Male incontinence

Summarized by Robert W. Griffith, MD
July 31, 2000 (Reviewed: December 13, 2002)

Introduction

Urinary incontinence is commonly regarded as a female problem. However, incontinence is not infrequent in older men, and is indeed reported in all age groups. It's prevalence has been reported to be as much as half that in women. Unfortunately, men with incontinence seldom discuss this with their health professional, so that potentially effective treatment is never applied. A recent study of the frequency of the condition among US Veterans reveals the extent of this problem.

Method

Male patients in the waiting rooms at three primary care Veterans clinics in Louisville, Kentucky, were invited to participate in the study, by completing an anonymous, written survey form. The questions covered basic demographics, previous genitourinary surgery, bladder medications, the subject's continence status, the number and frequency of episodes of incontinence, relevant discussions held with their health professionals, their interest in treatment, and a quality-of-life assessment (the Incontinence Impact Questionnaire [IIQ]¹ ). Current urinary incontinence was defined as involuntary urine loss in the past 12 months.

Results

Out of the 991 men approached, 840 (85%) agreed to participate. Their mean age was 59.8 years, and 16.4% were African Americans. Of the 840 participants, 809 provided usable surveys for analysis.

Current incontinence was reported in 25% of men aged 40 or below. Although incontinence was most prevalent in the 61- to 70-year age group (36%), it was reported with a prevalence of over 30% in all 10-year age groups from 41 up to 80 years; at 81 years and over, it was only 20%. Neither the amount nor the frequency of urine loss was significantly related to age.

Odds ratio (OR) calculations were used to examine relations between incontinence and potential variables. The risk for incontinence was significantly increased by previous prostate surgery (OR 2.05), bladder surgery (OR 3.29), and the use of antispasmodic agents (OR 3.29). No significant effects were found for prostate cancer, the use of diuretics, or prostate-active medications.
The frequency of incontinence was associated with small but significant changes in the subscales of the IIQ: emotional health, social relationships, physical activity, and travel.
Significantly, only 32% of subjects with current incontinence had discussed their problem with their health professionals. However, 75% of these subjects expressed an interest in evaluation and treatment of their problem.

Comment

This study shows that male incontinence is a real problem across all age groups, affecting men's quality of life, and yet one that is not often discussed with their physicians. This may be because of embarrassment, or the mistaken idea that nothing can be done.

In spite of the somewhat simple approach adapted by this study, it nevertheless demonstrates that there is much room for improvement in the diagnosis and management of male urinary incontinence. Genitourinary surgeons should be aware of the frequency of the condition following prostatectomy and bladder surgery. Sufferers should not suffer in silence, but question their health providers about improved management of their problem.

Source

• Urinary incontinence among male veterans receiving care in primary care clinics SH. Smoger, TL. Felice, GH. Kloecker, Ann Intern Med, 2000, vol. 132, pp. 547--551

Footnotes
1. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. SA. Shumaker, JF. Wyman, JS. Uebersax,  et al., Qual Life Res, 1994, vol. 3, pp. 291--306

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.