The Prostate and Male Urinary Leakage

Male urinary leakage, the prostate and incontinence aren’t perhaps the kind of topics for polite dinner party conversation. However, for men, it’s important to get informed about these issues and how they impact and affect other. To clear up any confusion, we sat down with Ralph Peeker, Professor and Chief Physician at the Department of Urology, Sahlgrenska University Hospital, Gothenburg.

Your prostate, it’s like a walnut

Any dialogue concerning male urinary leakage, incontinence or bladder leakage inevitably involves discussing the prostate gland. So how much do you know about yours? Situated right below the bladder surrounding the urethra, its main job is to produce a fluid that combines with sperm to make semen. In your twenties, your prostate is around the size of a walnut, or about 18-20 grams.

Like your ears, your prostate never stops growing

The good thing to know is that prostate growth is normal. “For some men their prostate grows a little bit. For others, a little bit more and, for some men, a whole lot more – it can grow up to half a kilogram,” says Peeker. Often prostate growth goes unnoticed, but for some men an enlarged prostate, or benign prostatic hyperplasia (BPH), can cause a range of symptoms. These include difficulty in starting to urinate, a feeling that the bladder is not empty after urinating, an interrupted or weak urine stream, a frequent urge to urinate and frequent nighttime urination. Known as lower urinary tract symptoms (LUTS) these are quite common, affecting around 25% of men over 40 years of age. With good treatments available, these symptoms don’t need to affect quality of life.

An enlarged prostate doesn’t mean cancer

According to Peeker it’s a ‘very common misconception’ to think that LUTS are a symptom of prostate cancer. While there are not so many early warning sign of prostate cancer, family history and diet can both be risk factors. The first step in checking is via a simple blood test known a PSA test.

Interestingly, prostate cancer grows slowly in a lot of cases. That’s why active monitoring is often a preferred management rather than surgery where incontinence, amongst other things, can be a side effect. Stress incontinence, which more commonly affects women, can be a temporary, or permanent, side effect of pelvic surgeries like a prostatectomy. This surgery involves removing the entire prostate, which can disrupt the sphincter function and result in urinary leakage. There are medicines and surgeries available to help ease, if not cure this. In mild cases, pelvic floor exercises, which help to strengthen your pc muscles, can help improve your bladder control and reduce urinary leakage. Regardless, if you’re concerned about any symptoms, testing or risks related to prostate cancer, it’s best to chat with your doctor so you’re well informed. 

“The prostate is often not the guilty organ”

While an enlarged prostate can cause male urinary leakage, bladder leakage and other types of incontinence, Peeker says we need to look beyond the pelvic region and to the brain when it comes to the main cause of male incontinence.

Your central nervous system is responsible for governing your ‘micturition reflexes’, or the ability to hold on when you need to go to the bathroom. These critical circuits in the brain can be disrupted when you experience a trauma such as a brain injury or a stroke, resulting in the involuntary leakage of urine that some men experience. Known as urgency incontinence, it’s the most common form of male incontinence.

But the disruption doesn’t even have to be as severe as a stroke. “It could be a minor disruption of blood and oxygen to the brain based on general atherosclerosis,” says Peeker. 

Where atherosclerosis is the hardening and narrowing of the arteries caused by smoking, a poor diet and inactive lifestyle. And while a bad diet hasn’t been clinically proven to cause incontinence, a healthy diet and active lifestyle can only be beneficial. “Everything gets better when it comes to the oxygenation of tissues in the body,” adds Peeker.

As for Peeker’s advice; “If I had a symptom of any kind, I would seek help for it.” So if you do have any questions regarding the prostate and urinary incontinence, have a chat with your doctor.

Male urinary leakage treatment and symptom management

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