The Guys Guide to Male Incontinence

Leaking urine isn’t a female-only problem, as millions of American men know, though they are likely not forthright in talking about it with their buddies, or their urologist.

male incontinence | Urology Associates | Denver Metro | senior father and adult son fishingI frequently see men with incontinence or bladder control problems who are not aware of the many options to stop the plumbing problems keeping them from the activities they love. Colorado is an active state, and I would like to keep men hiking, biking, fishing, playing with kids or grandkids, camping, throwing around the football or whatever activity they like best. I am here to share some options for male incontinence so you can get back to your favorite activity.

According to the Urology Care Foundation, women are about three times more likely than men to experience urinary incontinence, but about 25 percent of men have it, too. Understanding the problem and taking steps to relieve it, either on one’s own or with my urologic care, can help men overcome this bothersome obstacle that often carries emotional worries as well.

For instance, the psychological aspect can affect social life, preventing men from pursuing their normal activities. They might pass on going fishing or playing golf because they know they can’t be that far away from a bathroom for that long. Not many men want to go to a Rockies game with their friends if they know they might have to make a run (literally) for the bathroom when the bases are loaded with two outs.

Have a bladder control problem? We can help, if you’ll just make an appointment

Men can experience three general kinds of urinary incontinence.

Overflow incontinence is dribbling urine regularly. This is due to the bladder not emptying all the way when urinating.

Stress urinary incontinence (SUI) is when a cough, sneeze, lifting a heavy object or other activity causes the man to leak urine.

Overactive bladder (OAB) is the sudden, often strong urge to urinate. In this case, men can leak urine before making it to the bathroom in time.

Men may also experience OAB and SUI together. In addition, a man can have total incontinence, which means he leaks urine all the time due to failure of the sphincter muscle.

These kinds of issues can often be efficiently addressed. And most men’s urinary incontinence can be reduced significantly or cured altogether.

Interestingly, men are quicker than women to seek care once they start having bladder control problems. On average, women wait 6.5 years before seeing a healthcare provider; men wait 4.2 years. Perhaps women are much more used to hearing about or experiencing leakages, which causes them to wait longer to go to the doctor. I wish both would seek help sooner, but it is, of course, a touchy subject for anyone.

The mechanics of male incontinence

Each type of bladder control issue is caused by different factors. Bladder control problems can be short-term or long-term. Most cases of short-term male incontinence result from a specific health issue or recent treatment. For example, taking certain medications, such as those for colds, depression, sedatives, narcotics and diuretics, can cause short-term bladder control problems.

Chronic male incontinence is a long-term condition, and thus of greater concern to the man who has it and to his urologist as well. ­Chronic male incontinence issues are often related to prostate problems or treatments for them.

A lot of men I see think urinary incontinence is another of those things that always happens with age. While it is more prevalent at older ages – and more than 10 percent of men over 65 have bladder control problems – it is not a normal condition.

Let’s address why each type of chronic bladder control issue is likely to occur.

Cause of overflow incontinence. Two things can happen: you make more urine than the bladder can hold or the bladder can’t empty when it is full. Maybe the bladder muscle can’t contract as it should to squeeze the bladder, or there could be something blocking the flow. The result is urine dribbling (a constant drip) or only urinating a small amount, but having to do so frequently. An enlarged prostate gland or benign prostate hyperplasia (BPH) can cause overflow, as can a urethra that is too narrow.

Cause of SUI. This happens when the pelvic floor muscles have been stretched, causing them to weaken. That results in reduced support for the lower part of the bladder, leaving all the work of retaining urine in the bladder to the sphincter muscle. And when physical activity (or a sneeze or cough) pressures the bladder, urine leaks out. SUI is more common in women, but that does not put men in the clear. Heavy lifting can increase the chance for SUI, which is an activity many men participate in whether for their job or while working out.

Cause of OAB. The brain signals your bladder to empty, even though it may not be full, and the bladder muscles contract, squeezing out urine. This can also be caused by malfunctioning bladder muscles that contract on their own, squeezing out urine when the bladder isn’t full. These both result in a sudden, often strong need to urinate. One of the more common causes of male OAB symptoms is the prostate getting larger. This can be caused by aging or prostate cancer.

What can we do about it?

First off, go see a urologist. I’ll do a physical exam, talk to you about your symptoms and how long they’ve been going on, and run a test on your urine. If these don’t give us a solid diagnosis of the problem, we may do other tests.

