DEAR DOCTOR K:
I’m a man in my late 70s, and I’m having trouble holding my urine. Medicines have helped somewhat, but not completely. My doctor says he’s tried every medicine and that I may have to live with my problem to some degree. Is there anything else you can suggest?
Though you may not guess it from TV ads, losing control of urine — incontinence — is not just a woman’s problem. Men, particularly older men, can have trouble too. Studies find that one in four men your age experience incontinence at least once a year — and as many as one in 10 experience it nearly every day.
If medicines are not fixing the problem completely, there are other ways to manage urinary incontinence that are specifically designed for men. But first, I should say that many commonly used medicines may actually be a cause of incontinence. I’ve included a table of such medicines at the end of this post. If you’re on any of these, talk to your doctor about whether they might be responsible in your case.
As for treatments other than medicines that might help, several pads and other absorbent products are designed for the male anatomy. Drip shields (with light protection) or guards (that absorb more) with waterproof backings slip over the head of the penis. They can be kept in place with any tight-fitting briefs. For heavier incontinence, you can wear absorbent inserts, shaped to fit men, inside your own underwear or special mesh briefs.
If you have constant leakage, devices that collect rather than absorb urine can help. A condom catheter (or “Texas catheter”) is a soft sheath made of silicone or latex. It fits over the penis like a regular condom. It attaches to a drain tube leading to a urine collection bag. The bag is strapped to your leg, underneath your pants and out of sight.
Another option is a clamp placed around the base of the penis. The device is designed as an inflatable ring or a foam-lined frame. The clamp is tightened just enough to prevent urine from leaking. Every few hours, you loosen the clamp to urinate.
You may also be troubled by dribbling urine after the main stream has stopped. To avoid this, try to “milk out” the last few drops of urine. Using your fingertips, start an inch behind your scrotum and gently press upward. Keep applying pressure as you move your fingers toward the base of the penis under the scrotum. Repeat. This maneuver should move the pooled urine into the penis, where you can shake out the last few drops.
Ongoing incontinence can irritate your skin. After each leak, clean the area with lukewarm water or a gentle soap or cleanser. Then apply diaper rash treatment, or a lotion or cream made for incontinence.
Medications that can cause urinary incontinence
|Diuretics, such as hydrochlorothiazide (Esidrix, Hydrodiuril, Oretic), furosemide (Lasix), bumetanide (Bumex), triamterene with hydrochlorothiazide (Maxzide)||Increase urine production by the kidney.||Frequent urination, overactive bladder, stress incontinence.|
|Muscle relaxants and sedatives, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan)||Cause sedation or drowsiness, relax urethra.||Frequent urination, stress incontinence, lack of concern or desire to use the toilet.|
|Narcotics, such as oxycodone (Percocet), meperidine (Demerol), morphine||Cause sedation or drowsiness; relax bladder, causing retention of urine.||Lack of concern or desire to use the toilet, difficulty in starting urinary stream, straining to void, voiding with a weak stream, leaking between urinations, frequency incontinence.|
|Antihistamines, such as diphenhydramine (Benadryl)Anticholinergics and calcium-channel blockers, such as verapamil (Calan), nifedipine (Procardia), diltiazem (Cardizem)||Relax bladder, causing retention of urine; in some cases, increase urine production.||Difficulty in starting the urinary stream, straining to void, voiding with a weak stream, leaking between urinations.|
|Alpha-adrenergic antagonists, such as terazosin (Hytrin), doxazosin (Cardura)||Relax the bladder outlet muscle.||Leaking when coughing, sneezing, laughing, exercising, etc.|