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It’s often joked about among circles of post-pregnancy or post-menopausal friends, but urinary incontinence among men is rarely discussed. That doesn’t mean it doesn’t affect men. It does. Urinary incontinence (UI) in men is not always an inevitable part of aging, but for those men who do experience UI, there are options (aside from prescription drugs) for dealing with this uncomfortable issue.
UI is not a disease, but rather a symptom of another problem. The most common symptoms of UI are changes or problems with urination, including a weak stream, urgency, leaking or dribbling and more frequent urination, especially at night.
In men, UI is typically caused by either nerve or prostate issues. Nerve problems arising from long-term diabetes, stroke, Parkinson’s disease, multiple sclerosis and spinal cord injury can often lead to UI. Issues with the prostate, especially benign prostatic hyperplasia (BPH), may be the more common root cause of many cases of incontinence in men.1 This article will focus on UI related to the prostate.
The prostate is a male gland about the size and shape of a walnut and its main function is to produce the fluid that carries sperm during ejaculation. The urethra passes through the prostate from the bladder, which is why abnormalities in the prostate can affect continence. Benign prostatic hyperplasia (BPH) is the most common of these “abnormalities.” Simply put, BPH is an increase in non-cancerous tissue growth that leads to an enlarged prostate; it is common with age. As the prostate grows, it can squeeze the urethra and affect the flow of urine.2 While men in their forties and fifties can certainly experience lower urinary tract symptoms (LUTS) from BPH, more than half of men in their sixties and up to 90 percent of men in their seventies and eighties have LUTS associated with BPH.3 The first sign of prostate problems may manifest as a weak stream, dribbling, urgency, incomplete emptying of the bladder and frequent nighttime urination.
In addition to BPH, certain prostate cancer treatments, including surgical removal of the prostate and radiation treatment, may lead to UI.
As with any health issue, UI can be positively influenced by diet and exercise. One study found that after having their prostates removed due to cancer, those men who were at a healthy weight and were getting regular physical activity before surgery had the lowest prevalence of long-term UI, at 16 percent. Obese, sedentary men had the highest rates of UI, at 41 percent.4 The researchers speculate that regular exercisers have better muscle tone, which may promote better bladder control.
Speaking of muscle tone, Kegel exercises are very effective in strengthening the pelvic floor muscles, a group of muscles that hold the pelvic area together. The pelvic floor muscles support and maintain the proper functioning of the organs contained in the pelvis, including the bladder and urethra.5 (A quick Google search will lead you to a number of websites with instructions on how to properly perform Kegels.) Other “behavioral modifications” that can go far in managing UI are: managing fluid intake, especially before bedtime; scheduling trips to the bathroom (going to the bathroom at set intervals, whether you feel the urge or not); learning to delay urination by trying to hold off for several minutes when you feel the urge, slowly increasing the time between trips to the toilet; reducing or eliminating all caffeine and alcoholic beverages; and, though it may seem counterintuitive, staying hydrated— dehydration can worsen urge incontinence.
In addition to maintaining a healthy weight, staying physically active and adopting behavioral modifications, there are also a number of supplements that maintain prostate health, which in turn can prevent LUTS.
An extract from the African prune tree, pygeum has been used in Europe to treat BPH since the 1960s. Studies have found pygeum to significantly reduce urinary symptoms related to BPH, specifically a reduction in nighttime urination, an improvement in urinary flow, a decrease in “residual bladder volume” and a decrease in daytime frequency. One placebo-controlled study including 263 men found that those men who took 100 mg of pygeum for 60 days reported a 66 percent improvement in urinary symptoms compared to 31 percent in the control group.6 7
This antioxidant found in pink and red foods (tomatoes, watermelon, grapefruit) has long been used to promote prostate health.
A study including 40 elderly men with BPH found that daily supplementation of 15 mg of lycopene for 6 months stopped prostate enlargement, halting the progression of BPH. The placebo group saw a progression of prostate growth.8
Cranberry has a proven track record in preventing and treating urinary tract infections, and now research is also proving that cranberry extract may be beneficial for improving urinary symptoms related to BPH. A recent study found that a powdered cranberry extract (1,500 mg/daily for six months) significantly improved urinary symptoms in men with chronic prostatitis (inflammation of the prostate), including rate and volume of urine flow and the ability to completely empty the bladder.9
The conversation about vitamin D often revolves around the vitamin’s role in cancer and other disease prevention; however, vitamin D is also crucial for proper muscle function, including those muscles in the pelvic floor. Vitamin D influences muscle strength and function and a deficiency of vitamin D has been associated with a greater prevalence of urinary incontinence and other pelvic floor disorders.
Although it isn’t directly related to BPH, vitamin D may be an invaluable supplement in controlling incontinence through its ability to strengthen the pelvic floor muscles. 10 11 12
While it’s probably the last topic to come up during “guy talk,” urinary incontinence does affect many men. Sometimes it is related to a serious health issue, but more often it is related to the prostate. By adopting a few lifestyle changes and including a few beneficial supplements, you can regain control.
Note: Lower urinary tract symptoms rarely, if ever, go away on their own. Additionally, lower urinary tract symptoms can be caused by more serious health issues including prostate cancer, bladder cancer or urinary tract infections. If you are experiencing any lower urinary tract symptoms, please see your healthcare provider.