Why men should NEVER ignore a weak bladder

As a fit and active man in his early sixties, Raymond Starr had hoped to enjoy his golden years to the fullest. Instead, he was left with a fear of leaving the house or even climbing the stairs.

It wasn’t his mobility that was the problem: it was a much more delicate matter.

Like millions of other men, Raymond experienced the embarrassment and discomfort of urinary incontinence and the impact it can have on a man’s life.

In Raymond’s case, the problem started after surgery for prostate cancer. Diagnosed in 2017, he required a radical prostatectomy, in which the prostate was removed, to prevent the cancer from spreading.

‘I was warned that urinary incontinence would almost certainly be a problem after surgery,’ says Raymond, 67, a retired civil servant from Conwy in North Wales. “But I was just determined to get through the big operation I was facing.”

So he was shocked when, a few days after the successful surgery, doctors removed the catheter that had been inserted to allow his bladder to empty while he was in bed and found that it was “leaking like a running tap.”

Raymond was given incontinence pads to wear at home – ‘but the leakage was so bad I figured them out in minutes’.

His problem was so acute that almost any physical exertion would make him drenched, uncomfortable and embarrassed.

“Every time I coughed, sneezed, or got up out of a chair, I was leaking and I couldn’t control it,” he says.

“Even if I just went upstairs in the house, I was soaked in urine. I had such terrible problems in the beginning that it was difficult to look ahead to the future.’

In about 60 per cent of cases, radical prostatectomy, which around 2,000 men in the UK undergo each year after being diagnosed with prostate cancer, can cause nerve and muscle damage that can lead to poor bladder control.

It is one of many causes of incontinence in men, but while urinary incontinence in women – usually caused by childbirth – has a relatively high public profile, this does not apply to men.

In fact, it is estimated that one in ten men (versus 40 percent of women) suffer from it.

However, the actual numbers could be even higher. A recent survey by Prostate Cancer UK of 5,000 men over 40 found that half reported having experienced urinary incontinence at some point.

‘Many men definitely find it more difficult than women to talk about bladder problems,’ says Karen Powell, a nurse specializing in incontinence who runs a telephone advice line for the charity Bladder Health UK.

“Many men who call find it easier to talk on the phone than in person,” she says. “But it may have taken them a long time to work up the courage to reach out.”

Experts emphasize that the need to use incontinence pads at all is a sign a man should see his GP, and warn that some men risk lasting damage by ignoring incontinence-related symptoms until they become a crisis.

Another leading cause of incontinence in men is benign prostatic hyperplasia (BPH), which affects half of men over 50 and occurs when the prostate—the walnut-sized organ that produces fluid for semen—enlarges with age and by the urethra that drains urine out of the body).

This leads to symptoms such as wanting to urinate more often, but it also causes urinary retention, where the bladder never empties completely. If left untreated, it can cause urine to back up into the kidneys.

In the long term, this fluid deficiency causes serious kidney damage. But if the problem is caught in time, it can be easily treated with drugs to relax the bladder muscles or shrink the overgrown prostate; laser surgery to destroy excess prostate tissue; or an operation called transurethral resection of the prostate (TURP), which involves removing some of the prostate tissue to improve urine flow.

“We see about one male patient a month in our hospital who has irreversible damage to his kidneys because he kept putting off going to the doctor with urinary retention,” said Gordon Muir, a consultant urologic surgeon at King’s College Hospital in London. . ‘These patients usually end up on kidney dialysis for life or on the waiting list for a kidney transplant.

“In some cases, they are often older men with no social support, or they have learning disabilities and don’t realize the severity of their symptoms.”

He adds, “Some men ignore the symptoms of an enlarged prostate for several years before seeking help. Often we see men who have been dragged into the clinic by their partners who insist that they tell us to get up several times a night to go to the toilet.

“Some men worry that they smell bad or that they feel wet all the time and that they have to change their incontinence pads five or six times a day. Some become a complete recluse as a result.’

Another highly treatable cause of incontinence in men is overactive bladder, which affects more than one in 12 adults in the UK, causing an urgent and frequent urge to urinate.

In Raymond’s case, it took more than a year for his incontinence to improve significantly – thanks in large part to a daily routine of pelvic floor exercises recommended by a specialist. Experts believe that men with signs of incontinence should be encouraged to do regular pelvic floor exercises.

And it’s not just older men who bear the brunt of poor bladder function, warns Mr. Muir. A disturbing trend in recent years has been the significant damage done to their bladder by men in their teens and 20s through recreational use of ketamine.

Developed as a sedative for horses and used as an anesthetic in surgery, its illegal use has doubled in the past 15 years, government figures suggest.

But studies have shown that regular use of the drug can cause severe inflammation in the lining of the bladder, leading to urinary incontinence and retention, and eventually kidney failure. “In some young men, it destroys their bladder and they end up having to use a urostomy bag [an external bag that collects urine instead of the bladder]which must be emptied regularly and worn for life,” says Mr Muir.

A large 2019 study by Florida International University that looked at nearly 9,000 men ages 50 and older found that men with urinary incontinence were about 30 percent more likely to be diagnosed with depression than men with healthy bladders.

Such findings resonate with Raymond: “I’m quite a positive person, but I know that urinary incontinence can cause anxiety and depression for many men – in part because they find it difficult even to talk about it.”

While there is no accepted medical definition for what is ‘normal’, the NHS website urges men to respond to changes in their usual pattern. But even for men facing their incontinence diagnosis, life can be far from simple.

The charity Prostate Cancer UK has teamed up with toilet supplier PHS Group on a new campaign to ensure that all male bathrooms have special bins for used incontinence pads or pants. Currently there are none.

The Health and Safety Executive’s guidelines state that all women’s bathrooms must have “appropriate means” for disposing of sanitary items, such as incontinence pads, but make no mention of men.

The initiative, called Dispose With Dignity, was launched after a survey of 500 men with incontinence found that nearly 40 percent carried plastic bags with them when they left the house to put in urine-soaked items; a third had asked partners to keep it in their handbags; and 32 percent kept wet pillows or pants on — rather than being embarrassed to wear them.

PHS Group has designed special male incontinence trays for companies to use. Moto Group motorway service stations are the first to adopt them.

Meanwhile, five years after his surgery, Raymond is “about 80 percent better.” A few weeks after his operation, he was referred to an incontinence clinic and given instructions on how to do pelvic floor exercises (see box).

“I would do them 10 times a day, but even then I became very disillusioned because I couldn’t see that I was making any progress,” he says. “There is no quick fix. Gradually, after about a year, the exercises began to have an effect.

“Occasionally I still have a leak and if I stay in a hotel, for example, I wear incontinence pants for men just to be on the safe side. It was a post-surgery struggle, but in reality it was the least of my worries. Saving my life was more important.’