Bladder control in men


What is normal bladder control?
The production of urine is not at any time under our control, but as adults we have acquired the ability to recognise when our bladder is full, and to be able to hold on to urine until we reach the toilet. We therefore have control over when and where we pass urine. This control is possible because of messages passing between the brain and the bladder, and our ability to interpret these messages. When we have this control we are said to be "continent".


What is incontinence?
Incontinence is a sign that one of the mechanisms that keep us dry is not working correctly. How the incontinence affects you depends on what is causing it. For this reason it is important to seek professional help from your doctor or continence adviser (a nurse or physiotherapist with special expertise in continence management) so that the cause can be found and appropriate treatment given. You may be referred to a urologist (a doctor who specialises in treating disorders of the urinary tract).


What flow problems can men encounter?
One in three men over 50 years of age experiences some difficulty in passing water. The way men pass water changes gradually as they get older, so at first they may not notice there is a problem.


Typical changes include:

difficulty or delay in starting to pass water. The first step in starting the flow is to relax the muscles under the bladder in the pelvic floor. Delay in starting is common with ageing, and with prostate problems, but it can also be due to shyness if voiding in a public toilet. This affects about 30% of men, who have no problems passing urine in private.
stopping and starting in the middle of passing water
after finishing, a bit more urine trickles out. After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause an ambarrassing wet patch on the trousers. This is due to urine pooling in the water pipe (urethra). It can be prevented by making sure there is nothing pressing on the urethra, like tight clothing or zips. The drips can be helped by milking the water pipe using the fingers (see Milking technique below).
a smaller and weaker urinary stream, so it takes longer to pass water than it used to. It may also stop and start and as the bladder empties, the flow can slow down to just a trickle. This is called 'terminal dribble'.
a feeling of not quite having emptied the bladder. This symptom sometimes indicates the presence of residual urine, but is not always accurate at predicting this.


Is your urine flow 15 or less?
Some, or all, of these difficulties in passing water can happen because in most people over the age of 40, the prostate gland gradually becomes enlarged after 40 years of age. The prostate sits under the bladder and around the outlet (or urethra) through which urine passes to the outside. Enlarging of the prostate is called benign prostatic hyperplasia, or BPH. The difficulties caused by BPH can be relieved by medication or if necessary by surgery. If you are worried because you have difficulty passing water, consult your doctor who can advise you on treatment. Men with flow rates under 15 should talk to a health professional.

See also Bladder problems and the prostate

What is the milking technique for preventing dribble?
Wait a few seconds after passing urine for the bladder to empty completely. Place the finger tips of one hand under the scrotum (approximately three finger breadths) and apply gentle upward pressure. Keep the pressure on the midline and firmly move the fingers forward towards the base of the penis under the scrotum. This milks urine forward in the urethra where it can be emptied by shaking or squeezing in the usual way. Repeat this technique twice to ensure complete emptying. This whole procedure should take no more than a few seconds.


Storage symptoms or overactive bladder symptoms:

Increased frequency of bladder emptying
This refers to passing urine more often than usual in the daytime, and if there is also a need to get up at night, this is termed nocturia. Increased volumes of urine can be the cause. Drinking large volumes of fluid especially tea, coffee, chocolate drinks, or alcohol in the evenings, will mean a person has to empty the bladder more often.


Cold weather makes the bladder more irritable.

Diuretic medications like frusemide, prescribed for blood pressure or heart failure, can cause increased frequency. These tablets are best taken in the morning to allow time to get rid of the extra water in the body. Increased frequency can also arise simply because of an effect of ageing on the kidneys and bladder. An overactive bladder can be the cause.


Urgency alone or with urge incontinence
This means the urgent desire to empty the bladder, which if not responded to promptly, might lead to leakage of urine before reaching the toilet. It can be very embarrassing. Often it is caused by an overactive or irritable bladder. This can happen with ageing, but also if the bladder outlet is restricted by the prostate. Nerve problems to the bladder can also cause it.


Stress incontinence
This refers to leakage on coughing, straining or any exertion, and is uncommon in men. It can occur if nerve damage has occurred due to spinal injury, or if the urethral muscles are damaged after a prostate operation. You should discuss this with your doctor and the urologist.


Blood in the urine
If you notice any blood in your urine, or experience pain on passing urine see your doctor, because these symptoms can indicate a more serious problem.


What can I do about bladder problems?
For some bladder control problems, simple strategies such as Kegel exercises or bladder training may be helpful.