Men's Health

How the male urinary system works

The kidneys filter unneeded substances from the blood stream and send them to the bladder, a muscular bag which can stretch to hold up to 500ml when full. At half-full nerves tell the brain that it's time to urinate and send urine down the urethra, which is kept closed by two sphincter muscles. The inner sphincter will open when the bladder is full but the outer sphincter muscle can be voluntarily held shut to maintain control over urination. The pelvic floor muscles lie beneath the bladder and around the urethra to keep them working correctly. However, for some people there's an interruption to this chain of events causing a leakage..

There is no single cause of male bladder weakness but common factors include:

  • A swollen prostate impeding the passage of urine, can often lead to Urge Urinary Incontinence, or 'the sudden need to go'.
  • Prostate surgery can cause the muscles to become temporarily weakened or damaged leading to Stress Urinary Incontinence – involuntary leaks when you laugh, cough or undertake certain physical activities.
  • Urinary tract infections can cause overactivity in the bladder.
  • Nerve damage, brain injury or medication can sometimes block signals sent to the brain to urinate.
  • Being overweight can put extra pressure on abdominal and pelvic muscles.
  • Diuretic medications for circulatory illness can also increase the risk of bladder weakness.
  • Diabetes can lead to slight urine leakage.

What types of male bladder weakness are there?

The main types of bladder weakness in men are listed below. We've used the correct medical terms so that you'll be familiar with them should you choose to discuss your symptoms with your GP.

Urge Incontinence

Also known as an overactive bladder, this is the most common bladder weakness type for men. You experience a sudden urge to urinate and the bladder involuntarily expels urine. This is usually due to interference in the nerve signals between bladder and brain, often linked to either an enlarged prostate or as a result of prostate surgery.

You may also find that you need to urinate more frequently than the usual 4-8 times a day, and maybe also at night too. However, in certain cases you can 'train' your bladder to urinate less frequently and to avoid urinating at night  Your physiotherapist can help with this

Stress Incontinence

Around 10% of male bladder weakness occurs with a sudden physical exertion such as coughing, sneezing, laughing, exercising or heavy lifting. It usually only involves small amounts of urine and is generally connected to a weakening of the pelvic floor muscles. Your physiotherapist can get you on track with exercises to help with this

Mixed Incontinence

Some 10-30% of men experience mixed symptoms. Usually it's a combination of Stress Incontinence and Urge Incontinence. If you happen to have both bladder weakness types, there's usually one that causes more of a problem than the other, so you should focus on dealing with the most frequent symptom first. Again this is a job with which your Physiotherapist to help you.

Post-Micturition Dribble

This is when the bladder doesn't empty completely and continues to leak after urinating. This is also common with an enlarged prostate or weakened pelvic floor muscles  The physio can help you to strengthen those muscles

Overflow Incontinence

This is a constant or episodic flow of urine, usually caused by an obstruction or nerve damage. If you're experiencing this, it's probably best to get it checked out by your doctor, as they are able to identify symptoms and diagnose this type of male incontinence.

Functional Incontinence

This is an inability to reach the toilet in time because of the difficulties caused by physical or mental illness.

Neurological Bladder Disorders

Damage to the nerves as a result of illness (such as Parkinson's Disease, Multiple Sclerosis or brain injury) can affect the way the brain and bladder communicate. This results in an inability to control the bladder or empty it completely.

You will realise by now that there are many types of male bladder weakness. Certainly, everyone's experience is different. So if you're unsure of your symptoms, it might be an idea to keep a diary recording your urination pattern for a week so you can monitor what happens. You'll then have a record to discuss with your doctor or physiotherapist continence advisor should you wish to.

What you can do about male bladder weakness

Many men have told us how bladder weakness can really interfere with their lifestyle: they cut out certain activities and are constantly checking to see where the nearest toilet is and worrying whether they might smell of urine or that leaks would show through clothing. Well the good news is it doesn't have to be that way. With the right lifestyle changes and protection you can socialise, exercise and carry out all your daily activities with relaxed confidence.

In general, healthcare professionals tend to follow the least invasive methods to improve bladder weakness such as lifestyle changes, physiotherapy exercises and medical devices. If these fail to work, a specialist may consider whether a more invasive treatment is required such as medication or surgery.