Stress incontinence in men causes leakage on exertion, coughing, sneezing, or lifting. It is most common after prostate surgery, but it happens in men with no surgical history too. If this is you, you are not unusual, and there is plenty you can do about it.
Stress urinary incontinence (SUI) is leakage caused by a sudden rise in intra-abdominal pressure. It happens during coughing, sneezing, laughing, lifting, jumping, or any physical effort that spikes the pressure inside your abdomen and overwhelms the sphincter. There is no urge involved and no warning. The leak happens at the moment of the pressure event, and stops when the pressure settles.
The Mechanism
Urine stays in the bladder because the pressure at the urethral sphincter is higher than the pressure inside the bladder. Physical exertion pushes up the intra-abdominal pressure, and that gets passed on to the bladder. If the sphincter cannot match it with enough counter-pressure, the urethral closure pressure is overcome and you leak.
In men, the sphincter mechanism involves the internal sphincter at the bladder neck and the external sphincter controlled by the pelvic floor. When one or both are damaged or weakened, stress leakage is the result.
Causes in Men
- Radical prostatectomy: removing the prostate also removes the internal sphincter, so the external sphincter has to do the job alone.
- Other pelvic surgery: bowel resection, bladder surgery, or TURP (transurethral resection of the prostate) can all affect sphincter function.
- Pelvic floor weakness without any surgical history: carrying extra weight, a sedentary lifestyle, chronic straining at stool, and age-related muscle decline all reduce the pelvic floor's ability to hold closure under load.
- Neurological conditions: spinal cord injury, multiple sclerosis, and diabetic neuropathy can all affect the sphincter mechanism.
Treatment: PFMT as First Line
NICE CG97 recommends pelvic floor muscle training as the first-line treatment for stress urinary incontinence in men. For post-prostatectomy SUI, doing PFMT before surgery has been shown to improve how quickly continence recovers afterwards. Men awaiting prostate surgery who have had pre-operative PFMT instruction recover faster.
PFMT for SUI is about strengthening the external sphincter and pelvic floor to improve closure pressure. The technique is the same as for other pelvic floor work: squeeze and lift, hold for up to ten seconds, relax fully, repeat. The aim is to generate enough counter-pressure to match the spike from exertion.
Lifestyle Factors
- Weight: losing weight lowers intra-abdominal pressure, which directly reduces the load on the sphincter.
- Smoking: a chronic smoker's cough spikes intra-abdominal pressure again and again. Stopping smoking cuts that down.
- Constipation: straining at stool is the same bear-down pressure spike, over and over, so managing constipation cuts the number of those events.
Products and Surgical Options
For mild to moderate SUI, a male guard or pouch-style product sized to your current episode volume will handle the leakage comfortably. For severe or persistent SUI where conservative management has not worked, surgical options include the male urethral sling and the artificial urinary sphincter (AUS). Both are specialist procedures, and referral is via your GP to urology.