Incontinence: The Facts

Causes.

Incontinence is not a disease in itself, but rather a symptom or result of some underlying condition. It usually is caused by a damaged sphincter, the circular muscle that controls the flow of urine out of the bladder. When damaged—in men, often due to removal of the prostate to treat cancer— the sphincter cannot squeeze and close off the urethra. This causes the urine to leak.

Causes of Urinary Incontinence

Removal of the Prostate — Urinary incontinence can occur following prostate surgery. For men, a radical prostatectomy to treat cancer is the most common cause of incontinence.¹ In order to remove the cancer, parts or all of the tissues that help control urine flow may need to be removed. The rate of incontinence following radical prostatectomy surgery can be as high as 40%². Incontinence is less frequent following prostate surgery to treat an enlarged prostate (benign prostatic hyperplasia or BPH). Approximately 4% of men following prostate removal experience leakage so bad that it has a significant impact on their lives³. Several factors can affect rates of incontinence following prostate surgery, including age, general health and the amount of prostate and surrounding tissue removed during surgery. Patients often experience incontinence immediately following surgery but the leakage usually stops within weeks or a few months. When incontinence persists beyond a few months, you should consult your doctor.

Transurethral resection of the prostate (TURP) — is the most common BPH surgery and can provide long-term relief. It requires a 2-3 day hospital stay and activities are restricted for 4-6 weeks. Side effects can include urinary incontinece.

Infections and Medications — Urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.

Diseases — Causes of chronic incontinence include diseases or conditions that damage or weaken the urinary sphincter muscle. Spinal cord problems such as spina bifida, spinal cord injury and sacral agenesis (malformation of the lower spine) can cause incontinence, as can neurological diseases such as multiple sclerosis, Parkinson's disease, stroke, and diabetes.

DESD — Incontinence also may be the result of detrusor external sphincter dyssynergia. DESD is a serious condition most frequently seen in patients with spinal cord injury and multiple sclerosis. It is caused by lesions between the brain stem and the lower part (sacral region) of the spinal cord.

Urethral Strictures — Another cause of incontinence is recurrent bulbar urethral strictures. This is an area of hardened tissue that narrows the urethra, sometimes making it difficult to urinate. Urethral strictures can occur from scarring, trauma or infections. Strictures obstruct the flow of urine from the bladder, so the bladder must work harder to push the urine through the narrowed area.

1. Blaivas JG. Conquering bladder and prostate problems. New York: Plenum Publishing Corporation, p. 208.

2. Mulcahy JJ. Tips for successful placement of the artificial urinary sphincter. Contemp Urol. Sept. 1999; 46-51.

3. Herr HW. Quality of life of incontinent men after radical prostectomy. J. Urol. March 1994; 151(3): 652-4.