Urinary incontinence is the loss of voluntary bladder control that results in urine leakage. It can be temporary, as it frequently is when it is associated with various treatments for prostate cancer, or permanent. Urinary incontinence can also be associated with aging, BPH, urinary tract infections, obesity, diabetes, stroke, spinal cord injuries or disease, and use of certain medications or substances, such as alcohol, beta-blockers, cholinergic agents, or cyclophosphamide.
Living with incontinence can have a significant and distressing impact on quality of life, as can be attested to by people who suffer with the condition, and by research. In the EPIC (European Prospective Investigation into Cancer) study, for example, individuals with incontinence and overactive bladder reported decreased enjoyment of sexual activity, worse quality of life, and more depression than individuals without these urinary problems. (Coyne)
The causes of incontinence can depend on the type, of which there are four. In many cases the cause is unknown. The four types of incontinence are:
- Stress incontinence, which occurs when people laugh, sneeze, exercise, lift heavy objects, or engage in any other activities that increase pressure on the bladder, including sexual activity. It can be caused by weakening of the muscles that suspend the bladder or those that control urine flow, damage to the muscles that control urine flow following prostatectomy, or obesity.
- Urge incontinence, also called overactive bladder, is the loss of bladder control after experiencing a strong urge to urinate. Men who experience this type of incontinence cannot always make it to a toilet in time. It can be caused by urinary tract infections, diabetes, nerve damage, bladder irritation such as kidney stones, or use of certain medications such as diuretics or hypnotics.
- Overflow incontinence occurs when the bladder will not empty all the way. As a result, urine accumulates and can overflow. It can be caused by BPH, weak bladder muscles, nerve damage, vitamin B12 deficiency, a blocked bladder, or use of medications such as antidepressants, hypnotics, beta-blockers, calcium channel blockers, and antihistamines.
- Functional incontinence occurs in men who have normal bladder control, but they are unable to reach a toilet in time due to a medical condition, such as severe arthritis, or as a side effect of drugs that can cause confusion or sedation.
To better understand incontinence, it helps to know what continence is. There are two sphincters: the inner sphincter is the bladder neck and the external sphincter is the one used to start and stop urine flow. When the external sphincter is squeezed shut or contracted, you cannot urinate; when you are relaxed, you can. The internal sphincter typically shuts during orgasm. In men who have had a radical prostatectomy, the external sphincter often does not function properly, especially in the early weeks following surgery. This can result in stress incontinence, during sexual activity, when pressure is placed on the abdominal area.
Incontinence is also associated with radiation therapy, and in this case the incontinence is related to irritation to the bladder and not from stress. Men who have undergone brachytherapy often experience swelling of the prostate, which can impact urination and cause temporary incontinence.
The severity and duration of urinary incontinence varies widely from man to man depending on many factors (e.g., age of the patient, type of treatment received, other health issues) and can take a year or more to resolve.
Following prostatectomy or radiation therapy, some men experience stress incontinence during sexual activity, especially if there is pressure on the abdominal area. Some men and their partners may find this embarrassing. However, urine is usually sterile, and so while some urine leakage may be a nuisance, it will not cause infection. One way to help alleviate urine leakage is to make sure the bladder is emptied before sexual activity.
Another time urinary incontinence may occur is during orgasm. This is a condition known as climacturia. After prostatectomy, and rarely following radiation therapy, a man’s internal sphincter may not close properly before orgasm, allowing some urine to leak out. At the same time, the bladder contracts, which contributes to the urinary leakage. Up to 90 percent of men who undergo prostatectomy experience at least one episode of climacturia in the early stages after surgery. According to one study of 475 men, climacturia occurs in 20 percent of men who had undergone pelvic surgery, and the incidence of urinary leakage is unrelated to the type of prostatectomy performed. (Choi)
The main treatment approach for urinary incontinence related to sexual activity is a constriction band. This band is placed around the base of the penis after an erection is achieved. Men can change the amount of pressure the band provides, but some men experience pain with the band and/or find that it is uncomfortable or too unnatural to use. The antidepressant imipramine is sometimes prescribed to help the bladder neck contract, but it is not as effective in men who have undergone prostatectomy.
Choi JM et al. Orgasm associated incontinence (climacturia) following radical pelvic surgery; rates of occurrence and predictors. J Urol 2007 Jun; 177(6): 2223-26
Coyne KS et al. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int 2008 Jun; 101(11): 1388-95