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Treatment of urinary incontinence in men

 Treatment of urinary incontinence in men



Urinary incontinence indicates an involuntary escape of urine or loss of bladder control. In the majority of patients, problems can be stopped or alleviated by simple changes in life activities as well as targeted medical treatment.

Treatment of urinary incontinence in men

What is Urinary Incontinence?

Understanding your own body and functions

Types of urinary incontinence

What are the symptoms and complications of urinary incontinence?

Diagnosis of incontinence

Behavioral strategies as a first step in the treatment of male incontinence

Drug treatment

Exercises and other therapeutic methods

Surgery as an approach to the treatment of urinary incontinence

Conclusion

What is Urinary Incontinence?

Urinary incontinence occurs more often in older men than at a younger age, although incontinence is not just a normal part of aging.

Urinary incontinence is a common condition that can vary in severity from mild disturbances with only occasional escape of urine or only a stronger urge to urinate, to severe disturbances with loss of bladder control and complete leakage of urine. Despite the wide range of problems, urinary incontinence has a significant impact on the quality of life of affected patients.

 

Urinary incontinence in men is a specific condition with multiple causes and subtypes. It occurs more often in older men than at a younger age, although incontinence is not just a normal part of aging. If incontinence problems that limit daily functioning are present, a specialist urologist should be consulted for a more thorough examination and suggesting how to stop or at least alleviate this problem.

 

Understanding your own body and functions

The bladder is an organ located in a pelvis that stores urine, ie. urine produced in the kidneys. Urine from the bladder when urinating goes via the urinary tube. In urination, the nerve signals the muscles in the bladder wall to tighten. This activity drives the urine from the bladder into the urethra, which at the same time relaxes, ie. relaxing. The whole process allows the urine to be eliminated from the body freely.

 

In urinary incontinence, the bladder does not retain or release urine sufficiently successfully. This means that there may be an accidental involuntary drainage of urine. The same can happen because:

 

the bladder does not receive the correct nerve signals and is constricted at the wrong time or tightened too much;

the muscles around the urethra (urinary sphincter) do not function properly;

there is a blockage of the urethra, so urine can accumulate excessly in the bladder and cause leakage.

Types of urinary incontinence

Urinary incontinence in men is often associated with prostate disease.

There are a number of types of urinary incontinence. In all forms, involuntary escape of urine is present as a symptom, but different subtypes arise for different reasons:

 

Stress incontinence occurs when external pressure causes involuntary leakage of urine from a weakened bladder; such increased external pressure is caused, for example, by coughing or lifting of loads.

Urgent incontinence occurs when the patient receives an extremely strong and sudden urge to urinate, which causes the urine to escape before reaching the toilet; in these cases, bladder contractions are possible without when the patient desires, causing involuntary leakage of urine.

Overflow incontinence in men occurs when there is a blockage of bladder output (such as an enlarged prostate) that prevents complete bladder emptying; in these cases, the bladder overflows and leaks excess urine.

Functional incontinence is a rare form that occurs when the patient does not reach the toilet to urinate, for example because of immobility.

Total incontinence indicates a continuous leakage of urine due to a dysfunctional urinary sphincter.

Mixed incontinence indicates the joint occurrence of several types of incontinence described above.

 

Urinary incontinence in men is often associated with prostate disease. Incontinence can also occur as a result of medical interventions, such as medication side effects (diuretics, antidepressants, sedatives, opioid medications) or as a result of surgery in the pelvis (on the prostate gut). Alcohol can exacerbate the incontinence problems, and obesity is also a predisposing factor. Incontinence may also be associated with other diseases such as urinary infection, diabetes, multiple sclerosis, Parkinson's disease or Alzheimer's disease.

 

What are the symptoms and complications of urinary incontinence?

Stress incontinence is seen as leakage of urine when coughing, sneezing, laughing, changing position or lifting weights. In urgent incontinence, men report urgency, ie. a sudden and intense urge to urinate, which leaves very little time to reach the toilet in time. Men can also complain about the frequency of urination, when it is necessary to empty the bladder much more often than normal. With overflow incontinence, there is a constant urge, but with urination of small amounts of urine, and constant overflow and leakage of urine.

 

Chronic urinary incontinence can lead to irritating skin changes in places that are constantly exposed to urine. Skin rashes and infections may also require dermatological treatment. Incontinence also carries an increased risk of developing urinary infections. Incontinence also affects social and professional activities, and thus creates great difficulty in everyday life activities.

 

Diagnosis of incontinence

It is very important to determine the type of incontinence, since the treatment is very specific for different forms.

