Men and bladder control
Difficulties with passing urine are common as men age, often due to benign (non-cancerous) enlargement of the prostate gland. Problems can include a weaker urinary stream, delay in starting and incomplete emptying. Increased urinary frequency or urgency may also be experienced. Other causes include medications, an overactive bladder, nerve problems, surgery, bladder outlet restriction and some medical conditions. See your doctor for assessment and to exclude infection, particularly if there is blood in the urine or pain.
Are many people affected?
Over 600,000 adult New Zealanders (men and women) do not have full bladder control, but with the right advice and treatment a majority of those affected can have significant improvement. How the incontinence affects you depends on what is causing it. For this reason it is important to seek professional help from your doctor or continence adviser so the cause can be found and appropriate treatment given.
What flow problems can men encounter?
One in three men over 50 years of age experiences some difficulty in passing water. The way men pass water changes gradually as they get older, so at first they may not notice there is a problem. Typical changes include:
- difficulty or delay in starting to pass water. The first step in starting the flow is to relax the muscles under the bladder in the pelvic floor. Delay in starting is common with ageing, and with prostate problems, but it can also be due to shyness if voiding in a public toilet. This affects about 30% of men, who have no problems passing urine in private.
- stopping and starting in the middle of passing water
- a smaller and weaker urinary stream, so it takes longer to pass water than it used to. It may also stop and start and as the bladder empties, the flow can slow down to just a trickle. This is called 'terminal dribble'
- after finishing, a bit more urine trickles out. After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause an ambarrassing wet patch on the trousers. This is due to urine pooling in the water pipe (urethra). It can be prevented by making sure there is nothing pressing on the urethra, like tight clothing or zips. The drips can be helped by milking the water pipe using the fingers (see 'Milking technique' further below).
- a feeling of not quite having emptied the bladder. This symptom sometimes indicates the presence of residual urine, but is not always accurate at predicting this.
Is your urine flow 15 or less?
Some, or all, of these difficulties in passing water can happen because in most people over the age of 40, the prostate gland gradually becomes enlarged after 40 years of age. The prostate sits under the bladder and around the outlet (or urethra) through which urine passes to the outside. Enlarging of the prostate is called benign prostatic hyperplasia, or BPH. The difficulties caused by BPH can be relieved by medication or if necessary by surgery. If you are worried because you have difficulty passing water, consult your doctor who can advise you on treatment. Men with flow rates under 15 should talk to a health professional.
See also Bladder problems and the prostate
What is the milking technique for preventing dribble?
Wait a few seconds after passing urine for the bladder to empty completely. Place the fingertips of one hand under the scrotum (approximately three finger-breadths) and apply gentle upward pressure. Keep the pressure on the midline and firmly move the fingers forward towards the base of the penis under the scrotum. This milks urine forward in the urethra where it can be emptied by shaking or squeezing in the usual way. Repeat this technique twice to ensure complete emptying. This whole procedure should take no more than a few seconds.
Storage symptoms or overactive bladder symptoms
- increased frequency of bladder emptying
- urgency alone or with urge incontinence
- stress incontinence.
Increased frequency of bladder emptying
This refers to passing urine more often than usual in the daytime, and if there is also a need to get up at night, this is termed nocturia.
- Fluid amount and type: Increased volumes of urine can be the cause. Drinking large volumes of fluid especially tea, coffee, chocolate drinks, or alcohol in the evenings, will mean a person has to empty the bladder more often.
- Cold: Cold weather makes the bladder more irritable.
- Diuretics ('water' pills): Diuretic medications like frusemide, prescribed for blood pressure or heart failure, can cause increased frequency. These tablets are best taken in the morning to allow time to get rid of the extra water in the body.
- Overactive bladder: Increased frequency can also arise simply because of an effect of ageing on the kidneys and bladder. An overactive bladder can be the cause.
Urgency alone or with urge incontinence
This means the urgent desire to empty the bladder, which if not responded to promptly, might lead to leakage of urine before reaching the toilet. It can be very embarrassing.
- Irritable bladder: Often urgency is caused by an overactive or irritable bladder.
- Ageing/bladder outlet restriction: An overactive bladder can happen with ageing, but also if the bladder outlet is restricted by the prostate.
- Nerve damage: Nerve problems to the bladder can also cause be involved.
This refers to leakage on coughing, straining or any exertion, and is uncommon in men.
- Spinal injury/ prostate surgery: Stress incontinence can occur if nerve damage has occurred due to spinal injury, or if the urethral muscles are damaged after a prostate operation. You should discuss this with your doctor and the urologist.
Blood in the urine
If you notice any blood in your urine, or experience pain on passing urine, see your doctor, because these symptoms can indicate a more serious problem.
What can I do about bladder problems?
For some bladder control problems, simple strategies such as pelvic floor muscle exercises or bladder training may be helpful. To find out the most appropriate strategies for you, seek advice from your doctor, specialist or continence adviser (a nurse or physiotherapist with special expertise in continence management).
For information regarding good bladder habits, pelvic floor exercises, bladder training, prostate problems in men, contact the New Zealand Continence Association (details below under 'Further Information and Support').
Original material provided by the New Zealand Continence Association, and edited by everybody, August 2005. Reviewed by everybody, September 2011.