Prostate and Male Urinary Incontinence

The other night at dinner a friend was telling me that his buddy of over 30 years had to stop wearing khaki pants because he is embarrassed by wet spots caused by urination. I immediately asked him if his friend had a prostate procedure and the answer was yes, which he then followed up with the question - “why?”.

To understand the “why” you have to have a basic understanding of what the prostate is, where it is in the male body, and why a procedure may cause urinary incontinence.

First off, the loss of the ability to control urination by men is commonly caused by surgery or radiation treatments for prostate cancer. It may be a short term issue or can be a lifelong issue. Let’s drill down into the details to understand “why”.

Lets start with the basics of what the prostate is and what is does and how it helps hold urine. Urine is stored in the bladder after it is drained from the kidneys. The bladder holds the urine until there is an urge to urinate. The bladder is a hollow, muscular, balloon-shaped organ. Urine flows out of the bladder and leaves the body through a tube called the urethra. Urination occurs when muscles in the bladder contract and forces urine out of the bladder. While this is happening the muscles that surround the urethra relax an allow the urine to flow out.

Here’s where the prostate comes into the picture - it is a gland that surrounds the urethra.

An enlarged prostate gland can obstruct the urethra and can cause urination retention or other problems with urination.

Removing the prostate through surgery or destroying it through radiation (via external beans or use of radioactive seed implants) disrupts the way the bladder holds urine and can result in urine leakage. Radiation can also decrease the capacity of the bladder and cause spasms that force urine out. Surgery can also damage nerves that help control bladder function.

Surgeons and procedures have changed over the years to attempt to reduce these issues. When removing the prostate they may try to save as much of the area around the bladder and the sphincter muscles around the urethra reducing the damage to the sphincter. Doctor have also improved the process of how they place the radioactive seed implants that destroy the prostate while limiting damage to the bladder.

Any man who is going through surgery or radiation to treat prostate cancer should expect to develop some problems with urinary control. There are new techniques that may help some men only have temporary problems controlling urine, and many may regain full control of their bladder over time.

Treatments options may include (always speak with your doctor for any and all treatment options):

Pelvic floor exercises. Doctors will often start with behavioral techniques that train men to control their ability to hold urine. These exercises are often called “Kegal Exercises”

Supportive Care including behavior modifications. This often includes reduction in fluid intake, reducing/avoiding caffeine, alcohol, or spicy foods, and not drinking before bedtime. Regular and frequent urination and not waiting till the last minute to go may also be encouraged. Losing weight may also help. Medications that also interfere with incontinence may also be reviewed.

Medications may be reviewed as they can increase bladder capacity and decrease urination frequency.

Neuromuscular electrical stimulation is treatment used to retrain and strengthen week urinary muscles and improve bladder control. This treatment involves a probe being inserted into the anus and a current passed through the probe at a level below the pain threshold which causes muscle contraction. The patient is then taught to squeeze the muscles when the current is on. After the contraction the current is switched off.

Artificial sphincter is a patient controlled device mad of tree parts - a pump, a pressure-regulating balloon, and a cuff that encircles the urethra and prevents urine from leaking. Results from an artificial sphincter can cure or greatly improve up-to 70-80% of patients.

Bulbourethral sling is a device used to compress and suspend the urethra. It is made to help achieve ladder control.

Other surgery may also be available on your doctors recommendation to help men hold urine.

If you are experiencing male incontinence there are many products available to avoid embracing leaks through your clothing and also help control odors. Here is a link to our Male Incontinence Products that may help you live a more active and comfortable lifestyle after prostate surgery or radiation treatment.


To follow up on what started this discussion on why prostrate issues impact men and cause incontinence are: enlarged prostate may cause obstruction and flow of urine through the urethra making it difficult to urinate or control when to urinate. Treatments such as radiation and surgery will reduce or eliminate the prostrate, but may result in a reduction in bladder capacity and the inability to control urination and unwanted leakage. Luckily, treatments and surgeries are getting better. Any change in urination or feeling should be discussed with your doctor. Any treatments or changes to existing treatments should be discussed with your doctor.