The bladder is a storage tank for urine, bounded by the urinary sphincter, a band of tissue that contracts to hold urine in the bladder and relaxes to release urine. Loss of muscle tone in the sphincter or a defect in the nerves that control it can cause a "weak" bladder, resulting in involuntary loss of urine, or urinary incontinence. In men, an enlarged prostate can impinge on the urethra, the tube that carries urine out of the body, causing urinary symptoms.
Behavior Modification
Behavioral treatment addresses the symptoms, not the cause, of urinary problems. Measures such as voiding the bladder at frequent defined intervals, lengthening the interval between feeling the urge to urinate and using the bathroom or "double voiding"--emptying the bladder, waiting a few minutes and then trying again--can help some people with bladder trouble. The National Institute of Diabetes and Digestive and Kidney Diseases states that a few weeks of Kegel exercises to strengthen the urinary sphincter can improve bladder control in women, but the evidence is not clear for men.
Medication
Depending on the cause of urinary symptoms, medications might help. For men whose symptoms result from an enlarged prostate, alpha-blockers that relax the bladder or 5-alpha reductase inhibitors that shrink the prostate can be helpful. The Merck Manual recommends drugs that relax the detrussor muscle that squeezes the bladder to treat urge incontinence, or loss of urine after a sudden need to urinate, and drugs like pseudoephedrine or imipramine for stress incontinence, or loss of urine from pressures like coughing, sneezing or exercising.
Surgery
For men with urinary symptoms from an enlarged prostate, surgery to remove or reduce the prostate might be helpful. For cases of incontinence due to weak sphincter muscles or severe nerve damage, surgery to install an artificial sphincter might be the solution. Some men and women benefit from a sling procedure that uses the patient's tissue or an artificial mesh to cradle the neck of the bladder and provide additional support for the urethra.
Implanted Devices
If the problem lies with the nerves controlling the bladder, surgical implantation of a neuromodulation device can help. For women with stress incontinence, a doctor can implant a vaginal pessary, a stiff ring that holds the urethra in the correct position, or inject "bulking agents"--usually collagen or carbon beads--into the area around the urethra to narrow the opening and maintain its correct positioning.
