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Ask the Doctor: Tammy Ho, M.D.

Q. I have male urinary incontinence. What are my treatment options?

A. Male urinary incontinence, or involuntary leakage of urine, can be split into two main types: stress incontinence and urge incontinence.

Stress incontinence occurs when your urinary sphincter muscle is weakened, either as a side effect of a surgical procedure or after treatment of prostate cancer. Symptoms typically include leakage of urine with coughing, laughing, sneezing, changes in position, or increased activity. Depending on how much leakage you experience, there are a wide variety of treatment options.

For men who experience small amounts of leakage, pelvic floor physical therapy can strengthen accessory muscles, which help prevent leakage of urine. Hoag Pelvic Health Program specializes in treating both men and women for a variety of disorders, including urinary incontinence.

In men who have a higher degree of incontinence that affects the quality of their life, then incontinence surgery may be an option to discuss with your urologist. Surgical options include placement of a male urethral sling or an artificial urinary sphincter. A male urethral sling involves a small incision in the groin (between the base of the scrotum and the anus) and uses a synthetic, but safe, mesh to compress the urethra and improve incontinence. However, studies have shown that men who have previously undergone radiation have poorer results from a urinary sling.

For men who have previously undergone radiation or have large amounts of stress incontinence, an artificial urinary sphincter is the gold standard for surgical intervention. It involves placing an inflatable cuff around your urethra and a small pump hidden in your scrotum which opens the cuff to allow urination. It is a safe, effective way to vastly decrease urinary leakage.

The other type of incontinence (urge incontinence) is characterized by leakage of urine associated with urinary urgency and the inability to reach a bathroom in time. This is often related to overactivity of the bladder, which often responds well to medications. In refractory cases, some patients notice significant improvement with either injection of Botox into their bladder during a short clinic visit or implantation of an Interstim device through surgery.

It is important to schedule an appointment with your urologist who can assess your symptoms and discuss the proper treatment options for you.

Tammy Ho, M.D., attended Duke University for her undergraduate studies and medical school. She completed her urology residency at Washington University in St Louis and her fellowship in Male Reconstructive Urology at University of California Irvine. She practices in Newport Beach and Irvine.