Male incontinence: treatment, causes and options

Typical symptoms of male incontinence

Incontinence can look different from man to man. The most common symptoms are:

• Drip after urination
• Leakage when coughing, sneezing, laughing, lifting or physical activity
• Sudden and strong urge to urinate
• Frequent toilet visits during the day
• Nighttime urination
• Feeling that the bladder is not emptying completely
• Seeping leak between toilet visits
• Need for inserts or extra change of underwear

Symptoms can be affected by fluid intake, caffeine, alcohol, stress, sleep, medication, prostate conditions and physical strain. That’s why it’s important to look at the whole picture and not just the leak itself.

Types of incontinence in men

Stress incontinence

Stress incontinence means that you leak urine during physical exertion or sudden pressure increases. This can happen when you cough, sneeze, laugh, lift, stand up quickly or play sports.

In men, stress incontinence is particularly common after prostate surgery, where the closure mechanism and pelvic floor support function may be affected.

Urgency incontinence

Urgency incontinence is also called urge incontinence or urge incontinence. It is a sudden, strong urge to urinate that can be difficult to hold back.

This type of incontinence is often associated with an overactive bladder. It can also be seen with prostate enlargement, bladder irritation, neurological diseases or changes in bladder function with age.

Overflow incontinence

Overflow incontinence occurs when the bladder does not empty properly. Residual urine can remain and when the bladder becomes overfilled, seepage can occur.

In men, overflow incontinence can be related to benign prostatic hyperplasia, also known as BPH, where the prostate presses on the urethra and makes it harder to empty the bladder.

Incontinence after prostate surgery

Incontinence after prostate surgery is a major cause of urine leakage in men. It is especially common after prostate cancer surgery, where the closure mechanism and tissue around the urethra can be affected.

For some, symptoms gradually improve over time. For others, the leak persists and requires targeted training, assessment and possibly treatment.

Mixed incontinence

Mixed incontinence means that you experience both leakage with straining and sudden urge to urinate. Treatment must therefore address both pelvic floor function and bladder signaling.

Neurogenic incontinence

Neurogenic incontinence is caused by damage to the nerves that control the bladder and pelvic floor. This can be caused by neurological diseases, back problems, surgery or trauma. It is particularly important to assess the nervous system, pelvic floor function and bladder pattern.

Causes and risk factors of male incontinence

Incontinence in men is often caused by several factors at the same time. These include changes in the prostate, a weakened sphincter, overactive bladder, impaired nerve function, side effects from medication or a weakened pelvic floor.

Prostate enlargement

Benign prostatic hyperplasia, also known as BPH, can press on the urethra and make it harder to empty the bladder. It can cause frequent urination, weak stream, nighttime urination, urgency and in some cases overflow incontinence.

Prostate surgery

After prostate surgery, the sphincter, pelvic floor function and the tissue around the urethra can be affected. This can cause stress incontinence, postvoid dribbling or uncertainty during physical activity.

Timing, technique and targeted rehabilitation are important here. Many men benefit from pelvic floor training, but if there is no progress, a more comprehensive assessment may be needed.

Age and muscle weakness

Pelvic floor muscles and sphincter function can weaken with age. At the same time, the bladder can become more sensitive and nerve control can change. This can increase the risk of both urgency and leakage.

Neurological diseases

Diseases such as Parkinson’s disease, multiple sclerosis, stroke, herniated discs or other neurological conditions can affect the nerves that control the bladder, urethra and pelvic floor.

Medicine and lifestyle

Certain medications can affect urination. For example, diuretics, some blood pressure medications or medications that affect the nervous system. Caffeine, alcohol, obesity, smoking and constipation can also worsen symptoms.

How do you find the cause of male incontinence?

A good assessment starts with clarifying the pattern: When do you leak? How much do you leak? Is it with strain, sudden urges or after going to the toilet? Have you had prostate surgery, prostate enlargement, pain, infections or neurological symptoms in the past?

Urination diary

A urination diary can provide a clear picture of your symptoms. Make notes for 2-3 days:

• When you drink and how much you drink
• How often you go to the toilet
• When leakage occurs
• Whether leakage occurs under load or sudden urge
• If you have nighttime urination
• Whether coffee, alcohol or certain habits make symptoms worse

Assessment in the clinic

At MS Insight, the first visit starts with a thorough conversation about your symptoms, daily life, previous surgeries, medications, fluid habits, sleep, stress, pain and sexual function. The goal is to understand what is most likely driving the problem.

When appropriate, I use ultrasound to assess relevant structures, pelvic floor function and tissue condition. This may also include assessment of tension patterns, nervous system, body composition and the factors in everyday life that can affect bladder control.

This means that treatment is not chosen based on a standard package, but on an overall assessment of your situation.

What can you do for incontinence yourself?

Pelvic floor training for men

Pelvic floor training is not just for women. Men also have pelvic floor muscles and they play an important role in the urethra, sphincter function, after-drip, erection and pelvic stability.

You find the muscles by imagining that you want to hold in a fart and at the same time stop the urine stream. You should feel a slight inward and upward lift in the perineum, not a downward pressure.

You can read more in the guide on pelvic floor exercises for men.

Bladder training

Bladder training can be especially relevant for urgency incontinence. Here you work with fixed toilet intervals and gradually lengthening the time between urination.

The goal is to re-train the bladder to hold more urine and curb the sudden urge. It takes patience, but for many it offers better control in everyday life.

Lifestyle changes

Small changes can reduce strain on the bladder and pelvic floor:

• Reduce caffeine and alcohol if it makes cravings worse
• Distribute fluid intake evenly throughout the day
• Work on weight loss if excess weight increases pressure on the pelvic floor
• Avoid constipation as pressure can strain the pelvic floor
• Stop smoking if chronic cough triggers leakage
• Talk to your doctor if you suspect medication is affecting urination

When is self-training not enough?

Pelvic floor training is often an important first step. But there are situations where self-training is not effective enough or where symptoms require a more targeted assessment.

It may be relevant to seek professional help if:

• You’ve been training for 3 months without noticeable progress
• You are unsure if you are activating the right muscles
• You only tense your stomach, buttocks or thighs when you try to squeeze
• You have incontinence after prostate surgery
• You have drips or leaks that affect your everyday life
• You have urgency, frequent toilet visits or nighttime urination
• You also have erectile dysfunction, pelvic pain or decreased sensation in the lower abdomen

When training doesn’t work, it doesn’t necessarily mean you’re doing something wrong. It could be reduced muscle contact, weakened tissue, affected nerves, altered blood flow or a bladder that reacts too quickly.