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urology

Male Urinary Incontinence: Causes and Treatment Options

Urinary incontinence in men is commonly caused by an enlarged prostate (BPH), prostate surgery or radiation, overactive bladder, or nerve damage from diabetes or neurological conditions. It is not a normal part of aging. Effective treatments ranging from pelvic floor exercises to surgical options — including the male urethral sling and artificial urinary sphincter — exist for nearly every type.

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What are the main types of urinary incontinence in men?

Understanding the type of leakage helps direct treatment:

Stress incontinence: Leakage with physical exertion — coughing, sneezing, laughing, lifting, or exercise. In men, this is most often related to weakness of the urinary sphincter following prostate surgery (radical prostatectomy) or pelvic radiation for prostate cancer 1.

Urge incontinence (overactive bladder): A sudden, strong urge to urinate that is difficult to delay, followed by leakage. This occurs when the bladder contracts involuntarily. It may be caused by an enlarged prostate, bladder irritation, neurological conditions, or appear without a clear structural cause 2.

Overflow incontinence: The bladder becomes overfull and dribbles urine because it cannot empty properly. Common causes include a blocked outlet from BPH or a bladder that contracts poorly due to nerve damage (diabetic neuropathy, spinal cord injury) 3.

Mixed incontinence: A combination of stress and urge components. This is not uncommon, especially after prostate treatment.

Why does prostate surgery cause urinary leakage — and does it get better?

The external urethral sphincter — a ring of muscle that controls urine flow — sits just below the prostate. When the prostate is removed during radical prostatectomy, this sphincter is stretched and may be temporarily or permanently weakened. Most men experience some degree of stress incontinence immediately after catheter removal 1.

For the majority, function improves substantially over the first 6 to 12 months, particularly with consistent pelvic floor (Kegel) exercises started before surgery and continued afterward. Men who remain significantly incontinent after 12 months typically benefit from evaluation for further treatment. The 2024 AUA/GURS/SUFU guideline recommends considering surgical intervention as early as 6 months post-prostatectomy in patients with persistent incontinence resistant to conservative management 1.

How does an enlarged prostate (BPH) cause leakage?

BPH (benign prostatic hyperplasia) enlarges the prostate gland around the urethra, narrowing the urinary channel. This can cause:

  • Weakened urine stream, straining to start, incomplete emptying
  • Urgency and urge incontinence — the overactive bladder response triggered by obstruction
  • Overflow incontinence if the bladder becomes chronically overdistended

BPH-related incontinence is typically addressed by treating the underlying obstruction, with medications (alpha-blockers, 5-alpha-reductase inhibitors) or procedural options managed by a urologist 3. Treating the prostate often resolves or greatly improves the associated leakage.

Other causes of urinary incontinence in men

Beyond the prostate, other contributors include:

Overactive bladder (OAB) without obstruction: The bladder is simply overactive, contracting before it is full. This can occur at any age and has effective medication and behavioral treatments 2.

Neurological conditions: Diabetes with peripheral neuropathy, Parkinson's disease, multiple sclerosis, and spinal cord injury can all impair bladder nerve signaling, leading to either urgency/overflow patterns or poor sphincter control.

Urinary tract infections: Acute UTIs temporarily inflame the bladder and cause urgency incontinence. This resolves with treatment.

Medications: Diuretics, alpha-blockers prescribed for BPH (which can relax the sphincter as a side effect), sedatives, and some antihypertensives can worsen leakage.

Constipation: Significant rectal loading can press on the bladder and urethra, contributing to urgency and incomplete emptying.

What treatments are available for male urinary incontinence?

Treatment is matched to the cause and type:

Pelvic floor exercises (Kegel exercises): The foundation for stress incontinence, particularly after prostate surgery. These strengthen the external sphincter and pelvic floor muscles. A pelvic floor physical therapist can provide structured guidance — many men do them incorrectly without instruction.

Behavioral strategies: Scheduled voiding, urgency suppression techniques, limiting caffeine and alcohol, and managing fluid timing help urge and mixed incontinence 2.

