Urinary incontinence common in older men too

NEW YORK 24 aug 2010– It's not just women who suffer from urinary incontinence: Nearly one in twenty U.S. men have moderate to severe forms of the condition, which is as common as one in six among elderly men, a new study finds.

Research suggests that urinary incontinence affects women about twice as often as it does men. But the new findings, researchers say, underscore the fact that despite their relatively lower risk, men commonly deal with the condition as well.

The study found that among 5,300 U.S. men age 20 or older who participated in a government health survey, 4.5 percent reported symptoms of moderate to severe urinary incontinence -- defined as having leakage at least once a week, or once a month at volumes "more than drops."

Among men age 75 and older, 16 percent met that definition.

In all, that translates to an estimated 8.2 million U.S. men with moderate to severe urinary incontinence, the researchers report in the Journal of Urology.

"It's a common problem," said lead researcher Dr. Alayne D. Markland, of the Birmingham VA Medical Center and the University of Alabama at Birmingham.

Yet, she told Reuters Health, doctors and patients alike may not think to bring up urinary incontinence symptoms. "Older patients often think that it is just part of aging," Markland noted.

But she advised men to discuss any incontinence problems with their doctors, as there are a number of effective treatments.

The options include Kegel exercises -- a set of exercises that help strengthen the muscles of the pelvic floor -- as well as behavioral changes, such as scheduled bathroom trips and limiting fluids at certain times of the day. There are also a number of medications that help treat incontinence, and two of Markland's co-authors had relationships with companies that sell or research such drugs. In more severe cases, surgery may be an option.

Men with urinary incontinence will have the added step of needing a prostate check, because prostate-gland enlargement is a common cause of urinary symptoms.

Markland and her colleagues also found that several factors were linked to an increased risk of moderate to severe urinary incontinence.

One, not surprisingly, was older age. Another was major depression.

Among men who screened positive for major depression, about 11 percent had moderate to severe urinary incontinence, versus 4 percent of men who did not screen positive.

When the researchers accounted for other factors -- including age and the presence of chronic physical diseases -- depressed men had between two and three times the risk of moderate to severe urinary incontinence that non-depressed men had.

Other studies have seen a similar link between depression and urinary incontinence in both men and women, according to Markland. "But we don't know if that's a cause-and-effect relationship," she said.

On one hand, it's possible that serious problems with incontinence contribute to social isolation and depression in some people. Alternatively, there could be physiological effects connected to depression -- such as alterations in the brain chemical dopamine -- that impair bladder function.

Another possibility is that some of the medications used to treat depression cause incontinence as a side effect. Markland noted, however, that there is no evidence that the widely used SSRI antidepressants cause urinary incontinence.

In what Markland said was a rather surprising finding, the researchers also found that men with high blood pressure had an increased risk of incontinence. Roughly 9 percent had moderate to severe symptoms, versus 3 percent of men without high blood pressure. With other factors taken into account, high blood pressure was linked to a 30 percent increase in the risk of urinary incontinence.

As with depression, Markland said, the reasons for the connection between high blood pressure and incontinence are not yet clear. Again, she said it's possible that medications used to treat high blood pressure cause bladder control problems in some men, but that has yet to be shown.