The Emotional Toll of Urinary Incontinence in Men

From the WebMD Archives

Nearly one out of every five men over the age of 60 is having to deal with male urinary incontinence. That's a lot of people. But as common as male incontinence is, odds are good that you've never met a single guy who fessed up to having it. It's not exactly a topic men are anxious to discuss in the locker room or over drinks after work.

"For many men," says Tomas L. Griebling, MD, "incontinence is so embarrassing they won't discuss it with anybody." Griebling is vice chair of the department of urology at the University of Kansas in Kansas City.

But why is it so embarrassing? It's because there's more to male incontinence than just the symptom. It's a condition that can affect how you see yourself. "Adult diapers" used to be a punch line or a gag gift; now it refers to the product in a drugstore isle that you're trying to choose. Urinary incontinence can make a self-assured guy feel like a humiliated, bed-wetting kid. It can make a healthy, active adult suddenly feel like an invalid. Male incontinence can have a corrosive effect on your state of mind.

But life doesn't have to be so bleak. If you're dealing with male incontinence -- with leaking and the constant worry about leaking -- here's some very good news. You can get help.

"The bottom line is that incontinence isn't something you have to live with," says Edward James Wright, MD, assistant professor of urology at Johns Hopkins Medical School in Baltimore. "It isn't a normal consequence of life. It's a problem, but a fixable problem." If your symptoms are stressing you out and taking a toll on your life, here's what you need to know:

The Impact of Male Incontinence

A lot of different things can cause male incontinence. It's often a side effect after surgery for prostate cancer or, less often, an enlarged prostate (BPH). It can be a symptom or a result of many different health conditions, for example diabetes, strokes, or MS. Sometimes it can develop for less clear reasons, such as an "overactive bladder."

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Some guys deal with male incontinence pretty well. "I see some men who just pile on as many pads as they need, and it doesn't seem to slow them down," says Wright. But for many others -- because of different symptoms, experiences, and temperaments -- urinary incontinence can be debilitating.

"Some men with incontinence live in a state of constant anxiety," says Anthony R. Stone, MB, ChB. Stone is vice chair of urology at UC Davis Medical School in Sacramento. "They're thinking all day long, 'Is it going to leak through my pad?' That anxiety can have a huge, spiraling effect on their lives." Even the most mundane activities -- a meeting, a trip to the grocery store -- can become sources of enormous stress.

"If you peer into the lives of some men with incontinence," Wright tells WebMD "they would meet all the criteria for depression." They lose interest in things they used to enjoy and start secluding themselves, he says. Their jobs are affected and their sex lives fall apart. "But they're too embarrassed to talk about it," Wright adds, "so they wind up living in their own private hell."

So how specifically does male incontinence affect a man's life?

  • Work. Obviously, any guy with urinary incontinence is going to be anxious about mishaps while at work. But men who have jobs with physical demands may find that it's worse than that. "Some men find that heavy lifting at work can cause leaking," says Griebling. "They can be really stuck. Sometimes they try to change what they do at work or get a new job altogether."
  • Social Life. Incontinence can quickly diminish the scope of a man's personal life. Your pals ask you out on the town. Your girlfriend wants to go to the movies. But your decision is always dictated by the answer to the same question: how close will I be to a bathroom? Car rides of any length might seem out of the question. So can sports. Maybe the physicality of tennis triggers symptoms; maybe golf takes you too far from the clubhouse. When male incontinence is severe -- or severely stressful -- it can feel easiest and safest to stay home.
  • Relationships and sexual health. Male incontinence can put enormous stress on a marriage."I see some guys who really alienate their spouses," says Wright. "They're just not comfortable talking about it, so they push their wives away."

Their sex lives suffer too. "Some men limit or completely stop sexual activity because they have a fear of leaking," says Griebling. Unfortunately, it's not an irrational fear. "I've seen some men who only have incontinence during sexual activity," he tells WebMD. It doesn't take more than a single mishap for a guy to become terribly self-conscious.

  • Sleep. The stress of male incontinence alone can keep some guys awake. And if you're popping out of bed every couple of hours to run to the bathroom, you're not getting much rest. You start each day exhausted and dragging, which only makes your mood worse.

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Male Incontinence: The Downside of Self-Care

For understandable reasons, many men want to take care of male incontinence on their own. They're embarrassed and don't want to talk about it with their spouses or doctors. They may start buying pads or disposable underwear that they find in the store. Others don't even do that. Perhaps too sheepish to be seen buying such products in public, they secretively devise their own ways of stopping dribble and leaks.

"It's amazing how many men will improvise," says Stone. "There are a lot of helpful products out there, but they just don't use them."

Sometimes, this approach works well enough for a man to get by. Still, men who go it alone make life more difficult than it needs to be. What's more, they could be putting themselves at risk. Male incontinence can be a sign of a serious medical condition -- like diabetes -- that needs treatment. But if you never talk to a doctor about your symptoms, you won't get the diagnosis.

