After your doctor figures out what type of incontinence you’re dealing with, it’s time to decide on a treatment plan. It will depend on what’s causing your leaking and how bad it is. Treating it can involve changes in your behavior, your medications, or sometimes even surgery.
Lifestyle or Behavioral Changes
If it’s right for your symptoms, your doctor may decide to try changes to your routine and diet first before moving on to medication or surgery.
Bladder training. If you have urgency incontinence (a constant “gotta go” feeling), your doctor may tell you to practice holding your urine for a short time when you get the urge instead of going right away. You can start by holding it for 10 minutes. After you successfully do that a few times, you can increase your time. You can also use set times during the day to go, and increase the time in between those regular bathroom trips. You can help your body learn to wait longer by practicing breathing or relaxation techniques. With some effort, you may be able to tame your symptoms and only have to urinate every 3 or 4 hours. Keep in mind that you may not see results right away. But if you stay with it, you should benefit within a few months.
Watching what you eat and drink. Treating your leaks may be as easy as avoiding certain foods and beverages. Cut down on alcohol and caffeine. Many experts believe that these things can irritate the bladder and make urinary incontinence symptoms worse. Cut out coffee, tea, sodas, and alcohol to see if it makes a difference.
Avoiding foods that trigger symptoms. Spicy and acidic foods -- like citrus fruits and tomatoes -- are common culprits. Others include chocolate and artificial sweeteners. But everyone's different. You may find food has no effect on you.
Keeping a diary. Your doctor may ask you to keep a bladder diary. This is a record of both your diet and your leaking episodes. For a few days at least, keep track of how much you drink, how often you have to use the bathroom, and when you leak. Note anything in particular that might have triggered your symptoms, such as bending over in a certain way or drinking too much coffee. Your diary will give your doctor a good sense of your symptoms and how they're affecting your life. It can help find out which tests are needed to make the right diagnosis. Doing this may help you find out what’s triggering your leaks.
Double voiding. This is a technique you can use when you go to the bathroom to help your bladder empty out all the way. After you urinate, wait a minute or two, then try again immediately. Doing this can reduce dribble afterward.
Pelvic floor exercises. Some men think of Kegels -- or pelvic floor exercises -- as a woman's thing. But they can also help men strengthen the muscles around the bladder. Your pelvic floor is made up of a layer of muscles that stretch like a hammock from your pubic bone to your tailbone. They support your bladder and bowels. To strengthen these muscles, you can do Kegel exercises. These are exercises that involve tightening and holding the muscles that control your urine flow.
You’ll have to make sure you're flexing the right muscle. Exercising the wrong ones could increase the pressure on your bladder. The muscles you would use to stop yourself from passing gas are the ones to focus on.
Here's how you do it:
Tense the muscles for 3 seconds and relax them for 3 seconds. Build up slowly until you're doing three sets of 10 repetitions. Altogether, it should take about 15 minutes a day. You can do Kegels anywhere: in bed, at your desk, or watching TV.
You can do them several times a day (not while urinating) to help build your pelvic muscle tone. It may take about 3 to 6 weeks before Kegel exercises have the effect you want. But most men notice results sooner.
If you’re having trouble doing Kegels, your doctor may recommend using biofeedback, or special sensors that can show you when you’re moving certain muscles.
Space apart your drinks. Some men say that staggering their fluid intake can ease symptoms. If you have a lot of problems at night, it might help if you drink less before bed.
Stay hydrated. You may be tempted to cut way down on water and other drinks in the hope that it will prevent accidents. But it's a bad idea. If you drink less, your urine becomes more concentrated. The more concentrated the urine, the more irritating to the bladder -- which can lead to more urinary incontinence. So if you’re thirsty, have some water.
Treat constipation. There's some evidence that constipation -- and the straining that goes along with it -- can have a negative effect on the nerves that you use to pee. By treating your constipation -- with a high-fiber diet, for instance -- you may also help your incontinence.
Watch out for medication side effects. Make sure your doctor knows about every medicine and supplement you use. Some can cause or worsen urinary incontinence. Some antidepressants, sedatives, diuretics, and even cold and allergy medicines may trigger problems.
Plan ahead. A lot of guys with male incontinence get stressed out when they have to travel. Ease your anxiety by being prepared. If you're going on a road trip, map out the route and find places you can stop at regular intervals to use the bathroom. Knowing you have a plan will make you feel more confident.
Get support. Living with incontinence can be stressful and make you feel alone. Make an effort to stay connected with your friends and family. You might also benefit from a support group. Ask your doctor if there are any in your area.
There are many medications that can help get your bladder back to normal function. These include:
Antimuscarinics. These medications relax the muscles around your bladder to help them stop spasming. You can take them as a pill, a liquid, or use a patch. These medications include darifenacin (Enablex), fesoterodine (Toviaz), olifenacin (VESIcare), oxybutynin (Ditropan, Gelnique, Oxytrol), tolterodine (Detrol), and trospium (Sanctura).
Alpha-blockers. These are best if you’re dealing with an enlarged prostate that is blocking your urine flow. They relax the smooth muscle around the prostate and bladder to help the urine get out. Examples include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (Hytrin).
5-alpha reductase inhibitors. These medications keep your body from making the hormones that make your prostate grow and get too big. By shrinking your prostate, they help urine get out when it needs to. Examples include finasteride (Proscar) and dutasteride (Avodart).
Botox. Your doctor can inject botulinum toxin type A, or botox, into your bladder to relax it. This helps it hold more urine. You can get the injection during an office visit. A botox treatment can last 6 to 9 months.
Your doctor will likely try other treatments before moving on to surgery. However, you might need surgery if:
- Your urinary incontinence is chronic or severe
- You have blood in your urine
- You have chronic urinary tract infections (UTIs)
- You have a blockage that a doctor needs to remove
Options for surgery include:
Sling procedures. This surgery involves taking either tissue from other parts of your body, or synthetic material or mesh, and making a sling around your urethra and the thick part of the muscle connecting the bladder to it (the bladder neck). This is helpful if you’re dealing with stress incontinence. The sling helps close your urethra when you put pressure on it -- like when you exercise, cough, or sneeze -- so urine won’t leak out.
Artificial urinary sphincter. An artificial sphincter (the muscle that opens and closes your bladder) is one option for treating urinary incontinence which is the result of the removal of the prostate. A doctor puts a small, fluid-filled ring around your bladder neck. This helps keep your sphincter shut until it’s time for you to urinate. Once you have your artificial sphincter, you’ll have to press a valve under your skin when you go to the bathroom. This deflates it so urine can flow out of your bladder.
Prostate surgery. If an enlarged prostate is causing your urinary incontinence, your doctor may recommend a surgery to shrink your prostate.
Sacral nerve stimulation (SNS). Using an electric stimulator (similar to a pacemaker) under your skin, your doctor can stimulate your sacral nerve with electric pulses. This can help calm bladder spasms.
Urethral bulking. If your urethra has a hole that’s letting urine leak, your doctor can inject it with material (like collagen). This material will build up the urethra wall thickness, filling empty space, and creating extra resistance. Your doctor uses a needle through the skin or directly into the urethra to do it. You may need general anesthesia during the procedure.
Catheter. When you can’t get all the urine out of your bladder on your own, your doctor may want you to use a catheter to help things along. A catheter is a soft, thin tube you insert into the tip of your penis. Your doctor may ask you to do this several times a day, or you may use a catheter that can stay in your urethra all the time.