What Is the Best Treatment for Stress Incontinence?

Stress incontinence occurs in men whose urinary sphincter becomes weakened, usually as a result of trauma or surgery. Men who have undergone radical prostatectomy sometimes experience stress incontinence, but can also benefit from therapy. Situations that place pressure on the bladder, such as laughter, sneezing or coughing, can result in urine release.

Diagnosing stress incontinence

The first step in diagnosing stress incontinence is a simple discussion of elimination patterns and urinary leakage.  This should be followed by discussion of medical history, including past surgeries, any current illnesses or chronic conditions, and medications regularly taken.

A physical examination should follow to assess the sacral region, and a rectal examination to rule out possible physical causes that affect voiding. The doctor will use ultrasound to measure the residential volume of urine, lab work, and PAD test to rule out peripheral arterial disease. Patients may be asked to keep a voiding diary and/or a record of foods and drinks consumed, and the doctor may provide a short questionnaire to help patients identify patterns.

In some cases, especially when conservative therapies fail, the physician might perform further diagnostic assessment.  Cystoscopy (a narrow tubular instrument is passed through the urethra to examine the interior of the urethra and the urinary bladder), and radiological studies may be performed to determine if surgery should be considered.

Stress incontinence treatment options

After this basic diagnostic evaluation, the physician will start with recommending conservative therapy, and the goal of treatment is to increase the resistance of urine outflow.

Medications for incontinence may be prescribed or other options can be initiated. These may include pelvic floor training (which consists of contracting and relaxing the muscles that make up part of the pelvic floor – similar to kegel exercises for men), electrostimulation, or biofeedback (use of monitoring devices to display information about the operation of a bodily function that is not normally consciously controlled. This teaches a patient to control the function consciously), and even botox injections.

The injection of a bulking agent may be performed to prevent leakage. A variety of substances have been used to support the sphincter, including polydimethylsiloxane and dextranomer-hyaluronic acid copolymer.

Other therapies include herbal supplements, collagen injections (to fill out the neck and reduce pressure), paraurethral balloon compression, installing slings for support, or installing an artificial sphincter. The goal is to duplicate the natural function of the sphincter and provide a variable degree of resistance.

References

Börgermann C et al. The treatment of stress incontinence in men. Deutsches Arzteblatt International 2010 Jul; 107(27): 484-91

Dawson C, Nethercliffe J. Stress incontinence in men. In ABCs of Urology. New York: Wiley, 2012.

Goode PS et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 2011 Jan 12; 305(2): 151-59

Staskin DR, Comiter CV. Surgical treatment of male sphincteric urinary incontinence: the male perineal sling and [1] artificial urinary sphincter. In Wein AJ et al. Campbell-Walsh Urology. Philadelphia: Saunders Elsevier, 2007.


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