Urinary Incontinence After Prostate Surgery

But male incontinence isn't just a problem for the lone wolves who tough it out and refuse to see a doctor. Even guys who are under medical care -- and who are doing exactly what their doctors tell them -- can still wind up in a bad situation, experts say.

One of the most common sources of trouble is prostate surgery. Incontinence right after surgery is very common. But because it usually fades, doctors may downplay the significance.

"After surgery, doctors may be more focused on the patient's recovery and PSA levels," says Stone. "The incontinence can get swept under the carpet a bit." Most doctors just give some basic advice. They might recommend Kegel exercises and dietary changes, for instance.

But what many men don't realize is that these minor lifestyle choices aren't always enough. Sometimes male incontinence after surgery is severe and doesn't resolve on its own.

"I see loads of patients who have been doing 200 Kegel exercises a day for two years after surgery and it hasn't done anything," Wright says. "But they think that if they just keep doing the exercises, or if they're just patient enough, the problem will go away." What's worse, Wright tells WebMD, is that some guys come to think that it's their fault. They feel like they still have symptoms because they didn't work hard enough at recovery.

Wright's seen men who have been putting up with urinary incontinence every day for a decade or more after surgery. "They never realized that they could do anything about it," he says.

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Male Incontinence: Getting Support

If incontinence is having a major impact on your quality of life, it will really help to get some emotional support. "A lot of men don't say anything about their incontinence and suffer in silence," says Griebling. "But they could really find a lot of comfort in just talking to someone."

So where can you go to discuss such a topic? Here are some ideas.

  • Support groups. Living with male incontinence is isolating. So meeting other men in your position who are dealing with the same stresses and symptoms can be a big relief. "Some guys get a huge amount of energy and support from meeting with groups," says Wright. "They say that being in those meetings is what pulled them out of the hole." Support groups are not only ways of getting emotional support. They're also places you can trade practical treatment tips or advice about doctors.
  • To find a support group in your area, ask a doctor for recommendations. For men who have recovered from prostate cancer, the group Us Too runs popular support groups throughout the country.

However, some guys don't always get the expected relief from a support group. "I've seen some men who get worse after joining a support group," Wright says. "They just can't bear everyone else's stories and it sends them into a downward spiral." So is a support group right for you? Wright says the benefit varies from guy to guy. You won't really know whether a group will help you unless you try a few sessions and see.

  • Therapy. Male incontinence can lead to depression, and depression can be serious. So if you think your symptoms have become severe, get professional help. "When we see people who are having significant emotional issues related to their urinary incontinence, we refer them to colleagues in psychiatry or psychology," says Griebling.

Some men can get a lot of benefit from therapy, medication, or a combination of the two. If the idea of therapy doesn't appeal to you, keep in mind that it may be quite different from what you expect. Therapy doesn't mean lying on a couch talking about your childhood. Lots of therapists focus on working on specific, concrete issues. A therapist might zero in on how your symptoms are affecting you -- for instance, causing anxiety at work or interfering with your relationships -- and help you figure out ways to work through the problems.

  • Talking to your spouse. You may feel embarrassed, but experts say it's a good idea to talk about what you're going through with your partner. "In a good, supportive relationship, I think it's critical for a man to discuss it with his spouse," says Wright. Not only could you use your spouse's understanding and support right now, but your secrecy could be affecting your marriage. If you don't explain what's going on, your wife might think that you're having a problem with her, Wright says. "The gap between a husband and wife can just keep widening," he says. "It can get to a point of no return."

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Male Incontinence: Seeing a Doctor

If you're feeling down or depressed about your symptoms, getting emotional support is crucial. But don't lose sight of a main goal: getting rid of your urinary incontinence.

The stress or depression you feel has a very distinct cause -- male incontinence. If you can resolve the incontinence, the depression and anxiety may disappear overnight.

"Men who get treatment for their incontinence are the happiest patients we see," says Wright. "They bloom. They're alive again."

Experts agree that, no matter what the cause, the vast majority of male incontinence cases can be treated successfully. "I tell my patients that I can guarantee that they will be dry," says Wright. "Sometimes the solution is simple, and sometimes it's more complex surgery. But there's always a solution."

So if you've been making do with male incontinence -- and suffering emotionally -- it's time to go back to the doctor. Find out what your options are. Together, you and your doctor should be able to solve this problem for good.

WebMD Feature Reviewed by Brunilda Nazario, MD on March 10, 2009

Sources

SOURCES:

Tomas L. Griebling, MD, John P. Wolf 33° Masonic Distinguished Professor of Urology, associate professor and vice chair of the department of urology, University of Kansas.

Anthony R. Stone, MB, ChB, professor of medicine, vice chair of urology, UC Davis Medical School, Sacramento.

Edward James Wright, MD, assistant professor of urology, Johns Hopkins Medical School; director of neurourology and chief of urology at Johns Hopkins Bayview Medical Center, Baltimore.

NIDDK: "Urinary Incontinence in Men."

NIDDK's National Kidney and Urologic Diseases Information Clearinghouse: "Urinary Incontinence in Men."

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