What is ‘stress’ incontinence?
Stress incontinence refers to the urine leakage experienced when an activity or action places downward pressure on the bladder and pelvic floor muscle. The most common events are laughing, sneezing, coughing, lifting something heavy or during high impact sport.
Incontinence isn’t a stand-alone condition, regardless of the type, but a symptom of an underlying cause. For male stress incontinence, that’s often a prostate treatment that has led to the weakening of the pelvic floor muscle.
What exactly happens when you leak?
The actions or events described above exert downward pressure on the pelvic area, pushing urine out of the bladder and causing the leak. For most men, a strong pelvic floor muscle is capable of ‘clenching’ and holding urine in, even under this type of force. But if the muscle has been weakened or damaged, then the ability to stay dry when these stress-causing events occur, may not be there.
What causes stress incontinence in men?
The most common cause is prostate surgery performed to remove a benign or cancerous gland, medically referred to as a prostatectomy or TURP (Transurethral Resection of the Prostate).
Not all men who have this type of operation experience stress incontinence afterwards. If surgery is still ahead of you, you may be interested to know about the risk factors that increase the chance. These are documented by the Australian Family Physician website as:
- Body Mass Index (BMI)
- Pre-operative bladder function and urinary continence status
- Prior radiation therapy
- Pre-operative length of the membranous urethra (see illustration below)
- Previous surgery involving the prostate or urethra
- Pre-existing vascular health issues
- The stage of the disease
Before proceeding with surgery, it’s essential that you understand all the risks, so discuss them with your doctor.
You can read about prostate surgery in more detail in this article, Enlarged Prostate Gland or Prostate Surgery
Other than surgery, lifestyle factors also play a role, especially those that weaken the pelvic floor muscles. These can include persistent straining from constipation, being overweight or having a chronic cough – often associated with smoking.
Treatments for male stress incontinence
The good news for men is that if they do experience incontinence after prostate surgery, it usually corrects itself within 6 to 12 months. If it’s stress incontinence, the recovery can be fast-tracked with exercises that will help get the pelvic floor back into shape.
Although it’s less common, in some men, the pelvic floor may just have weakened over time, so it is possible to experience stress incontinence without having had surgery. Poor lifestyle habits and family history can also contribute to this.
Regardless of the cause, pelvic floor exercises will strengthen the muscle and should resolve the issue by improving the ability to withhold urine under pressure exerted from sneezes, etc.
In addition to exercises, make sure you’re adopting good bladder and bowel habits, such as:
- Avoid constipation with a healthy diet, exercise and drinking plenty of water
- Stop smoking
- Keep your weight within the healthy BMI range of 18.5 to 24.9. You can use the Heart Foundation BMI calculator to discover where you are on the scale
- Use the toilet when you feel the urge – don’t hang on, especially for bowel motions
- Avoid food and drinks known to irritate the bladder
- Avoid repeated heavy lifting – at least until the muscle is stronger
Once you’ve located the muscles, get in a comfortable position and clench it for a couple of seconds, relax for 10 seconds and then repeat, building up to 10 repetitions. Try not to hold your breath, squeeze your buttocks or tighten your thighs and abdominal as this shares the load with those other muscles and reduce the effectiveness of the exercise. When you start, you may find lying down easier (with less downward pressure) and work up to doing them sitting or standing.
When you’re comfortable doing these, try fast, hard contractions to squeeze your pelvic floor muscles as hard as you can and then let go straight away. Repeat up to 10 times.
To build endurance, use the same technique as the strength exercise, but extend the ‘hold’ to 10 seconds, building up to 10 repetitions. Relax for 20 seconds between each repetition to allow the muscle to recover and avoid excessive fatigue. When you’ve comfortably mastered these, you can take it up a notch by adding abdominal resistance. Lay on your back with your feet lifted off the ground, which will activate your core muscles. Repeat the exercises above.
Endurance increases your ability to ‘hold on’ longer. Although holding on isn’t typically an issue associated with stress incontinence, but still useful for improved bladder control.
Locating the male pelvic floor
There is a persistent myth that only women have a pelvic floor muscle – but that’s not true! Men also have this sling of muscle that runs front-to-back, between the legs, connecting to the pubic bone and the coccyx (tailbone). And, just like women, it supports the organs in the pelvis as well as assisting with continence.
The first step is locating the right muscle. Imagine you’re trying not to break wind, taking care not just to squeeze your buttocks. Pay close attention to the internal muscle you’re clenching to perform this exercise – that’s your pelvic floor.
If you’re still uncertain, next time you’re at the toilet, try stopping the urine flow mid-stream. Doing this also uses your pelvic floor but shouldn’t be done regularly as stopping and starting the stream isn’t considered a ‘good bladder habit’.
Exercising the muscle
The great thing about pelvic floor exercises is that you don’t need any special equipment, clothing or even runners. You can do them standing up, sitting or lying down – while you’re watching TV, at a cafe or driving.
If you have recently had surgery, speak with your doctor before starting any exercise. They will be able to advise you on the time required for healing; otherwise, you could do some damage. Similarly, if you have an upcoming operation, discuss pelvic floor exercises with the surgeon as it may be beneficial to strengthen the muscle to reduce the risk of incontinence later.
Like most exercises, there are two aims; increase strength and increase endurance. In the case of stress incontinence, strength will improve the ability to hold on under pressure.
Living with stress incontinence
For most men, stress incontinence will be annoying but temporary. Even so, be aware that it can have a severe emotional impact, so take care. You can read more about that, in this article, Incontinence Can Take a Psychological Toll on Men
Make sure you’re adopting the good bladder habits described in the ‘Treatment’ section above.
Discuss pelvic floor exercises with your doctor and if given the all-clear, start and stick with them. Remembering to do them can be the biggest challenge. Try associating them with other regular activities throughout your day, like putting the kettle on, checking emails or at red lights when you’re out driving. You should notice an improvement within two to three weeks. If not, check back with your doctor who can refer you to a Continence Physiotherapist who’ll be able to check your technique and give you a tailored program.
While getting your pelvic floor muscle back into shape, you may find the security of an absorbent product reassuring. Many men find the idea of a ‘pad’ very disconcerting, but these days there are products specifically and anatomically designed to for males. You can read more in this article, Understanding Incontinence Pads for Men, which includes tips on the right underwear, placement, changing and disposal, as well as busting plenty of myths!
Managing male stress incontinence
All TENA products have been specifically designed to absorb the thin, fast flow of urine, keeping you dry, odour free and feeling confident.
If your stress incontinence is resulting in just a few drops or a small leak, TENA Shield may be a good option. They’re black, super-thin (only 3mm) and anatomically shaped, a bit like a protective cricket box. They’re soft, absorbent and breathable, fitting snugly and invisibly into the front of your regular briefs (not boxers).
For more protection, check out the range of TENA Guards. Like TENA Shields, they’re anatomically shaped, soft and comfortable. Available in three levels of absorbency, they quickly absorb and lock away fluid, leaving you dry and odour free.
For a more comprehensive comparison of these options, head to the article titled TENA Shield and TENA Guard – What’s the Difference?
Deciding on the right product can be challenging. If you’re still uncertain, try TENA’s Product Finder Tool where you can also order free samples.
Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.