About 25 million Americans have urinary incontinence. It's estimated that three-fourths are women, but that leaves more than five million men with bladder problems.
Men can have incontinence due to an enlarged prostate or prostate surgery, but other causes may play a role too.
Still, men are often uninformed about the issues, and they may face challenges -- physically, socially and emotionally -- when dealing with the diagnosis.
Here's what you should know about male incontinence.
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It's more than post-void drips.
Most men have mild post-void drips, hence the oft-quoted, "No matter how much you shake and dance, the last two drops get on your pants."
But frequent, excess leakage after urination is not normal, says William Steers, M.D., chair of the urology department and Paul Mellon professor at the University of Virginia School of Medicine, in Charlottesville.
If it makes you uncomfortable, shows through your clothes or causes skin irritation, it's a form of incontinence -- and it could be a symptom of a more serious problem.
It's not uncommon.
Between 2 percent and 15 percent of men ages 15 to 64, and 5 percent to 15 percent of men over 60 who live at home (as opposed to a nursing home), have incontinence, according to the National Association for Continence (NAFC).
Prostate removal for cancer treatment is one of the most common causes. "Most patients who come to see me about stress urinary incontinence are men who've had surgery for prostate cancer, nine out of 10," says Dr. Steers. (In stress incontinence, coughing and sneezing can trigger leakage.)
If patients have stress incontinence and have not had prostate surgery, another condition -- such as a neurological disorder, spinal injury or diabetes -- may be to blame, says Dr. Steers.
Extra weight can be a cause.
As you age, the muscles that control bladder function start to lose strength, and weight gain can put extra pressure on the bladder.
Although obesity seems to affect women more than men when it comes to bladder control, Dr. Steers says he's increasingly seeing the connection in his male patients.
Cigarette smoking, heavy drinking and diabetes also increase a man's risk of bladder problems.
Prostate trouble is often to blame.
Most men experience prostate enlargement with age. It can block the urethra and cause overflow incontinence, which is the leakage of a small amount of urine, or difficulty urinating.
Prostate removal due to cancer can also damage or weaken the pelvic floor muscles and nerves around the bladder, and it may cause significant leakage issues for about half of men just after surgery. One in five still has problems a year or more later.
This is one reason doctors often suggest "watchful waiting" for slow-growing prostate cancers, says Dr. Steers. Delaying the surgery can also help you avoid erectile dysfunction.
Parkinson's disease and stroke can play a role.
In some men, incontinence problems can be caused by nerve damage from diabetes, a stroke, Parkinson's disease (which mostly affects men), or multiple sclerosis (which mostly affects women).
In addition, men are more likely to be involved in car or motorcycle accidents, workplace injuries or active-duty combat, which puts them at higher risk for spinal cord injuries that can trigger incontinence, says Nancy Muller, Ph.D., executive director of the NAFC.
Male-geared products may help.
"Fortunately, the manufactures of adult absorbent products have recognized, finally, that the male anatomy is different from female," says Muller. "Only recently have major incontinence brands come out with gender-specific adult products."
Men can find absorbent or disposable underwear, ranging from briefs to boxers, as well as compression pouches that support the urethra, in most pharmacies.
For severe incontinence episodes, consider an external collection unit, which fits like a sheath over the penis and contains a collection bag (that fits inside a pair of briefs).
Surgical options exist
Men with severe stress incontinence can consider surgery if other therapies fail.
Doctors can implant an artificial rubber sphincter around the urethra. The sphincter is inflated and deflated to control urine flow. Another procedure, called the bulbourethral sling (or male sling), supports the urethra with a mesh hammock.
Urge incontinence can be treated with sacral nerve stimulation, a pacemaker-like electrical stimulator that is implanted under the skin and sends signals to the sacral nerve to control bladder activity. Doctors may also recommend prostate surgery for cases of overflow incontinence caused by an enlarged prostate.
There are medications for men.
Medications for male incontinence often target the underlying cause. For example, drugs can be used to shrink an enlarged prostate or reduce symptoms of neurological disorders.
If you experience urge incontinence, also known as overactive bladder, your doctor may prescribe anticholinergic or antispasmodic medications to calm the muscles in your bladder. Certain types of antidepressants are also sometimes effective for bladder problems.
Fluid intake matters.
Watching your fluid intake could help you improve incontinence symptoms, even without medication or surgery.
"Sometimes we find that men are drinking full six-packs of beer, and if your resistance is already low, then that's going to cause a problem," says Dr. Steers. "If you make more urine, you stress the system."
Limiting alcohol in general, as well as caffeine and carbonated beverages, can help. Staying hydrated and drinking water when you're thirsty is always healthy, says Dr. Steers, but there's no need to aim for a certain number of glasses a day.
Some medications make it worse.
Some common medicines, such as diuretics, antihistamines and antidepressants, can cause urinary leakage, so your doctor may also look at drugs you're already taking.
Skin problems shouldn't be ignored.
Chronic leakage and post-void "after-dribble" tends to cause more skin irritation in men than in women, says Muller. "They have more problems with rashes and skin fungus, and often don't give enough attention to the perineal area around the scrotum."
Moisturizers and barrier creams can keep skin from becoming too dry and inflamed. Men who use absorbent pads or products should change them every few hours to prevent infection.
Men can do Kegels too.
Kegel or pelvic floor exercises, in which you squeeze and hold the muscles you'd use to stop urination, aren't just for women.
A small 2010 Italian study suggests that men who do them for one month before prostate removal surgery have less incontinence after.
The NAFC recommends a set of 10 slow and 10 fast contractions, two or three times a day, gradually working up to about 80 repetitions a day.
"It's just like bench presses at the gym," she says. "Doing too much too soon can actually damage the muscles, so you can't rush into it."
Men have issues some women don't.
Men can face unique physical and emotional challenges with incontinence. "For starters, women are used to wearing pads several days of the month," says Dr. Steers, "whereas a man is not socially attuned to wearing anything down there. Just the idea can be really embarrassing to them."
It may also be hard to avoid situations where leakage is common, he adds.
More men than women might have jobs that entail heavy lifting, for example, or friends might expect participation in sports like golf and tennis, which can put pressure on the bladder.
There are online resources for men
Only 18 percent of men versus 33 percent of women talk to their doctor about their symptoms, according to an NAFC survey of people with bladder problems.
Plus, more online resources are aimed at women. (Men can, however, refer to the What Every Man Should Know section of the NAFC's site.)
Men who've had prostate surgery may benefit from a prostate cancer support group, which can help address a range of emotional and physical and issues. Local support groups can be found at ustoo.org.
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