Today's post is dedicated to a problem that compromises the physical and emotional well-being of those who live with this condition, which can affect the life quality and even limit social and physical activities, as well as the sexual life. I am talking about urinary incontinence, the involuntary loss of urine.
In Brazil this condition affects more than 10 million people, 25% of the cases affect men over 60 years old, who have undergone urogenital surgery, whether prostate, penis, rectum or testicles.
Despite being treatable and widely curable, urinary incontinence is a source of embarrassment and difficult in social interaction. That is why many people usually hide the situation and end up causing serious damage to themselves.
The most common reasons for not seeking help or treatment include thinking that the loss of control of the bladder is a natural part of aging or that nothing can be done to correct it. By reading this text you will understand why this is just a myth. Now there are methods of evaluation and treatments that can cure the lack of urinary control or improve it significantly.
This text presents the causes, symptoms, types and treatments of urinary incontinence and encourage you to consult an urologist as soon as you recognize any of the symptoms. The support of a specialist is essential to make an accurate diagnosis and to define the best treatment option.
The urinary incontinence can have different levels, mild, moderate or severe and may have a temporary or permanent condition. It can be triggered by a trauma, neurological disease or involuntary bladder contractions. In the specific case of men, it can also occur as a side effect of prostate or urethral surgery.
The highest incidence, however, occurs due to the weakening of the sphincter of the urethra, the muscular structure responsible for containing the urine, after a prostate surgery, either the removal or treatment of BPH (Benign Prostatic Hyperplasia). In most cases, there is a progressively recovery of the urinary incontinence during the first year after surgery, only 3% to 20% of patients will need treatment. While the problem persists, the best way to control urine is to use diapers or other absorbent products.
Defining the cause of incontinence is key to lead to a successful treatment. The most suitable medical evaluation to this purpose is the Urodynamics. It is important to note that the exams are not painful, do not require special preparation and can be done in the doctor's office. With the results of these exams, the exact cause of incontinence can be defined to discuss treatment options. Allied to the Urodynamics are also required urine exam, ultrasonography, an x-ray of the bladder and an urodynamic study.
Male urinary incontinence can have various symptoms, all of them are easy to identify.
If you feel the sudden urge to urinate without being able to control it, or if you notice that it leaks while practicing physical activity, while sneezing or laughing, it is very likely that you have this condition.
Even if the condition is considered mild, it is important to seek medical help to identify what type of incontinence you are suffering from and to look for the appropriate treatment. It may be mild, moderate or severe. Keep reading the post to understand the types.
There are four basic types of urinary incontinence. Only a careful and individualized evaluation for each case will help the physician to obtain an accurate diagnosis to define the appropriate treatment.
When the loss of urine happens through a cough, sneeze or a laugh, it is what we call "Effort". This is the most common type in men who have undergone prostate surgery.
When the urge to urinate is sudden in a way that it is difficult to get to the bathroom in time, the type of urinary incontinence is "Urgent", usually caused by a blockage of the urine flow due to an enlarged prostate.
The "Mixed" incontinence comes from the combination between the two mentioned above, and in "Overflow" the bladder never empties completely, leaving a trace of urine that can cause discomfort and pain. The most common cause in the case of "Overflow" is the prolonged blockage of the urine flow of the prostate, where the bladder muscle eventually becomes flaccid and unable to contract.
The treatment for male urinary incontinence depends essentially on the type and severity of urinary loss. It is important to evaluate your condition in order to get the best diagnosis and guidance on possible alternatives.
If it is diagnosed as short-term condition, it is possible to treat it with external devices, such as latex probes, urine storage products. Moreover, there is also the option of mechanical devices that include the penile clamp and compression rings. They are devices plugged to the penis that interrupt the flow of urine when closed, without causing discomfort.
In order to have a fast recovery, it is indicated that the patient do exercises to strengthen the pelvic floor, a noninvasive procedure performed with the guidance of physiotherapists and the urologist. When the pelvic floor is strengthened, the muscle contraction is able to sustain the increase in pressure in the abdominal area that occurs when the patient makes some effort, such as coughing or sneezing.
There are also options of treatment with use of medications to relax the bladder, called anticholinergic, besides behavioral therapy, pelvic rehabilitation and electrical stimulation. Surgery is the most indicated option for patients who have undergone prostate treatment and did not present a good response to the options mentioned above due to the weakening of the sphincter mechanism of the urethra. On the next topic, we will get to know more about it.
In most cases, urinary incontinence resulting from prostate surgery is temporary and self-limiting.
The first treatment option for these cases is the "Kegel Exercise". This practice involves the contraction and relaxation of certain muscles around the base of the bladder and urethra to strengthen the pelvis and help the patient to recover his symptomatology.
To help the patient to identify correctly the points to be stimulated, to gain awareness in controlling their urinary tract muscles and to ensure better results, exercise can be combined with biofeedback devices, a variety of instruments used to record small electrical signals that are emitted when specific muscles are stimulated to urinate. These exercises should be practiced correctly so it can offer a better result; therefore, the guidance of a trained professional is essential.
When the urinary incontinence does not show good responses to these less invasive treatments, it is necessary to perform a surgical procedure. Usually this decision is made when patients remain with urinary incontinence for more than 12 months after prostate surgery.
Check out more details on the methods available below.
Surgical treatment for urinary incontinence
Prostate surgery may weaken the sphincter mechanism of the urethra and thereby cause urinary incontinence. When this condition remains for a long period and does not respond to clinical treatments, the solution is to do a surgery.
There are three alternatives that correct the involuntary loss of urine. When the incontinence is moderate or severe, the most appropriate one is the implant of the Artificial Urinary Sphincter. First applied more than 40 years ago, this option presents a high efficiency and low rate of complications.
In a simple surgery performed with only one incision, local anesthesia, and hospitalization for the maximum of one night, a cuff is implanted around the urethra attached to a pump in the scrotum and the balloon containing the fluid to the device. After the period of evaluating the implant, in a period of about 4 to 6 weeks, the artificial sphincter is activated to allow the reestablishment of urinary control. From then on, when the person wants to urinate, the pump is compressed and the cuff is opened for about 2 or 3 minutes, until it closes again. The pain during the postoperative is minimal and the patient can return to work after 2 or 3 weeks.
Image: Artificial Urinary Sphincter
Another option of implant in an equally minimal invasive procedure are the Suburethral Slings. Indicated for patients with mild or moderate incontinence, without prior radiation therapy and with high urine loss during effort testing, they consist of a polypropylene strip. When implanted, it provides a significant tension with stability of the tissues and urethra, avoiding or minimizing urinary losses.
Sometimes urinary incontinence may be associated with erectile dysfunction. In such cases, it is possible to implant the sphincter and the prosthesis in the same surgical procedure. Before performing the surgery, it is essential to diagnose if there was a thinning or loss of penile size, common with advancing age, and then perform the penile reconstruction. The purpose of this procedure, accomplished according to the published concepts of the Egydio’s Technique, is to obtain, along with the cure for urinary incontinence and erectile dysfunction, the best recovery of the size and caliber of the penis up to the limit of nerves and vessels.
As you can see, urinary incontinence has a solution and should not be treated as a taboo.
If you are experiencing this or know someone in this situation, it is necessary to seek medical help. Whatever age, the appropriate treatment can give back your social life, self-esteem and health.
MD, PhD, Referência Mundial no Tratamento da Doença de Peyronie, Pênis Curvo e Implante de Próteses Penianas. Doutor em Urologia pela USP, CRM 67482.