Urinary leakage in men and women

As husband and wife urologists, we talk a lot about the urinary tract and how it affects our patients.

In women, the most common urinary concern is incontinence, or the involuntary leakage of urine. There are several causes and many treatment options exist depending on the type.

The two main types of urinary leakage in women are urge urinary incontinence and stress urinary incontinence. For women with urge incontinence, treatment is aimed at improving quality of life disrupted by overactive bladder. Overactive bladder is characterized by urinary urgency, frequency, waking up at night to urinate, with or without urge urinary incontinence. The most important first steps a patient can take to reduce bother include limiting caffeine intake, minimizing fluid intake (unless you have kidney stones, you do NOT need to drink 8 glasses of water a day), and urinating on a schedule every two hours or so while awake. The next step in treatment is medication. Many medications are no longer used due to unfavorable side effects of dry mouth, constipation and even dementia. Newer medications are much safer and better tolerated. Be sure to ask your doctor if your bladder medication is associated with an increased risk of memory loss and dementia.

If medications fail, “third line therapy” is available. This includes tibial nerve stimulation, Botox bladder injections and an outpatient procedure to place a neuromodulation device (think of this as a pacemaker for the bladder). Treatment duration with Botox can last up to 9-12 months and neuromodulation is typically effective for 10-15 years or more, at which point a battery will need to be replaced.

For women with stress incontinence, the mainstay of treatment is procedural, either with an in office urethral bulking agent or a surgically implanted mid-urethral sling. These procedures can be curative and greatly improve women’s quality of life.

In men, the majority of leaking is due to prior prostate cancer surgery. This type of leakage with movement and activity is called male stress urinary incontinence. In addition to pelvic floor muscle exercises, procedural interventions exist as well. The mainstay of treatment is a procedure in which an artificial urinary sphincter is inserted. This is for men with the most severe leakage who are using many pads daily. It involves an inflatable cuff that encircles the urethra, a reservoir behind the pubic bone that stores the fluid when not around the urethral cuff and a pump placed in the scrotum to move the fluid from one location to another. Slings are also used in men with milder incontinence. In both instances, the goal is to get patients down to 1-2 light pads daily.

Men can also experience urge incontinence and treatments are similar as for women; however, some differences do exist which can relate to enlarged prostate.

The bottom line is, if you are suffering from urinary incontinence, many treatment options exist and we encourage you to speak with your doctor about these issues.

-D. Joseph Thum and Lauren Wood Thum are both board certified Urologists at Urology Specialists in Sioux Falls, SD. Dr. Joseph Thum also sees patients in Worthington. In their free time, they enjoy the outdoors and spending time with their sons and German Shepherds. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.