How we treat male incontinence is based on what we find out as the cause, and also on how much the control problems are affecting your life. At Urology Associates, we generally like to start with what you can do on your own and go from there.

If lifestyle changes (listed below) don’t solve your problems, we may move to medications. Some cases may require surgery, but not that many do.

Deciding factors on pursuing surgery include severity of symptoms, recurring blood in the urine, recurring urinary tract infections and the need to remove blockages that may harm kidney functions. Sometimes surgery has to be done to correct ongoing incontinence after the prostate gland has been previously removed. We can perform the following surgical procedures for male incontinence.

  • Nerve stimulation for OAB. Also called neuromodulation therapy, this involves implanting a small device under the skin near the tailbone that sends electrical impulses to the nerves going to the bladder. It acts like a heart pacemaker by controlling bladder contractions. Other neuromodulation therapies may also help.
  • Sling surgery for severe urinary incontinence. A bulbourethal sling goes under the bulb part of the urethra and is secured to bone or muscle. This lifts up and compresses the urethra, helping it resist pressure from the abdomen.
  • Urethral bulking. To prevent urine leakage, we close a hole in the urethra or thicken its wall by adding material to it.
  • Adding an artificial sphincter. This is an inflatable silicone device we place around the urethra that acts like the sphincter muscle.

In persistent cases of male incontinence in which treatment options above aren’t sufficient or desired, you may need to consider wearable absorbent products. Another management option is surgical insertion of an indwelling catheter that drains urine into a holding bag.

What you can do about it

Hopefully, your bladder control issue can be taken care of primarily by your own actions. Here are things you can do.

  • To strengthen your pelvic floor muscles, do exercises like Kegels, the ones women do that are essentially tightening your muscles like you’re trying to hold back urine.
  • Maintain a healthy weight, as carrying too many pounds means more pressure on the bladder.
  • Reduce caffeine consumption because it’s a diuretic that increases urination.
  • Don’t have more than one alcoholic drink a day.
  • Also limit carbonated beverages.
  • Avoid constipation, which adds stress to the bladder, by eating a high-fiber diet.
  • Don’t smoke (you’d be surprised at all the urologic trouble smoking can cause).
  • Practice the double void: urinate as much as you can, relax, urinate again.
  • Try to modify your bladder’s behavior by scheduling bathroom trips at set times during the day.

Those tips on lifestyle can often be very effective. If they don’t work, you really should see me or another urologist – at Urology Associates, of course.

Do yourself a favor. Don’t be the average guy with male incontinence and wait 4.2 years to make an appointment. Start taking control of that bladder today.

How Smoking Affects Five Urologic Conditions

Erectile dysfunction, bladder cancer, kidney cancer, infertility and overactive bladder can all be negatively affected by smoking.

Urologic Condition impacted by smoking | Denver Urology Associates | man breaking cigarette

Many lifestyle choices can affect your risk of cancer and other urologic conditions. If you want to reduce your chances for erectile dysfunction, infertility, overactive bladder and cancer of the bladder and kidneys, smoking is at the top of the list of habits to ditch.

It is not just cigarettes that are the problem. E-cigarettes, hookas and smokeless tobacco are often underestimated as health risks but they can be just as harmful as cigarettes. You could also be at a high risk if you are exposed to second-hand smoke.

According to the Centers for Disease Control and Prevention, 15 percent of Americans over 18 currently smoke cigarettes. This is the leading cause of preventable disease and death in the United States. Smoking accounts for 1 in 5 deaths, that is more than 480,000 deaths each year.

Smoking doesn’t always lead to death. It can cause urologic conditions and other major health concerns. More than 16 million Americans are living with a smoking-related disease.

If you are a smoker, I recommend you talk to your doctor about stopping. The longer and more frequently you smoke, the more your risk for many conditions increases. I am going to focus on the urologic conditions that are affected by smoking.

Erectile dysfunction

Erectile dysfunction (ED) impacts 20-30 million American men and is caused by a range of psychological and physical factors. Among them is smoking cigarettes. This should come as no surprise since smoking can damage your blood vessels, and ED is often the result of poor blood supply to the penis.

The urologic condition of erectile dysfunction is more common as a man gets older but it can develop at any age. A 2005 study found that ED was more likely in men who smoked, and for younger men experiencing ED, smoking is very likely the cause.

Quitting smoking can often improve your vascular health and in turn your erectile health.

