Urinary incontinence in men and women: What are the causes?

Leading consultant urological surgeon Mr Rajesh Kavia sheds light on the most common causes of urinary incontinence in both men and women, and details the most impactful lifestyle changes which can help to manage symptoms in this informative article for patients.

What are the most common causes of urinary incontinence in men?

One of the most common causes of incontinence in men is related to previous surgical intervention on the prostate gland. This could be benign prostatic disease which was treated with a procedures such as transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP) which help to make urinary flow faster. Additionally, radiotherapy or surgical treatment options, including robotic prostatectomy, used to treat prostate cancer can lead to urinary incontinence. Typically, this is stress incontinence which occurs with coughing or sneezing.

The other type of incontinence men can experience is urgency incontinence, where they feel desperate to go for a pee but can’t quite hold on. This is often results in flooding of the urine which can be quite distressing as it may lead to significantly more leakage than with stress incontinence. Small volume leakage, on the other hand, may be managed with containment devices such as pads.

Other reasons for incontinence include medical conditions such as diabetes, multiple sclerosis or Parkinson’s disease, where the signalling between the brain and the bladder is not working quite as it should. Another reason for leaking is paradoxical in that the patient is in retention and they are unable to actually empty the bladder, which leads to overflow and leakage.

Urinary incontinence is a really important condition to get on top of because it’s one of the most common factors which lead to patients moving into nursing homes. Effective treatment can therefore bring the patient a good standard of life. Additionally, patients experiencing urinary incontinence can become withdrawn and may be reluctant to take part in daily activities such as shopping and going to the cinema or to attend social events.

What are the most common causes of urinary incontinence in women?

The leading causes of incontinence in women are multifactorial, but the most common factor is childbirth which can make the pelvic floor weak. This type of incontinence is stress incontinence, which occurs when the patient coughs, sneezes or does exercise and the leaking may be small or large in volume.

The other type of incontinence often seen is women is overactive bladder or detrusor overactivity, where they experience sudden urgency and don’t have time to reach a toilet. This type of incontinence can cause complete flooding of the urination which can be related to pelvic floor weakness or other medical conditions.

In a lot of patients, incontinence can be idiopathic. I see patients from the age of ten to twelve years up to one hundred and five, many of whom live with an overactive bladder throughout their whole life but there are treatment options available to help with management.

Rarer causes of urinary incontinence include prior surgical problems or fistulation between the bladder and the vagina resulting from childbirth which can cause constant leakage. Even more rarely, anatomical anomalies where the ureter (the tube which connects the kidney to the bladder), doesn’t go into the bladder but rather goes beyond the sphincter, meaning leakages can occur.

Are there any lifestyle changes that can help in managing urinary incontinence?

When patients come to us with urinary incontinence, we will always recommend lifestyle changes as part of the management of symptoms according to the National Institute for Health and Care Excellence (NICE) guidelines. This applies for both men and for women.

Often, we ask patients about how much they are drinking because some people may be drinking three to four litres of fluids a day. Although this is fine if you don’t have urinary problems, for those experiencing issues with frequency and urgency that volume may be too much. Cutting down on fluids overall may be helpful but it’s important to stress that this means reduction in your intake of liquids, not dehydrating yourself. We would therefore always ask patients to do a frequency volume chart which measures quantities going in and coming out.

Bladder retraining can also be helpful, particularly in cases of an overactive bladder. This means trying to hold on for a little bit longer each time you feel an urge to pee, starting with maybe two minutes and working up to five, ten and eventually fifteen minutes to give you that time to get to the toilet before you are completely incontinent.

Certain drinks, such as caffeinated drinks, fizzy drinks and those with sweeteners can make a difference to some patients and therefore, cutting those out can be very helpful. This can be a bit tricky as many patients do like their morning or afternoon cup of coffee and we have become more of a coffee based society with many people frequently visiting coffee shops as part of their socialising.

Another key form of conservative treatment is pelvic floor exercises which strengthen the pelvic floor to help with the signalling between the brain and the bladder. We know from previous studies that when you get a sudden urge to pee, squeezing your pelvic floor muscle provokes something called the pro-continence reaction which causes the urge to drop away a little.

For patients with an overactive bladder, the aim of pelvic floor exercises is to reduce the urge and gradually increase the length of time between feeling the urge and needing to pass urine. For stress incontinence, the objective of pelvic floor exercises is to strengthen the muscles and this is often managed quite well by patients themselves or with the help of a physiotherapist.

You can learn more about how to perform pelvic floor exercises and when surgery is indicated in Mr Kavia's additional expert article on urinary incontinence. 

If you are concerned about urinary incontinence and wish to schedule an appointment with Mr Kavia, you can do so by visiting his Top Doctors profile.