Off The Record – I wet the bed

OK men. It happens. And not just to women after having babies. It happens to you too. I have found over the years men do not like to talk about this – until it’s too late – or until their partners drag them into my office kicking and screaming. Why? Because they are tired of watching you live this way.

It’s called urinary incontinence – the involuntary loss of urine. If you are married to a woman, or have been around women long enough, there’s a good chance your wife/lady friend knows exactly what this is. She might have to run to the bathroom every time she sneezes. She might ask you to pull over on road trips every hour. But this isn’t a ‘woman’ problem – it’s a bladder problem! And you have one too.

Let’s begin with some education

The brain is connected to the bladder, the bladder is a muscle, and when told it’s ok to empty your bladder, your urethral sphincter relaxes, opens, and the bladder muscle squeezes and you (are supposed to) empty your bladder. But this isn’t a one-way street. Your bladder tells your brain we gotta go, your brain tells your bladder it’s ok to go, but only when it’s supposed to be ok to go – like when you’re standing or sitting over the toilet, a tree, or whatever. Are you starting to see that there are quite a few steps here, and therefore quite a few ways this can go awry?

Sphincter

Try saying that word aloud three times. The next time you feel angry, or heated, or are in a verbal debate with someone, just say the word sphincter three times. I promise you’ll laugh and then forget about why you were even angry in the first place because it’s just a lot of fun to say the word sphincter. And do you want to know something? You actually have two sphincters in your urinary tract – an internal one that you can’t control and an external one you can. Don’t let the names confuse you – both are located on the inside.

Ok, I digress. Saying sphincter out loud distracted me. Now you know a little bit more about how your bladder is supposed to work. When we talk about urinary incontinence, or urinary leakage, there are two broad categories: Stress Urinary Incontinence and Urge Urinary Incontinence.

Stress Urinary Incontinence

Overall, we tend to manage stress urinary incontinence with surgery, because it’s usually a surgical problem, or incontinence as a result of surgery. This is essentially for those of you who have had prostate surgery. Radical prostatectomies – surgery to remove the entire prostate for cancer – have a high rate of urinary leakage immediately after surgery. This tends to improve over time, but for about 20% of all patients, the incontinence persists after a year. These patients would benefit from a surgical evaluation. Leakage can also occur as complications from prostate procedures for non-cancer reasons like an enlarged prostate (BPH).

My happiest patient are the guys who come see me and get this fixed. It’s life changing

I like to explain to my patients that stress incontinence occurs with physical stress. This is leakage when you cough, sneeze, laugh, lift heavy objects, and swing a golf club. After prostate surgery, leakage may occur as soon as you stand up, or when you are walking, or it could just be a constant trickle all day. Sound miserable? It is miserable. My happiest patients are the guys who come see me and get this fixed. Seriously, it’s life changing. OK back to the talk.

Leakage caused by stress urinary incontinence is a pelvic floor/sphincter issue. There are two incredible surgeries to fix this. One is a urethral sling; the other is an artificial urinary sphincter. You’ll have to see a Urologist and have an evaluation to discuss which one is best for you.

I personally love sphincters. I think you know that already based on my recommendation to repeat the word three times. An artificial urinary sphincter – AUS as we call them – is a device that replaces your external sphincter. It is essentially a balloon that inflates, holds your urethra shut, and with the squeeze of a pump, it deflates and lets you urinate. No one knows it’s there. You make a stream that sounds like a regular urine stream. Head to www.fixincontinence.com for some videos and more information. You can even type in your zip code and find a Urologist nearby who does them. You are now well on your way to becoming a bionic man! And yes – before you ask – you can have an AUS and an IPP (Inflatable Penile Prosthesis) – the Cadillac of the Crown Jewels!

Urge Urinary Incontinence

This is when your bladder muscle misbehaves and you leak on the way to the bathroom, or around running water, or in cold weather. It’s when your bladder says let’s go but then only gives you 5 seconds to get there, and it’s running down your leg before you’ve even taken your first step. This type of incontinence can come along with neurologic diagnoses, after a stroke, with diabetes, etc. It’s often managed by medications and lifestyle changes.

See if you can improve your incontinence symptoms by adjusting your diet

A good Urologist will start by asking you about your diet and drinking habits. What you put in your body comes out in some shape or form. There are many things that irritate your bladder and increase your urgency and frequency. These include: caffeine, acidic foods/beverages, artificial sweeteners, dark liquids, etc. You can google ‘bladder irritants’ and come up with some pretty good stuff. This is step 1 – educate yourself about your bladder and see if you can improve your symptoms by adjusting your diet.

Quick myth debunking: Dehydrating yourself does not make you leak less – it’s the opposite! Your bladder hates concentrated, dehydrated, acidic urine. The best thing that you can do is drink fluids – and I’m talking water. If your urine is dark yellow, you aren’t drinking enough water.

These meds work to calm your bladder muscle down so it doesn’t squeeze whenever it wants

If adjusting your diet isn’t good enough, we often move on to medications. There are two broad categories here – anticholinergics and beta agonists. Big words, I know. You might hear names like Oxybutynin, Detrol, Trospium, Mirabegron – just to list a few. These medicines work to calm your bladder muscle down – to try to relax it more so that it doesn’t squeeze whenever it wants. They have side effects and contraindications so make sure you talk to your Urologist before you start any of these.

And if the medications don’t work, if they give you side effects, or cost too much money, other options include Botox (for your bladder – not just that beautiful face of yours), neuromodulation, and other procedures.

If you can find a great pelvic floor therapist, and if your urologist recommends it – do it

And here’s another free tip for you. If your Urologist suggests Pelvic Floor Physical Therapy – do it! But I caution that not all physical therapists are created equally and pelvic floor PT is a unique subset of physical therapy. If you can find a great pelvic floor physical therapist, and if your Urologist recommends it – do it. Pelvic PT is life changing for many patients. Give it a chance before you scoff!

Find a fiber supplement at your local pharmacy and add it to your daily routine

And one more freebie. I should really figure out how to collect tips off of this – I’m giving away so many of my secrets! Work on your bowels. Constipation is going to worsen your urinary symptoms. If you struggle with this, find a fiber supplement in your local pharmacy and add it to your daily routine. Your bladder and your prostate will thank you.

Before I close out, I have to say the word penis. It just wouldn’t be an Off the Record Post without it. Take care of your bladders, your bowels, your prostates (if you have them), and of course, your penis, penis, penis!
b