer next to your skin for more comfort.
     
  • Penile Clamps — Penile clamps put pressure on the penis in order to compress the urethra and prevent leakage. A variety of external penile clamps are available. These clamps are kept in place until your bladder is full and then removed to allow urination.
     
  • Condom Catheter (External Catheter Drainage) — A condom catheter is a sheath with a tube at the end that slides over and fits on the penis. The tube allows urine to drain into a storage bag.

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Surgical Options: ISD

  • Image: male slingMale Sling — Pictured to the right, the male sling creates support for the urethra by partially wrapping a strip of material, often polypropylene mesh, around the urethra. This material is then attached to the pelvic bone with tiny screws. This keeps constant pressure on the urethra so that it only opens when you consciously try to urinate. This approach is generally recommended only if you have a lesser amount of incontinence.
     
  • Artificial Urinary Sphincter — An artificial urinary sphincter is a common choice for men who have not responded to other forms of treatment. During the surgery, a storage reservoir is placed near the bladder, a fluid-filled cuff is wrapped around the urethra and a pump is placed in the scrotum. The procedure takes approximately 45 minutes to an hour and most patients stay in the hospital overnight.
     
    The devices will not be activated for six weeks, giving you time to heal. Once your doctor has activated the devices, you simply squeeze the pump a few times when you want to urinate. This opens the urethra and allows the bladder to empty. The sphincter automatically closes again in one to two minutes when the bladder is empty.

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Overflow Incontinence

Non-surgical Options: Overflow

  • Self-intermittent Catherization (SIC) — Self-intermittent catherization involves the patient inserting a small catheter into the urethra to drain the bladder and then removing the catheter. The patient uses a clean, but not sterile, catheter each time and does this four to six times a day. 
     
  • Foley Catheter (Indwelling Catheter Drainage) — A Foley catheter is a thin tube inserted through the urethra into the bladder, allowing urine to drain from the body into an external bag. A balloon filled with sterile water is at the end of the tube and holds it in place. This is typically used as a last resort for men who are unable to empty their bladder and/or have severe leakage.

Surgical Options: Overflow

  • In some cases of overflow incontinence the cause is an obstruction of the prostate in those individuals who continue to have reasonable bladder function. Surgical relief of this obstructing tissue can correct the urinary retention and thus the overflow incontinence. A variety of methods including microwave therapy, laser therapy and transurethral resection of the prostate exists. The standard for treatment is a transurethral resection of the prostate. This requires a spinal anesthesia and a 30 to 60-minute surgical procedure done through the patient's urethra. The patient remains in the hospital one night, leaves the hospital with no catheters and is usually feeling completely normal in two weeks.

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