Understanding prostate health and bladder leaks in men

Men tend to suffer from overflow incontinence, which is also known as chronic urinary retention.  This condition mainly affects older men due to an enlarged prostate.   The prostate, which plays an important role in the production of semen, is also a part of the urinary system and as men age, the prostate can enlarge, leading to the condition known as overflow incontinence or “drip incontinence." The blockage of the urethra causes urine to accumulate in the bladder, gradually stretching its wall muscles and increasing pressure, resulting in urine continuously leaking.  In some cases, it can even lead to kidney problems if the urine backs up.

In some cases, surgery is advised which can bring about bladder leakages after prostate surgery, although this tends to be a temporary issue.  The removal of the prostate during surgery can result in stress incontinence, similar to women’s stress incontinence. However, pelvic floor training can help strengthen the external sphincter muscle and improve its locking force.

Prostate surgery may be necessary due to a benign or malignant enlargement of the prostate. If the prostate must be removed surgically, parts of the urethra and its sphincter muscle are often also affected. The sphincter muscle at the outlet of the bladder is responsible for opening and closing the bladder. If the muscle is damaged, the function of the sphincter can be impaired.

However, whether the sphincter muscle is affected depends greatly on your age and certain pre-existing conditions as well as the surgical technique and the size of the prostate.

If the muscle is damaged during surgery, then stress incontinence can occur. ‘Stress’ in this case refers to the increase in pressure caused by sneezing, coughing, laughing or carrying heavy objects. This leads to an unwanted loss of urine. Stress incontinence is the most common form of urinary incontinence following prostate surgery but urge incontinence (also called overactive bladder) may also occur. Those affected report a constant urge to urinate even when the bladder is barely full.

Unfortunately, it is very difficult anatomically to not damage the urethra during prostate surgery because the prostate surrounds the upper part of the urethra and parts of the sphincter muscle. Fortunately, the outer sphincter is usually not affected and can be strengthened using targeted training. This helps to alleviate incontinence over time.  Along with prostatectomy, treatment with radiotherapy can also weaken the bladder muscles and lead to male urinary incontinence.

While the prostate in young men is about the size of a walnut, over the course of a man’s life the number of prostate cells steadily increases. The prostate grows and closes increasingly tighter around the urethra. This change has nothing to do with prostate cancer but can still affect continence. This is often associated with the following symptoms:

• Frequent urge to go to the toilet, also at night
• Problems with starting to urinate
• A weak urine stream and a feeling that the bladder is never completely emptied
• Or even unwanted loss of urine

Treatment of benign enlargement of the prostate depends on the individual symptoms and the size of the prostate. Medications are an option as is prostate surgery. Your doctor will provide you with the necessary information.

The risk factors for benign enlargement of the prostate includes:

• the use of hormones,
• hereditary factors,
• an unhealthy diet,
• smoking
• alcohol consumption 

Immediately after surgery almost every man has difficulty controlling his bladder. After about 3 months one in two men is still affected but the number drops again over the next few months. 18 months after radical prostatectomy (removal of the prostate), 4 to 21 in 100 men still report that they experience unwanted loss of urine, particularly in stress situations such as coughing, sneezing or laughing. In these cases the pressure in the abdominal cavity and thus on the bladder also increases. After 5 years about one-quarter of those affected still use incontinence pads such as MoliCare® pads or disposable pants. In about 7% of men the urinary incontinence is permanent.

Because a part of the sphincter muscle is usually retained after surgical removal of the prostate, this muscle can be specifically trained and take over from the removed muscle. The difficulty is that many people do not know exactly where this muscle is located and how it can be strengthened. It is therefore advisable, particularly at the start, to work together with a specially trained physiotherapist.

The pelvic floor is a sheet of muscle that supports the organs in the abdominal cavity with openings for the urethra and bowel. The better trained this muscle is through pelvic floor exercises, the more pressure it can withstand, particularly if stress is placed on the bladder.

MoliCare® offers men a range of innovative, leak prevention pads and pants, that have been developed especially for them. Due to men’s urine having a different exit point from the body depending on the position of the penis in the underwear, MoliCare®’s men products have been designed to shape the male anatomy and rapidly absorb liquid at the necessary point providing superior protection.