Incontinence in Men

In childhood, girls usually develop bladder control at an earlier age than boys, and bedwetting is more common in boys. However, adult women are far more likely to experience urinary incontinence because of the anatomy of their urinary tract and the stresses caused by pregnancy and childbirth.

Nevertheless, men may experience urinary incontinence as a result of prostate problems, and both men and women can experience nerve damage that leads to urinary incontinence. Its prevalence increases with age, but it is not an inevitable part of aging.

Male incontinence is a medical problem. To find a treatment that addresses the root of the problem, you need to talk to your healthcare provider.

The body stores urine in the bladder. During urination, muscles in the bladder contract or tighten. This forces urine out of the bladder and into a tube called the urethra that carries urine out of the body. At the same time, muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move.

Male incontinence occurs if the bladder muscles contract or the muscles surrounding the urethra relax without warning.

The 4 types of incontinence in men are:

• Stress incontinence, caused by weak pelvic and sphincter muscles
• Urge incontinence (Overactive bladder), caused by damaged or irritable nerves, in which the bladder squeezes at the wrong time
• Overflow incontinence, that results when an individual is unable to empty the bladder
• Temporary or Reversible incontinence, related to conditions, like: Urinary tract infection, Constipation, Delirium.

Cause of Incontinence
Nerve ProblemsAny disease, condition, or injury that damages nerves can lead to urination problems. Nerve problems can occur at any age.

• Chronic diabetes may develop nerve damage that affects bladder control
• Stroke, Parkinson's disease, and multiple sclerosis affect the brain and nervous system-can lead to bladder emptying problems
• A person with overactive bladder may have any two or all three of the following symptoms: urinary frequency, urinary urgency & urge incontinence
• Spinal cord injury may affect bladder emptying by interrupting the nerve signals required for bladder control

Prostate ProblemsThe prostate is a male gland about the size and shape of a walnut. It surrounds the urethra below the bladder.

• Benign Prostate Hypertrophy: The prostate gland commonly becomes enlarged as a man ages. As it enlarges, it can squeeze the urethra and affect the flow of urine. The commonest symptoms are-hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence.
• Prostate removal: Is one treatment for prostate cancer. In some cases, the surgery may lead to erection problems and Urinary Incontinence.
• Radiation: This procedure is another treatment method for prostate cancer. Treatment can result in either temporary or permanent bladder problems.

For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder, and then release it at the right time.

Today, many treatment options are available. Choice of treatment depends on:

• The type of incontinence
• The seriousness
• Which is the best option for you

Different treatment options for male incontinence include:

• Bladder training
• Lifestyle changes, such as losing weight or cutting out certain foods
• Medications
• Surgery

As a general rule, the simplest and safest treatments should be tried first.

Conservative Methods

Behavioral Treatments

For some men, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom. As you gain control, you can extend the time between trips.

Kegel exercises

Bladder training also includes Kegel exercises to strengthen the pelvic muscles, which help hold urine in the bladder. Many clinicians find them to be an important element in therapy for men.

No single treatment works for everyone. Treatment depends on type and severity of problem, lifestyle, and your preferences, starting with the simpler treatment options. Many men regain urinary control by changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. If these behavioral treatments do not work, you may choose to try medicines or a continence device. For some men, surgery is the best choice.

If  you have or have been treated for urinary incontinence, we would like to know how conservative methods have helped live an active lifestyle.

Incontinence in Women

Urinary incontinence is the accidental leakage of urine.

Life's events can weaken the pelvic muscles. Things such as pregnancy, childbirth, and being overweight can do it. One in three women who have ever had a baby wet themselves.

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Your hip bones are part of the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvis bone.

Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. These muscles prevent the leaking of urine and stool. Bladder control exercises strengthen the muscles that hold the bladder and many other organs in place.

Finding the Right Muscles

This is very important!

For bladder control exercises, you should tighten the two major muscles that stretch across your pelvic floor. They are the "hammock" muscle, and the "triangle" muscle. Here are three methods to check for the correct muscles:

• Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles.
• Imagine that you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, those are the right muscles for pelvic exercises. 
• Lie down and put your finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Pelvic Floor Muscle (Kegel) Exercises are designed to strengthen the muscles of the pelvic floor that support the bladder and close the sphincters. The general approach for practicing incontinence exercises is as follows:

Begin with empty bladder.

Start with gravity assisted positioning-Hips higher than the heart

Supported Bridge

Elbows/knees Position

CONTRACT-RELAX TECHNIQUE: Tighten the pelvic floor muscles as if attempting to stop urine flow or hold back gas. Hold for 3 to 5 seconds and relax for same length of time. Repeat 10 times. Breathe normally.

QUICK CONTRACTIONS:Repeat contractions of pelvic floor muscles while maintaining a normal breathing rate and keeping accessory muscles relaxed. Try 15 to 20 repetitions per set with coughing and sneezing.

ELEVATOR EXERCISES: Imagine riding in an elevator. As the elevator goes up from one floor to next,contracts the pelvic floor muscles a little more. As strength and awareness improves, add more floors to the sequence of the contraction. Relax the muscles as if descending one floor at a time.

Remember!!

• Performing Kegels with a full bladder can cause urinary tract infections & can further weaken the pelvic floor muscles.
• Don't squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscle.
• Breathe normally.

You can exercise while lying on the floor, sitting at a desk, or standing in the kitchen. Using all three positions makes the muscles strongest. As working against gravity is like adding more weight.

How to Protect the Pelvic Muscles

You can protect your pelvic muscles from more damage by bracing yourself.

Think ahead, just before sneezing, lifting, or jumping. Sudden pressure from such actions can hurt those pelvic muscles. Squeeze your pelvic muscles tightly and hold on until after you sneeze, lift, or jump.

After you train yourself to tighten the pelvic muscles for these moments, you will most likely have fewer accidents.

Be patient. Don't give up. It's just 5 minutes, three times a day. You may not feel your bladder control improve until after 3 to 6 weeks. Still, most women who do bladder control exercises notice an improvement after a few weeks.

Urinary Incontinence should not cause embarrassment. It is a medical problem, like arthritis and diabetes. There is a solution!


Looking for an Evidence? Here it is:
http://www.ahrq.gov/news/press/pr2012/muscleuipr.htm