Stress Incontinence in Men: What You Need to Know

Do you leak urine when you go for a run, lift something heavy, or sneeze or cough? You're likely dealing with something called stress urinary incontinence or SUI. One of the biggest misconceptions is that SUI is a normal part of aging. It isn't. The good news is that effective treatment options exist.

Today, we've asked one of our nurse practitioners, Colleen Barry, to discuss stress incontinence in men, including treatments. (We also have an article on stress urinary incontinence in women.)

As with all content on our blog, the following is meant to be educational, not medical advice. Always consult your healthcare provider about your specific situation.

What is stress urinary incontinence (SUI) in men, and how is it different from other types of urinary incontinence?

COLLEEN BARRY: Stress urinary incontinence (SUI) is the involuntary loss of urine caused by pressure increasing in the abdomen during physical activity, such as coughing, sneezing, laughing, or exercising. SUI can occur when the pelvic floor muscles—which support the urinary tract—weaken.

According to the Mayo Clinic, stress urinary incontinence is more prevalent in women, comprising about 48% of all cases, while it accounts for only around 10% of cases in men. 

What causes stress urinary incontinence in men?

COLLEEN BARRY: SUI in men can happen after prostate removal surgery, typically to treat prostate cancer. The prostate is a walnut-shaped gland that sits at the base of the bladder. While its primary function is to provide additional fluid that nourishes semen, it also helps control urine flow and prevent bladder leakage. 

If the prostate is removed, urine flow may be affected, and leakage can occur. During prostate surgery, the urethral sphincter is sometimes damaged, which can lead to stress urinary incontinence. 

Being overweight or chronic coughing can also contribute to SUI in men since both can put added pressure on the pelvic floor.

Other rare affecting indications for SUI in males include neurologic disease or trauma.

Is stress urinary incontinence the same thing as urge incontinence (overactive bladder)?

COLLEEN BARRY: No, they are different conditions. As I mentioned, stress urinary incontinence is when a person leaks urine after activity. Urge incontinence, on the other hand, is a type of urinary incontinence that causes a sudden, strong urge to urinate, followed by involuntary urine leakage. 

Urge incontinence is associated with overactive bladder (OAB). OAB refers to urinary urgency with or without urge incontinence. SUI can be caused by urinary retention, detrusor overactivity, urinary sphincter deficiency, and urethral hypermobility. SUI can be exacerbated by pressure caused by activities like exercise, coughing, or laughing. 

Urge incontinence is much more common in men than women. According to the Mayo Clinic, approximately 80% of men with urinary incontinence experience urge incontinence, while this condition affects about 31% of women. Note: It's possible to have both SUI and urge incontinence at the same time. This is referred to as "mixed incontinence."

Because SUI and urge incontinence are different conditions, we treat them differently. While we do have medications to treat OAB, we don't currently have approved medications in the U.S. to treat SUI.

How is SUI diagnosed? Are there specific tests or evaluations that medical providers like you do?

COLLEEN BARRY: We assess the patient's symptoms, review a patient's bladder diary, thoroughly review their medical history, and perform a physical exam. Urodynamics testing can also be helpful and provide further insights.

How is stress urinary incontinence in men treated? 

COLLEEN BARRY: Effective treatment options exist, including non-invasive ones that many patients can start with. At GBU, we follow the American Urologic Association guidelines to determine a treatment plan of care using research-based evidence.

Lifestyle/behavioral modifications: 

• Keep a diary. A bladder diary can help you and your doctor understand a pattern of incontinence.
• Schedule your bathroom breaks. This is also known as "timed voiding." Basically, you're retraining your bladder. By timing when you pee and gradually increasing the time between bathroom breaks, your bladder muscle and the muscles around it will strengthen.
• Double void. Each time you go into the bathroom to pee, give yourself an additional 90 seconds after you pee and try to urinate a second time to fully empty your bladder.
• Do pelvic floor exercises. A pelvic floor physical therapist can guide you on appropriate exercises and ensure you perform them correctly. Pelvic floor PT can significantly improve both SUI and urge incontinence.
• Maintain a healthy weight, and if you smoke, stop. A healthy weight will reduce pressure on the pelvic floor. Smoking cessation is essential to your overall health, but in this case, it can also help alleviate chronic coughing that can contribute to SUI.

Non-surgical options:

• Penile clamps. These clamps restrict the flow of urine from the penis.
• Condom catheter. This is an external device that you fasten on your penis. It collects urine in a bag, which you can empty into the toilet.

Surgical options:

• Urethral sling. Your doctor might recommend this option if you have mild to moderate SUI. The Urology Care Foundation describes this well: "A soft mesh tape is placed under the urethra through a cut between the scrotum and rectum. It supports the urethra and sphincter muscle by pushing up on the urethra and causing some coaptation (closure) of the urethra to prevent leaks."
• Artificial urinary sphincter. This is an option if you have severe SUI. It's the most common treatment for male SUI. Doctors insert an inflatable cuff to aid in closing the bladder. You squeeze a pump when you need to pee, which releases the cuff and allows urine to flow.
• Intermittent catheterization. This can help overflow incontinence due to poor bladder contractility with urinary retention. 

What advice would you give to men who are hesitant to seek help for their symptoms due to embarrassment or stigma?

COLLEEN BARRY: Education is power. Management and treatment options are available for urinary incontinence, including SUI. Don't suffer alone or in silence. Make an appointment with your physician and discuss options. Your quality of life matters. Let us help.