Bladder cancer

According to the National Cancer Institute, bladder cancer is estimated to represent nearly 5 percent of all new cancer cases in 2017 in the U.S. More than 79,000 new cases are expected in 2017, with 16,870 estimated deaths. Bladder cancer becomes more common as a person ages, and men are 3 to 4 times more likely to get it than women.

Tobacco is the most common risk factor for developing cancer. Smokers are 4 to 7 times more likely to develop bladder cancer than nonsmokers. Fifty to sixty-five percent of bladder cancers are attributable to smoking in men, and 20-30 percent in women.

Why? Smoking causes harmful chemicals and drugs to collect in the urine. These chemicals affect the lining of the bladder and raise the risk of bladder cancer.

Kidney cancer

Smoking affects the kidneys because tobacco makes its way into the bloodstream, which is then filtered by the kidneys.

In 2017 nearly 64,000 U.S. adults will likely be diagnosed with kidney cancer. The main risk factors for kidney cancer are being a male, age, obesity, genetic factors and smoking. A review of the United Kingdom kidney cancer cases found that an estimated 29 percent of cases in men and 15 percent of cases in women were caused by or associated with smoking. That data also showed that the risk is greater in those who have been smoking longer and more frequently.

Overactive Bladder

Overactive bladder (OAB) affects an estimated 33 million Americans. OAB includes urinary urgency, frequent urination, leaking of urine and the need to wake up from sleep to urinate. Urge incontinence in specific is 3 times more common in women who smoke cigarettes compared with those who have never smoked.

One cause of OAB is smoking. Smoking bothers the bladder, which can cause frequent urination. Smoking also causes chronic coughing in many patients, which can lead to urine leakage due to the muscles in the bladder weakening.

Infertility

Smoking has always been strongly discouraged during pregnancy, but many people do now know that it can also have detrimental effects on the ability to conceive a child. This is because smoking can harm the genetic makeup of eggs and sperm, reduce hormone production, and affect the environment of the uterus, leading to infertility. The infertility rate for smokers is twice as high as for those who don’t smoke.

Studies have found that success from in vitro fertilization is diminished if either partner is a smoker. The chance of a miscarriage is also higher, as well as for birth defects in your child.

The good news is that the effects of smoking on infertility can be reversed within a year of quitting. Some studies even show that two months after stopping smoking your chances of conception can be higher.

Poor healing after surgery for urologic conditions

If you are a smoker about to have surgery, you should be aware of some extra concerns. The chemicals in cigarette smoke can increase the chance that your bones or tissue may not heal well. They also bring an increased chance of infection and pain after surgery.

Smokers have anywhere from 2 to 10 times the risk for their bones or wounds not healing after surgery. They also often take longer to heal than nonsmokers.

Smoking affects how our bodies heal by changing the way we handle oxygen, restricting blood vessels. This makes it difficult for hemoglobin and oxygen to get to the tissue where they are needed. It also makes your blood thicker, impeding its flow through narrowed blood vessels.

Make a plan to quit smoking

If you are interested in quitting smoking and using tobacco, give yourself the best chance of success by talking to your doctor openly and honestly. Being truthful about your use will help your doctor find the best treatment for you to quit, whether that’s behavior and/or medical therapy.

Another great resource is the Colorado QuitLine. They offer a free program to Colorado residents over the age of 15, providing special tools, research-based information, a support team, and a community of others trying to become tobacco free.

Quitting smoking even after you have been diagnosed with a disease that may have been caused by the tobacco can improve your health. Regardless of your age, you can substantially reduce the risk of urologic conditions and disease, including cancer, by quitting.

Stopping the use of tobacco can have many mental and physical benefits including:

  • Better quality of life
  • Longer life
  • Easier breathing
  • More energy.

It is the job of my fellow physicians and myself to help our patients follow a healthy lifestyle that includes ending their dependence on tobacco and nicotine.

Vasectomy Myths Debunked

A vasectomy is the most reliable form of permanent birth control, so why aren’t more men having them done?

Vasectomy Myths | Denver Urology

One of the most common procedures we conduct at Urology Associates is a vasectomy. A vasectomy is a form of permanent male birth control by permanent sterilization that prevents the release of sperm to mix with semen when a man ejaculates.

Compared with the female sterilization process of having the fallopian tubes “tied,” vasectomies are much more reliable, faster and safer. So why do only 9 percent of sexually active men in the United States get vasectomies, while 27 percent of women get tubal ligations?

Well, there’s a lot of fear involved when men think about vasectomy, because they’ve been buying into myths about the V word.

