Bladder weakness in men a major taboo – but effective solutions are available
One in five people suffer from a weak bladder at some point in their lives. For men, the main factors include ageing and complications following an operation, such as prostate cancer surgery. Psychologically, incontinence is a taboo subject for men and such an emotional burden that it can lead to self-imposed social isolation or even suicidal thoughts. However, effective treatments for incontinence are out there. Implants, for example, can provide relief following prostate cancer surgery, while urge incontinence can be controlled with drugs and Botox injections. These and other options for treating urinary incontinence formed the focus of discussions between leading urologists, physiotherapists, carers and other experts at the Austria Center Vienna from 7-10 September.
“One in five people suffer from a weak bladder at some point in their lives, and women and men alike are affected,” said Prof. Wilhelm Hübner, coordinator of the expert committee at the incontinence centre of the Confraternität Private Hospital in Vienna and scientific director of this year’s global congress of the International Continence Society. “Although much has been done in recent years, bringing an end to the taboo surrounding incontinence, particularly in men, remains extremely important. Many people suffer in silence – resigning themselves to something along the lines of ‘incontinence won’t kill you, but it does rob you of your freedom’. They simply accept the psychological burden as part of the problem. Unfortunately, in many cases we see that men affected by the condition increasingly isolate themselves socially out of shame, start harbouring suicidal thoughts or end up delaying or refusing oncological treatments due to a fear of possible secondary incontinence. But it doesn’t have to be this way as effective treatments for incontinence are available. What’s more, the treatments given to patients are not stressful, and the results are often so outstanding that patient feedback tends to be overwhelmingly positive due to the quality of life they regain,” he explained.
Contemporary treatment of incontinence following prostate cancer
Prostate cancer is the most common form of cancer in men. In Austria, the number of new cases diagnosed each year is put at around 4,400. Treatment of the disease can compromise the patient’s continence. And this continues to put many men off from having life-saving surgery. After an operation, lots of patients suffer psychologically, with their incontinence and possible complications such as impotence providing a permanent reminder of their cancer. The good news: urge incontinence – which can develop in the wake of an operation due to tissue damage incurred when the cancer is removed – can be treated effectively. “It is common for continence to return once the wound has fully healed – which can take up to half a year after the operation itself. That said, only 5-15% of patients experience such severe urinary incontinence that further treatment is required,” Hübner noted. Unlike in women, for whom post-pregnancy and post-partum stress incontinence can be treated by building up the pelvic floor muscles, the causes for men often involve damage to the smooth muscle – something which cannot be treated with physiotherapy. “To bring the issues with the sphincter system caused by the absence of the prostate under control, various implants can be fitted which increase resistance in the urethra and, in doing so, regulate the bladder sphincter. The type of implant and the surgical procedure selected depends on the specifics of the individual patient’s case and is often carried out in special centres due to the complexity of the treatment. The satisfaction rate among male patients is 90% once the new implant is activated,” the urologist explained.
The future of implants is digital
At present, the different implants that regulate the bladder sphincter are triggered manually by activating a hydraulic pump inside the body. “However, the future of implants lies in electronic approaches. In a few years it will be possible to trigger the sphincter via a small remote control or smartphone. This represents a further step towards making life easier for patients,” Hübner confirmed.
Age a risk factor for urge incontinence
In addition to stress incontinence, which primarily develops in men as a result of various factors including surgery, males can also develop urge incontinence or an overactive bladder. In these cases they experience a sudden, unexpected need to urinate, which leaves them unable to get to a toilet on time. “While just 5% of men aged 30-40 are affected, the risk increases with age, reaching 20-25% for men aged 60-69. Temporary relief is provided by a new generation of medicines that can be taken around 1.5 hours before embarking upon activities where WC facilities are not immediately accessible, such as excursions, bus trips, flights or cinema visits. A longer-term solution that is particularly effective for older people involves injecting Botox directly into the wall of the bladder,” added Hübner. This has the effect of “muting” the bladder, and as a result two to four weeks after the treatment is administered the symptoms associated with an overactive bladder disappear for a period of six months.
About the International Continence Society
The Annual Meeting of the International Continence Society – which will take place this year at the Austria Center Vienna from 7-10 September – and the ICS journals promote a worldwide multidisciplinary approach to continence research and training. The Austrian Medical Continence Society (MKÖ) is the national point of contact for those affected and their relatives.
Internationales Amtssitz- und Konferenzzentrum Wien, Aktiengesellschaft (IAKW-AG) is responsible for maintaining the Vienna International Centre (VIC) and operating the Austria Center Vienna. The Austria Center Vienna is Austria’s largest conference centre, with 19 halls, 180 meeting rooms, and some 26,000 m² of exhibition space, and is one of the top players on the international conference circuit.