What Are the Most Common Causes of Bladder Incontinence in Older Men?

A fellow caregiver asked...

What are the most common causes of bladder incontinence in older men?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

The answer depends on whether the incontinence is temporary (short-term) or chronic (ongoing). Common reasons for temporary incontinence include a medication side effect, drinking too much caffeine or alcohol, urinary tract infection, and delirium. When the situation changes or is treated, the incontinence tends to end quickly. These same situations can also exacerbate chronic incontinence.

The five most common causes of bladder incontinence in men over 50 are:

Urge incontinence

Urge incontinence (also called overactive bladder) refers to a sudden, strong need to urinate before the leakage. People with urge incontinence may always feel a need to "go," but then they may not feel the need once they're in a bathroom. Or they may feel a need to urinate frequently, especially at night. Even after voiding, the urine may continue to dribble out.

Nerve damage (from injury or a nerve disorder such as Parkinson's disease) and an enlarged prostate (see below) are the main causes of urge incontinence. The nerves may send wrong information to the brain about when the bladder needs to empty. Tumors and urinary stones may also block the bladder-nerve-to-brain signals. Urge incontinence may also be the result of some other medical condition, such as stroke, diabetes, or an infection. In many chronic cases, no specific cause for the urge incontinence can be found.

Overflow incontinence

In overflow incontinence, the person never feels the urge to urinate and the bladder simply keeps filling, until small amounts literally overflow the bladder and leak out.

In some cases caused by nerve damage, the brain receives no messages that the bladder is full until it's too late. Prostate enlargement (see below) also often causes this kind of incontinence, which is one reason overflow incontinence is far more common in older men than women.

Prostate incontinence

The prostate gland is involved with male reproduction, not urination. But it's located just below the bladder, so when there are problems with the prostate (infection or enlargement), it can interfere with normal urination. (It's not technically a separate type of incontinence, but prostate problems can cause urge, overflow, or stress incontinence.) Treatment of the prostate problem often improves the related bladder problem.

Incontinence is also a common problem after surgery or other treatment for prostate cancer.

Functional incontinence

In this situation, the person has normal bladder control, but physical limitations impair the ability to use a toilet promptly. For example, the person may have arthritis or Parkinson's disease, which makes it difficult for them to move quickly and efficiently. People suffering from dementia (such as Alzheimer's disease) may have incontinence if they forget or don't notice their need to go to the bathroom.

Stress incontinence

This kind of incontinence occurs when pressure (the "stress" in its name) is put on the abdomen, such as when sneezing, coughing, getting out of bed or a chair, laughing, or doing some kinds of exercise. The neck of the bladder and the urethra fail to close properly, due to some kind of structural weakness, and the pressure pushes urine out of the bladder. (People with strong muscles can withstand the extra pressure and therefore aren't incontinent.)

The musculature involved may weaken with age or from damage following surgery, such as colorectal surgery or prostate cancer surgery.

Mixed incontinence

Many older people have a combination of types of incontinence, such as stress incontinence with urge incontinence, or urge incontinence with functional incontinence.