In an attempt to debunk the various myths surrounding vasectomies and get all the facts out in the open, I’ve compiled a list of typical misunderstandings that patients have regarding vasectomies.

A vasectomy murders your sex drive

No way. A vasectomy will not affect your sexual desire, sex drive or your ability to have erections and ejaculate. Everything, including your orgasms, should remain unchanged. Although it’s important to wait until you feel recovered enough to have sex following the procedure. Some men experience mild aching in their testicles when they are sexually aroused, however most of the enjoyable aspects of intercourse won’t be altered.

A vasectomy hurts like the Dickens

I get it, it’s a sensitive area and you are likely anxious about a surgery around this part of your body. While every patient is unique and some discomfort is always possible with any surgery, a vasectomy generally is not painful. Some patients may experience a slight tugging or pulling while the doctor locates the vas deferens during the procedure, as well as a dull ache and mild pain in the scrotum and groin as the anesthesia wears off. In order to reduce pain and swelling you can take over-the-counter anti-inflammatory medication or apply a bag of ice or frozen vegetables to the affected area. If pain lasts for longer than a week and the symptoms aren’t getting any better, it is important to let your physician know.

I’m going to have a long, painful recovery

Not really. Many patients are pleasantly surprised with how quickly they are able to get back in action. Patients usually recover from a vasectomy in about a week. I recommend they wait a few days before having sex or jumping back into strenuous activity.

One of the most important parts of recovery from a vasectomy is rest. Many men, after my own heart, schedule their procedure during March Madness. It’s a great opportunity to grab a bag of frozen peas and post up on the couch for a couple of days while your body recovers.

A vasectomy procedure takes a good while and feels weird

Weird? Maybe the idea can make you feel weird, but the procedure is very quick, lasting about 20-30 minutes from start to finish. Here’s what to expect:

  • A local anesthetic to numb the scrotum.
  • A small puncture with needle is made on each side of the scrotum.
  • The doctor finds, cuts and seals the vas deferens, the small tubes sperm travel in to mix with semen.
  • The cut tubes are returned to the scrotum and closed with a few small stitches.

Patients who are considering having a vasectomy should be sure about not wanting to have any more children in the future. By blocking the vas deferens during the procedure, the sperm’s pathway is blocked, it can’t combine with the semen that is ejaculated during sexual climax. Without sperm a woman’s egg cannot become fertilized in order to result in a pregnancy.

Vasectomies fail and men end up getting women pregnant

Here’s where old data might be tripping you up. Over the years, urologists have greatly improved vasectomy success rates. Today, if done properly by a well trained and experienced surgeon, failure rates for vasectomies are around 0 percent. It’s considered the most effective form of birth control.

But, just because you’ve had a vasectomy doesn’t mean that it’s immediately effective. It usually takes 10 to 20 ejaculations to clear sperm completely from the semen. Only 1 to 2 women out of 1,000 will have an unplanned pregnancy in the first year after their partners have had a vasectomy – and that’s typically due to failure to wait until sperm has completely cleared from the semen before having intercourse without birth control. After a vasectomy, sperm produced is absorbed into the body.

It’s a good idea to check back in with your doctor for a sperm count before forgoing other birth control methods. Very rarely, the vas deferens will spontaneously reconnect on their own allowing the sperm to mix with semen.

Having a vasectomy will make my semen look funny

For the most part, your ejaculatory fluid will look exactly the same as it did prior to the vasectomy procedure, because less than 3 percent of the volume of ejaculate is made up of sperm. Because the tubes are blocked before the seminal vesicles and the prostate, you will still ejaculate the same amount of fluid, just without the sperm.

If I change my mind and want children, I’m out of luck

Actually, the “permanent” in permanent sterilization can be reversed by reconnecting the vas deferens in vasectomy reversal. But it’s a difficult procedure.

During a vasectomy reversal, the surgeon will make a small incision on either side of the scrotum and check the vas deferens fluid for sperm. If sperm is present, the physician will reconnect the ends of the vas deferens to the epididymis, thereby allowing sperm to pass through again. If there is no sperm, the surgeon will need to perform a more difficult procedure to bypass the blockage in the epididymis to reconnect the vas deferens.

A vasectomy reversal’s efficacy varies depending on how long it’s been since the initial sterilization, how it was done and the patient’s overall health condition. Another consideration is that a vasectomy reversal is a very delicate process that requires an experienced surgeon. The procedure can take, on average, 4 to 5 hours. About 10,000-30,000 men reverse their vasectomies annually.