Bladder control problems in men

The production of urine is not under our voluntary control. However, as adults, we have developed the ability to recognise when our bladder is full, and to be able to hold on to urine until we reach a toilet. This means we have control over when and where we will pass urine.

This control is possible because of messages passing between the brain and the bladder, and our ability to interpret these messages. We can learn to use this mechanism to delay passing urine.

The bladder and the urethra

Image credit: BruceBlaus Wikimedia Commons

Structures that help keep urine in the bladder are the pelvic floor muscles and the urethral sphincter.

The pelvic floor muscles help to hold all of the pelvic organs in place. When the pelvic floor muscles are strong, the urethra and bladder cannot move out of place. This helps keep the urethra closed, so urine cannot leak from the bladder.

The urethral sphincter is a band of muscles around the urethra. When these muscles are strong, they squeeze tightly and keep urine in the bladder. When you want to urinate you can relax these muscles.

Most symptoms of bladder control problems are due to the flow or storage of urine. Some men get a mixture of symptoms. Most symptoms are usually not serious but sometimes they can be due to a serious condition like prostate cancer. It’s important to see a doctor if you have any of the following symptoms – even if they are mild:

• Struggling to start peeing (called hesitancy).
• Producing a slow stream of pee.
• Taking a long time to pee.
• Wetting the bed.
• Peeing more often than usual (urinary frequency).
• After-discharge of pee.
• A feeling of incomplete bladder emptying.
• Having a sudden urge to pee (urinary urgency).
• Leakage of pee before getting to the toilet (urinary incontinence or overactive bladder).
• Leakage from coughing, sneezing, laugh or exercising (stress incontinence).

Some symptoms may not be due to bladder control. For example, as we get older we make more urine at night and this has nothing to do with your bladder.

There are some symptoms that you need to seek urgent help for, as they could be due to an infection, prostate cancer or kidney failure. These need urgent treatment.

Ageing

As you get older, your body changes. The muscles in your bladder change and can become weaker so your bladder may not be able to hold pee in. Your prostate gets bigger which can sometimes affect the flow of urine from your bladder. Also, with older age, the body tends to store fluid during the day and gets rid of it at night while lying flat. This results in extra urine production at night.

Your prostate gland

The prostate is a small gland found in men. It is about the size of a walnut and sits just below your bladder. Its job is to secrete a milky fluid that becomes part of the semen and nourishes the sperm. Because the prostate gland is located close to the bladder, it can affect the flow of urine from your bladder. This causes a condition called benign prostatic hyperplasia (BPH), also called prostate enlargement. The prostate often gets blamed for many bladder problems but it’s not always at fault.

Other causes of prostate-related urinary conditions include prostatitis, infection or prostate cancer. Read more about common prostate conditions.

Other causes include:

• medical conditions such as urinary tract or bladder infection
• surgery such as spinal surgery or prostate surgery
• bladder tumour or stone
• medications such as diuretics (water tablets)
• high amounts of alcohol and caffeine
• smoking.

A man with a prostate problem may have any one, or a combination of these symptoms:

• difficulty starting the flow of urine
• slow urine stream once urination has started
• the need to urinate more often than usual during the day (frequency)
• having to wake during the night to urinate multiple times (nocturia)
• dribbling either after urinating, or between visits to the toilet
• feeling the urgent need to urinate (urgency)
• sensation that emptying is not complete.
• having to urinate again within a short time of having just urinated.

How can prostate conditions lead to incontinence?

• Partial blockage of the urethra by the prostate:
  • As the urethra narrows, the bladder has to contract more forcefully to push urine out the urethra.
  • Overtime, the increased effort required to empty the bladder makes the bladder muscles grow stronger and more sensitive. The bladder begins to contract even when it contains only a small amount of urine, creating the need to urinate more frequently and urgently. Sometimes urine leaks before you have time to get to the toilet (urge incontinence).
  • The narrowed urethra may also prevent the bladder from emptying completely when you urinate, which can cause a build up of urine and lead to leakage between trips to the toilet (overflow incontinence). This requires medical attention.
• Nerve and muscle damage:
  • surgery for prostate problems can sometimes damage the muscles and nerves of the sphincter (the muscle that helps hold urine in the bladder) resulting in short- or long-term incontinence
  • the potential for damage depends on the extent of the surgery.

How is prostate-related incontinence treated?

If you are concerned about any prostate or urinary symptoms talk to your doctor. There are also health professionals with special expertise in bladder control problems. Make sure you take part in making decisions about the diagnosis, treatment options, outcomes, risks, complications and costs.

Bladder control problems don’t have to ruin your lifestyle. See your doctor if you have symptoms and they can find out what is causing your bladder problems and give you the help you need. This could include self-care measures, medication, exercises or referral to a specialist. A surgical fix should always be a last resort.

Don’t hesitate to seek help. Your doctor will be able to tell you more about your options.

The following adjustments to your lifestyle can improve your bladder control.

Diet

Avoid or cut down on alcohol, caffeine and fizzy drinks. They can irritate your bladder and make you need to go more urgently.

Fluid intake

• Work out how much fluid (eg, water, juice, coffee, tea, fizzy drinks) you drink each day. Usually 5–6 drinks a day in total is enough. There is no right amount to drink – often people think they should drink a lot more than they need.
• Try keeping a bladder diary(external link) or using an app to monitor how much fluid you are drinking and how often you are peeing.
• Limit your fluid intake in the evening and try to not drink anything in the 2 hours before you go to sleep. Make sure you still drink enough water earlier in the day.

Try to keep bowel movements regular

• As your bladder and bowel are next to each other, a full bowel affects bladder function.
• Many people find their bladder control problems are worse if they are constipated (finding it hard to pass poo), which can happen if you don’t empty your bowel regularly or don’t eat enough fibre. 
• Avoid straining while emptying your bowels as this can overstretch the muscles of your pelvic floor and may lead to weakness developing. 

How to pee

• Empty your bladder completely, especially at night or before going on a long journey. 
• If you have find there is a bit more urine trickling out after you have finished peeing, try shaking the end of your penis.
• Try sitting to pee or peeing twice.

Weight

Try to maintain a healthy weight, as being overweight puts extra strain on your pelvic floor muscles.  

Quit smoking

If you smoke, get support to quit smoking. Research suggests that smokers are more likely to experience urinary incontinence and urinary stress. This is due to the excessive strain that repetitive coughing puts on your pelvic floor. 

Check your medicines

• Ask your pharmacist or doctor if any of your medicines could be the cause of your symptoms or making any symptoms worse.
• Diuretic medications like frusemide, prescribed for blood pressure or heart failure, can increase frequency of needing to pee. These tablets are best taken in the morning to allow time to get rid of the extra water in the body.  
• Don’t make any changes to your medicines without speaking to your doctor first.

Incontinence pads

Try using pads inside your underwear to can soak up any leaks. You can find these in the supermarket.

Pelvic floor muscle exercises 

Doing pelvic floor muscle exercises should help improve continence problems in men. Exercises should be practiced regularly, and it may take some weeks for the benefit to be seen. Read more about pelvic floor exercises.

Bladder training

The aim of bladder training is to improve bladder control and increase the amount of urine the bladder can comfortably hold, without urgency or leakage. Learn more about bladder training.

Continence NZ(external link)(external link) Information and education on continence topics. Also, a free helpline phone 0800 650 659.