Embarrassing topics from the urologist's point of view

The following is an interview we had with Tamás Banyó, MD, a urologist at the Buda Health Center, regarding the generally considered taboo subject of incontinence that affects both sexes and the changes in the prostate that affect the control of urination in men.  He immediately reassured us, first thing, that both syndromes are treatable.

What preconditions lead to these unpleasant symptoms?

Women are more prone to having problems in controlling urination. Though the problem of involuntary urine leakage affects both sexes, incontinence is more prevalent in women due to their physiology and hormones.  It is estimated that 16% of women and 5% of men are affected. 

The lower urinary tract, female genitalia, the womb and vagina, the lower part of the alimentary canal, the rectum and the anus are found in the pelvic area.  If the urogenital diaphragm does not close well for any reason, there is a strong chance of incontinence.  In women, injury during pregnancy, during childbirth or during gynecological interventions may affect the condition of the diaphragm.  Also, excess weight may put unnecessary amount of pressure on the pelvic floor and weaken the sphincter muscles.  The breaking down of the mucous membrane of the urethra during menopause, as a result of hormonal changes, can also cause urination problems.    

In addition, the possibility of incontinence is increased in both sexes by recurring urinary tract infections, bladder and kidney stones, neurological disorders (stroke, Parkinson’s and Alzheimer’s diseases and multiple sclerosis), diabetes, certain medications (tranquilizers, sleeping pills, some blood pressure medications, cardiac medications, diuretics, muscle relaxants and antidepressants) as well as an improper life style (stress, obesity, smoking, not enough liquid intake, too much caffeine and alcohol consumption).

What about men?

The urinary complaints of men are mostly connected with the prostate.  The prostate is a glandular organ located below the bladder and surrounding the urethra.  The prostate in the young may be acute and later, chronic inflammation and in the elderly prostate enlargement and tumors make life miserable.   Incontinence may be a symptom of prostate enlargement if it is accompanied by abdominal or back pain, fever and a weak urine stream.

Sixty percent of the men above the age of 50 years suffer from benign prostate enlargement that also causes urination problems.  A clear-cut indication of this condition is the need to urgently urinate, the difficulty in emptying the bladder and the urine leaving the body without force and dripping.   

Surgery is not absolutely necessary.  Milder cases can be treated with medication and a change in life style - most important is the giving up of alcohol and spicy foods, shorten the time you spend sitting - pumpkin seeds have a good effect.  In the event of surgery, the benign enlarged portion is removed only.  The prostate itself remains

Cancer of the prostate is not a seldom occurrence in the elderly.  One sixth of the male population suffers from it but, fortunately, not every tumor is life threatening.  We don’t know its exact cause, however, social standing may be a risk, the environment, the genetic factors, the condition of our immune system, improper diet and our age.  Your prostate should be checked regularly past the age of 50 years since only the advanced tumors cause complaints.  In any case, this is another reason for going to see your doctor with complaints of incontinence since they may signal a problem in time.

Incontinence then is a symptom rather than a separate disorder?

Yes, that is correct and the problem may manifest itself in various ways depending on the root cause, background disease or abnormality.  The most prevalent is stress urinary incontinence which happens when physical movement or activity - such as sneezing, coughing, laughing, or heavy lifting – puts pressure on your bladder in cases where the sphincter muscles that control urine flow do not work properly. 

Another type of incontinence is urge urinary incontinence when you have a sudden, intense need to urinate and barely make it to the bathroom.  The cause may the increased activity of the bladder muscles, weakened sphincter muscles and a change in the neurological center controlling urination due to a change in brain function following a stroke, Parkinson’s disorder, brain tumor, etc.  In the latter case, reflex incontinence, the complete loss of control over our urination process, may result. 

There is also the overflow urinary incontinence where a small amount of urine leaks constantly.  It can be caused by a tumor or an enlarged prostate gland blocking the flow of urine, preventing the bladder from ever emptying completely.

Can the sphincter muscles be strengthened?

While urination is an inherited capacity, urinary retention, on the other hand, is the result of a training process.  Even adults should keep toning these muscles.  It is no wonder that in countries where belly dancing is popular, incontinence is unheard of in women.  Temporary incontinence often occurs during pregnancy, stopping on its own but a urinary retention problem in the post menopausal period is inexcusable.  Perineal exercises are compulsory in many countries after childbirth.  These special pelvic floor exercises are of great help and are recommended not only for women but also for men.  Furthermore, the rehabilitation of the perineal musculature may not only stop incontinence but increase sexual activity and helps orgasms.   

What would you recommend to the incontinence sufferer?

We found out that there are many forms of incontinence and that they can be the result of several factors.  A thorough gynecological or urological examination is essential as well as, general and special laboratory tests, diagnostic imaging of the abdomen (x-ray, CT and MRI), when required, and a urodynamic examination, bladder endoscopy, cytoscopy, etc. may be necessary as well in order to find the cause and set up a diagnosis.  These tests and examinations can all be performed at the Buda Health Center.

Once the cause of the incontinence is established, medication therapy may be prescribed and surgery indicated.  Incontinence can also be treated conservatively and kept under control.   The patient can also contribute greatly by making life style changes, cutting back on coffee consumption, stopping cigarette smoking and losing weight.

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