BPH and Urinary Incontinence

Posted on: March 12, 2024

As most men age, their prostate continues to grow. When the prostate gland begins enlarging again during its second main growth phase that occurs when a man enters his mid-20s, it begins setting the stage for potentially disruptive urinary challenges that can occur later in life. These differences in urinary demands can be annoying or bothersome at first, but can eventually become life-altering or even dangerous. A disease called benign prostatic hyperplasia or BPH, also referred to as prostatic hyperplasia or an enlarged prostate, is typically to blame for these annoying urinary symptoms. Even though being diagnosed with BPH means that the prostate has enlarged abnormally, BPH is a benign condition and not cancer, and it isn’t suspected of leading to cancer. Unfortunately, BPH-induced Lower urinary tract symptoms (LUTS) that some men begin experiencing as they enter their 40s and 50s, can become more problematic as men reach their 60s and beyond. And yet another urinary complication, related to BPH, that some men have to deal with is a voiding issue known as urinary incontinence.

When a man is diagnosed with benign prostatic hyperplasia, it typically means that the prostate gland has grown large enough to begin causing various urinary symptoms such as a poor or intermittent urine stream, increased frequency, dribbling, difficulty urinating, urgency, the feeling of incomplete bladder emptying, nocturia (waking frequently at night to urinate), urinary incontinence and more.

What is Urinary Incontinence?

According to the Mayo Clinic, urinary incontinence is the loss of bladder control resulting in an unintentional leakage of urine. As a man gets older and his prostate continues to grow larger, the prostate can put added pressure on the urethra (the tube that carries urine from the bladder out of the body) and the bladder which stores urine. While the prostate tends to increasingly pinch the urethra as it gets bigger, the bladder walls concurrently grow thicker (trabeculation) in response to having to work harder to expel urine.⁵ This overworked condition causes the bladder muscles to weaken, leading to various types of urinary incontinence.¹

When the brain signals that it is time to urinate, the bladder muscles contract, and urine flows through the urethral tube until it exits the body. However, when benign prostatic hyperplasia is present and the enlarged prostate irritates the bladder, it can block or decrease the flow of urine. “This can result in painful urination, urinary retention, and other incontinence symptoms, such as urinary leakage.”¹

With the male urethral tube extending from the floor of the bladder, through the prostate, and to its termination at the tip of the penis, its length can reach 7 to 8 inches. This is 5 times the length of a female’s urethra, so there are ample opportunities for constriction to occur as urine exits the bladder and attempts to make its way out of the body.³

Types of BPH-Related Urinary Incontinence

Urinary incontinence can present in various forms with those diagnosed with BPH. They are listed below. Any one of these types of urinary incontinence can be problematic, but a man diagnosed with benign prostatic hyperplasia can display one or multiple types of incontinence depending upon their unique anatomy, how large the prostate has grown, and in what orientation.

Overflow Incontinence

An enlarged prostate can obstruct the flow of urine, leading to incomplete emptying of the bladder. Over time, the bladder may become distended (swollen or bloated), and this can result in urine leaking out when the bladder is full.⁶

Urge Incontinence

BPH can lead to irritative symptoms, including the sudden and overwhelming urge to urinate. This urgent need to go can result in the involuntary loss of urine before one can reach the restroom.

Stress Incontinence

Although not quite as common with benign prostatic hyperplasia, stress incontinence can result from the prostate’s increased pressure on the bladder and can manifest itself with the weakening of pelvic floor muscles and the urethral sphincter. This can result in the leakage of urine during abdominal pressure episodes such as laughing, coughing, sneezing, grunting, lifting heavy objects, or even exercising.¹

Functional Incontinence

A mental or physical issue can make it difficult to make it to the bathroom in time. An overfilled bladder can be irritative enough to slow movement and could become a detriment to being able to urinate when desired. Also, the inability to remove clothing in time could serve as a physical barrier that can lead to functional incontinence.²

Overactive Bladder (OAB)

This type of urinary incontinence in men is typically attributed to a bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia and results in urinating more frequently than typical.⁴

Nocturia

Bedwetting or frequent urination at night are forms of urinary incontinence that can interfere with sleep habits, increase tiredness, and lead to a lower quality of life.¹

Post-Void Dribbling

When suffering from benign prostatic hyperplasia, there can be a fair amount of post-urination dribbling (incontinence) depending upon the circumstances. This can result in the need for absorptive pads or undergarments to handle unwanted excess urine.¹

Mixed Incontinence

When more than one type of urinary incontinence is experienced, it could end up being classified as mixed incontinence. Typically, a mixture of urge and stress incontinence is to blame.²

In Conclusion

Urinary incontinence is a legitimate concern for anyone suffering from it, but it can be especially frustrating, annoying, inconvenient, and embarrassing for men who have to add this distraction to all of the other BPH symptoms they may be experiencing. Benign prostatic hyperplasia and urinary incontinence are intertwined and coexist together for some unfortunate men.

With the most common types of urinary incontinence being stress incontinence, post-void dribbling, and urge incontinence, some men with benign prostatic hyperplasia have their work cut out for them.¹ It’s therefore important for men who are experiencing BPH symptoms caused by LUTS, including urinary incontinence, to consult with their primary care physician or urologist for ways of treating prostatic hyperplasia. This may include lifestyle modifications or changes, medications, or surgical procedures.

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