|Incontinence is not a disease in itself, but rather a symptom or result of some underlying condition. It usually is caused by a damaged sphincter, the circular muscle that controls the flow of urine out of the bladder. When damaged—in men, often due to removal of the prostate to treat cancer—the sphincter cannot squeeze and close off the urethra. This causes the urine to leak.
To determine the type and cause of incontinence, doctors take a complete medical history and conduct a thorough physical examination. Specialists such as urologists use a variety of testing methods to determine the cause and type of urinary incontinence.
Types of Urinary Incontinence
There are five basic types of incontinence. In many cases, individuals experience symptoms of more than one type of incontinence. Proper diagnosis of the type of incontinence is an important factor in successful treatment.
Causes of Urinary Incontinence
- Stress Incontinence-Occurs when you leak urine during a physical activity like lifting, exercising, sneezing and coughing.
- Urge Incontinence-Occurs when you have an overwhelming need to urinate and are not able to hold urine long enough to reach a toilet.
- Mixed Incontinence-A combination of stress and urge incontinence, where you have symptoms of both conditions.
- Overflow Incontinence-When your bladder never completely empties, which causes urine to leak.
- Functional Incontinence-Factors outside the lower urinary tract, such as weaknesses in physical and/or cognitive function, cause this form of incontinence.
A variety of health-related factors can result in urinary incontinence. To effectively diagnose and treat urinary incontinence, a doctor must determine the cause.
- Removal of the Prostate—Urinary incontinence can occur following prostate surgery. For men, a radical prostatectomy to treat cancer is the most common cause of incontinence.¹ In order to remove the cancer, parts or all of the tissues that help control urine flow may need to be removed. The rate of incontinence following radical prostatectomy surgery ranges from 3% to 60%²,³ Incontinence is less frequent following prostate surgery to treat an enlarged prostate (benign prostatic hyperplasia or BPH). Severe incontinence following prostate surgery occurs in less than 5% of patients.4,5 Several factors can affect rates of incontinence following prostate surgery, including age, general health and the amount of prostate and surrounding tissue removed during surgery. Patients often experience incontinence immediately following surgery but the leakage usually stops within weeks or a few months. When incontinence persists beyond a few months, you should consult your doctor.
- Infections and Medications—Urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.
- Diseases—Causes of chronic incontinence include diseases or conditions that damage or weaken the urinary sphincter muscle. Spinal cord problems such as spina bifida, spinal cord injury and sacral agenesis (malformation of the lower spine) can cause incontinence, as can neurological diseases such as multiple sclerosis, Parkinson's disease, stroke, and diabetes.
- DESD—Incontinence also may be the result of detrusor external sphincter dyssynergia. DESD is a serious condition most frequently seen in patients with spinal cord injury and multiple sclerosis. It is caused by lesions between the brain stem and the lower part (sacral region) of the spinal cord.
- Urethral Strictures—Another cause of incontinence is recurrent bulbar urethral strictures. This is an area of hardened tissue that narrows the urethra, sometimes making it difficult to urinate. Urethral strictures can occur from scarring, trauma or infections. Strictures obstruct the flow of urine from the bladder, so the bladder must work harder to push the urine through the narrowed area.
1. Blaivas JG. Conquering bladder and prostate problems. New York: Plenum Publishing Corporation, p. 208.
2. Litwin MS, Hays RD, Fink A. Ganz PA, Leake B, Leach GE, Brook RH. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA. Jan 1995; 273(2):129-35.
3. Herr HW. Quality of life of incontinent men after radical prostatectomy. J. Urol. March 1994; 151(3):652-4.
4. Krane RJ. Urinary incontinence after treatment for localized prostate cancer. Mol. Urol. Fall 2000; 4(3):279-86.
5. Mulcahy JJ. Tips for successful placement of the artificial urinary sphincter. Contemp Urol. Sept. 1999; 46-51.