It is very important to determine the type of incontinence, since the treatment is very specific for different forms. Diagnosis begins with a conversation with the patient about symptoms and prior health, and a physical examination. Laboratory tests are required, which include urine analysis to eliminate the possibility of infection or other urinary abnormalities. The ultrasound examination assesses the appearance of the urinary tract and includes the determination of the amount of residual urine in the bladder behind urination.

 

Diagnosis also includes a urinary diary, with the patient keeping a record of the amount and time of fluid intake, as well as urination, and urine episodes that occur over several days. If necessary, the urologist may also require urodynamic testing, ie. a more detailed assessment of the behavior of the bladder when filling and emptying.

 

Behavioral strategies as a first step in the treatment of male incontinence

Changing lifestyle habits (fluid intake, diet change, smoking cessation and maintaining normal weight) are the first steps in treatment.

Treatment depends on the type of incontinence. Treatment may include lifestyle changes, simple exercises, drug treatment, surgical treatment, or a combination of the above methods.

 

Behavioral strategies are the first recommendation for all forms of incontinence. This involves changing certain lifestyle habits, such as reducing fluid intake. Coffee and alcohol, carbonated beverages, as well as acidified foods are bladder irritants and should therefore be avoided. Fiber foods should be included in the diet to encourage a regular stool. Furthermore, it is advised to exercise and maintain a normal body weight, as well as to stop smoking.

 

There are additional helpful procedures, such as introducing a urination schedule, which indicates urinating every 2 to 4 hours instead of waiting for the urge to urinate. Bladder training is also recommended, a process of delaying urination for about ten minutes when the urge to urinate occurs. Double urination is a procedure that involves urination and then forced urination after a few minutes, all with the aim of completely emptying the bladder.

 

Drug treatment

The pharmacotherapeutic approach in the treatment of urinary incontinence in men involves the use of anticholinergics, mirabegron and alpha blockers. Anticholinergics (darifenacin, solifenacin, tolterodine) are medicines that calm down excessive bladder activity and thus escape of urine. A similar effect is achieved by the mirabegron, which relaxes the bladder and consequently increases the amount of urine it can store.

 

Alpha blockers (tamsulosin, alfuzosin, doxazosin) relax the bladder neck and prostate, which facilitates bladder emptying - especially in patients with pronounced urinary incidence and overflow incontinence. In case of signs of urinary tract infection with incontinence disorders, antimicrobials will be prescribed. antibiotics.

 

Exercises and other therapeutic methods

Kegel exercises are especially effective in stress incontinence, but can contribute to the treatment of other forms of urinary incontinence.

Pelvic floor muscle exercises or Kegel exercises are recommended for patients to strengthen the muscles that help control urination. These exercises are especially effective for stress incontinence, but can also contribute to the treatment of other forms of incontinence. The exercises are performed in such a way as to try to simulate the stopping of the flow of urine by squeezing the muscles. Such a grip should be maintained for about five seconds, then relaxed for five seconds. The same action must be repeated in at least three batches ten times each day, and over time the duration of the squeeze may increase.

 

Continental products (such as pads or diapers) can be used as an aid in the treatment of continence, primarily to facilitate daily life functioning. Botulinum toxin (also known as Botox) can be used in patients who have an overactive bladder and when there is no response to medication - in these cases Botox is injected into the bladder wall.

 

Electrostimulation is the process of treating incontinence by using gentle electricity through an electrode that strengthens the functions of the pelvic floor muscles or stimulates the nerves responsible for controlling urination. It is usually performed in batches of multiple treatments, primarily with stress and urgent incontinence.

 

Surgery as an approach to the treatment of urinary incontinence

Surgical treatment is only possible in certain conditions when it comes to urinary incontinence in men. For example, in an enlarged prostate that causes overflow incontinence, it is possible to remove the prostate tissue in order to eliminate the blockage of the passage of urine from the bladder into the urethra. In incontinence disorders that occur after surgery for prostate cancer, surgery techniques for urinary tube suspension are possible.

 

There is also one surgical option called artificial sphincter, in which a small ring is placed around the urethra. When the ring is inflated it keeps the urine in the bladder. On the other hand, when the ring is released, by pressing a small valvus placed under the skin, the urine is then released urgently from the bladder.

 

Conclusion

Unlike women, urinary incontinence in men is not a fully explored area, and the cause of this problem should always be taken into account. After an adequate diagnosis, the patient is advised to start conservative therapy, then try medication, and in the event of failure with the patient, a possible surgical approach should be discussed.


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