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Management Of Stress Incontinence

management-of-stress-incontinence_300Stress incontinence occurs in men whose urinary sphincter becomes weakened, usually caused by trauma or surgery. Situations that place pressure on the bladder, such as laughter, sneezing or coughing, result in urine release. Men who have undergone radical prostatectomy sometimes experience stress incontinence, but can also benefit from therapy.

Diagnosing Stress Incontinence

The first step in diagnosing stress incontinence is a simple discussion of elimination patterns and urinary leakage. This should be followed by discussion of medical history, including past surgeries, any current illnesses or chronic conditions and medications regularly taken.

A physical examination should follow to assess the sacral region, and a rectal examination to rule out possible physical causes that affect voiding. The doctor will use ultrasound to measure the residential volume of urine and lab work and a PAD test to rule out peripheral arterial disease. The doctor may ask patients to keep a voiding diary and/or a record of foods and drinks consumed, and he may provide a short questionnaire to help patients identify patterns.

In some cases, especially when conservative therapies fail, the physician might perform further diagnostic assessment. Cystoscopy (a narrow tubular instrument is passed through the urethra to examine the interior of the urethra and the urinary bladder) and radiological studies may be performed to determine whether surgery should be considered.

Treatment Options

After this basic diagnostic evaluation, the physician will start with recommending conservative therapy; and the goal of treatment is to increase the resistance of urine outflow.

Medications for incontinence may be prescribed, or other options can be initiated. These may include pelvic floor training (which consists of contracting and relaxing the muscles that make up part of the pelvic floor — similar to Kegel exercises for men), electrostimulation or biofeedback (use of monitoring devices to display information about the operation of a bodily function that is not normally consciously controlled). This teaches a patient to control the function consciously. Even Botox injections may be given.

The injection of a bulking agent may be performed to prevent leakage. A variety of substances have been used to support the sphincter, including polydimethylsiloxane and dextranomer-hyaluronic acid copolymer.

Other therapies include herbal supplements, collagen injections (to fill out the neck and reduce pressure), paraurethral balloon compression, installing slings for support or installing an artificial sphincter. The goal is to duplicate the natural function of the sphincter and provide a variable degree of resistance.

For more information on men’s health, see prostate.net.

Sources

[1]  Börgermann, Christof, et al.; The Treatment of Stress Incontinence in Men, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908931/

[2] Dawson, Chris and Nethercliffe, Janine, Stress Incontinence in Men. In ABCs of Urology, New York: Wiley, 2012.

[3] Goode PS et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 2011 Jan 12; 305(2): 151-59

[4] Staskin DR, Comiter CV. Surgical treatment of male sphincteric urinary incontinence: the male perineal sling and [1] artificial urinary sphincter. In Wein AJ et al. Campbell-Walsh Urology. Philadelphia: Saunders Elsevier, 2007.

Filed Under: Alternative MedicineEasy Health Digest™Men’s Health

About the Author: Dr. Geo Espinosa is the Director of the Integrative Urology Center at New York University Langone Medical Center and the Chief Science Officer at Prostate Research Labs. Before joining NYU, Dr. Espinosa was a clinician, researcher and director of clinical trials at the Center for Holistic Urology at Columbia University Medical Center. He is a licensed naturopathic doctor, licensed acupuncturist, a Certified Nutrition Specialist and a Registered Herbalist. Dr. Espinosa is an author of the naturopathic entry in 1000 Cures for 200 Ailments (Harper Collins, March, 2007) and “Prostate Cancer — Nutrients that may slow its progression,” Food and Nutrients in Disease Management (Maryland: Cadmus Publishing, 2009). Dr. Espinosa also serves on the editorial board of the Natural Medicine Journal. Dr Geo is a frequent speaker at universities, medical schools and conferences on Integrative Health, nutrition and natural treatments for prostate disease. Read more on Dr. Geo.

Facebook Conversations

  • Chelsea Sawyer

    Incontinence is actually the side effect of prostate surgery or radiation therapy. Thus, men are encouraged to perform Kegel exercise as well as opt for incontinence products like those that are offered at http://www.incontinencechoice.co.uk/

  • Charles Runels

    There’s a new and safer way to achieve the same results as Coaptite. Using blood-derived growth factors to treat stress incontinence avoids the risk of granuloma formation.

    You can find out more by going to the following website: http://OShot.info/members/stress