Medications for urge incontinence: Antimuscarinic drugs and beta-3 agonists reduce bladder contractions. They do not help stress incontinence.

Male urethral sling: A minimally invasive surgical procedure that repositions and compresses the urethra to restore continence. Best for mild to moderate post-prostatectomy stress incontinence in men without prior radiation 1.

Artificial urinary sphincter (AUS): A surgically implanted device that surrounds the urethra with a cuff the patient manually deflates to urinate and then allows to refill. The current AUA/GURS/SUFU guideline recommends AUS over slings for men with prior radiation and for moderate-to-severe post-prostatectomy incontinence 1.

Treating BPH: For overflow or urgency incontinence caused by obstruction, relieving the blockage often resolves the leakage 3.

Common questions

Is urinary leakage in men ever normal?

Occasional leakage is not 'normal' in the sense of being inevitable, but it is common and often treatable at any age. Urinary incontinence is not something men simply have to accept — evaluation by a urologist frequently reveals a treatable cause.

How long does incontinence last after prostate surgery?

Most men see significant improvement in the first three to six months after radical prostatectomy, with continued recovery up to 12 to 18 months. The pace of recovery varies and is influenced by age, nerve preservation during surgery, and consistent pelvic floor exercise. Men with persistent significant leakage beyond 12 months should discuss further surgical options with their urologist.

Do Kegel exercises really work for men?

Yes — pelvic floor muscle training has good evidence for improving continence in men after prostate surgery, particularly when started early and done consistently with proper technique. A referral to a pelvic floor physical therapist is worthwhile if you are unsure you are performing them correctly.

What is the difference between a male urethral sling and an artificial urinary sphincter?

A male urethral sling is a minimally invasive mesh procedure that repositions the urethra to restore passive continence — best for mild to moderate post-prostatectomy incontinence in men without prior radiation. An artificial urinary sphincter (AUS) is a surgically implanted device with a fluid-filled cuff around the urethra that the patient manually deflates when urinating. The AUS is the preferred option for moderate-to-severe incontinence and for men who have had pelvic radiation.

Which specialist handles male urinary incontinence?

A urologist is the appropriate specialist — specifically one with expertise in male lower urinary tract dysfunction or reconstruction. Some academic centers have dedicated male incontinence programs. Gale can help you identify appropriate specialists and prepare for your evaluation.

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When urinary symptoms in men need prompt attention

  • —Complete inability to urinate (urinary retention) — go to an emergency department
  • —New urinary leakage with back pain, leg weakness, or numbness — may suggest spinal cord involvement
  • —Blood in the urine alongside new incontinence — warrants evaluation to rule out bladder or prostate pathology
  • —Leakage accompanied by fever — could indicate urinary tract infection or prostatitis

Inability to urinate is a urologic emergency requiring same-day evaluation. Go to an emergency department or urgent care immediately.

This article describes common causes and treatments in general terms. Evaluation by a urologist — including a physical exam, urine tests, and possibly urodynamic testing — is necessary to determine the type and cause of incontinence and the most appropriate treatment for your situation.

References

  1. 1.Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL (2024). Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024). Journal of Urology. doi:10.1097/JU.0000000000004088 ✓Surgical options for post-prostatectomy incontinence including male urethral sling and AUS; AUS preferred over slings for radiation history and moderate-to-severe incontinence; timing of surgical intervention at 6 months for persistent incontinence
  2. 2.Lightner DJ, Gomelsky A, Souter L, Vasavada SP (2019). Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. Journal of Urology. doi:10.1097/JU.0000000000000309 ✓Behavioral and lifestyle therapies as first-line for OAB/urge incontinence; antimuscarinic and beta-3 agonist medications for urge incontinence in men
  3. 3.Lerner LB, McVary KT, Barry MJ, et al. (2021). Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Part I — Initial Work-up and Medical Management. Journal of Urology. doi:10.1097/JU.0000000000002183 ✓BPH as a cause of urgency, overflow incontinence, and obstructive urinary symptoms in men; medical management with alpha-blockers and 5-ARIs

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.