Male incontinence

Male pelvic floor muscles play a critical role in urinary control. 13% of Australian men suffer from some degree of urinary incontinence - that's about 1.4 million men.

Many of these could turn that uncomfortable situation around. All it requires is a short term commitment to a simple program to strengthen their pelvic floor muscles.

Manual exercise is possible for some - while others may need a little extra help with mild electrical stimulation from an InControl medical device. 

Male pelvic floor anatomy

The pelvic floor muscles are situated at the bottom of the pelvis, in a roughly horizontal orientation to support the pelvic and abdominal organs. There are two openings in men: one to allow the urethra to pass through on its way from the bladder to the penis and the other at the anus.

Diagnosis

Male incontinence may be caused by a range of serious health issues. If you are unsure of the cause of your incontinence we strongly advise that you speak to your doctor.

Once it is confirmed that weakened muscles are the cause (or even the partial cause) of your leakage problem, then InControl may be of significant help.

Functions of the male pelvic floor

The functions of the pelvic floor are numerous and important. They include:

  • Regulating continence, by opening and closing the urethra and anus

  • Supporting the organs situated directly above - prostate, bladder, rectum and seminal glands

  • Making an essential contribution to core strength. The pelvic floor is the centre of gravity in your frame - as part of your core muscles it makes a fundamental contribution to movement, back strength and stability

  • Playing an essential role in sexual function - a strong, supple pelvic floor enhances sexual response, improves performance and heightens the sense of pleasure

Muscle stimulation for strength, control, stability and performance

If you have read this far you will realize that the pelvic floor has an extensive array of muscles and connective tissues, and is richly endowed with blood vessels and nerves, making it highly responsive to assisted exercise using electrical stimulation.

It is also important to remember that the bladder detrusor and the internal sphincters are all smooth or involuntary muscle and cannot respond to manual exercise. Electrical stimulation is the only external way to stimulate the nerve fibres supplying these muscles.

The perineum anatomy determines the best location for electrode placement for all of the above applications - incontinence, support, stability and sexual performance.

It is not desirable or necessary to stimulate the muscles directly. Rather, the objective is to stimulate the motor nerves and sympathetic nerve fibres that supply the relevant muscles, i.e. the various branches of the pudendal nerve, the ventral primary rami and the parasympathetic fibres.

Our recommendation is to:

  • Place one small electrode on the perineum, i.e. the surface area between the anus and the scrotum

  • One large electrode over the sacrum, i.e. the large, triangular bone at the base of the spine and above the coccyx

The area between the pads is large enough to cover and stimulate all the motor nerves and sympathetic nerve fibres in question.

Dose is determined by intensity, the number of muscle contractions per day and the number of days in the program of treatment.

Incontinence after prostate surgery

Please note: Electrical stimulation should not be used anywhere near an active malignancy.

Urinary incontinence is common in men who have had surgery or radiation treatment for prostate cancer. Medical science continues to improve treatments to reduce the risk and extent of post-surgery and post-radiation incontinence.

Following treatment, there are different types of urinary incontinence and differing degrees of severity:

  • Some men dribble urine

  • Others will experience a total leakage

  • Loss of urine with a cough, sneeze or laugh is called stress incontinence and is the most common type of urine leakage men experience after surgery

  • The need to frequently urinate with episodes of leakage, called urge incontinence, is the type seen most often after radiation treatment

Why Do Prostate Treatments Cause Urinary Incontinence?

Urine is stored inside the bladder until you have the urge to urinate. The bladder is a hollow, muscular, balloon-shaped organ. Urination happens when:

  • The muscles in the wall of the bladder contract, forcing urine out of the bladder

  • At the same time, muscles that surround the urethra relax and allow the flow of urine

The prostate gland surrounds the urethra. An enlarged prostate gland can obstruct the urethra.

Continence problems may arise as follows:

  • The enlarged prostate can cause urination retention and other problems with urination

  • Removing the prostate through surgery or destroying it through radiation disrupts the way the bladder holds urine and can result in urine leakage

  • Removing or destroying the prostate gland, which is the size of a walnut, initially creates a hole where the gland once was; it takes time for this hole to heal over

  • For most men the healing will have closed the hole after approximately 12 months - most men but not every man

  • Radiation can decrease the capacity of the bladder and cause spasms that force urine out

  • Surgery can, at times, damage the muscles and nerves that help control bladder function

InControl after surgery or treatment - Once the cancer is in remission

If InControl is used during the post-operative recovery period, it can help with surgery healing. This process is not about muscle strengthening, rather it is about electrical stimulation of cell membranes encouraging them to open and so:

  • Receive oxygen and nutrients at the wound site

  • Breakdown scar tissue and carry away dead cells

If portions of muscle are irretrievably lost due to complete and permanent denervation, then assisted exercise is indicated and applied directly to the muscle.

Male anatomy outline 1.jpg

Continence related muscles

The pelvic floor muscles most important for maintaining continence include:

  • The internal and external anal sphincter muscles - they constrict the anal canal

  • The internal and external urethral sphincter muscles - they control the opening and closing of the urethra

  • Bladder detrusor muscles - one muscle relaxes the bladder, another contracts during urination to release urine

  • Puborectalis muscle - aids in voluntary retention of faeces

Pelvic support muscles

These muscles act as the sling to support the organs of the pelvic cavity:

  • Coccygeus - elevates the pelvic floor

  • Iliococcygeus - elevates the pelvic floor

  • Levator ani - elevates the pelvic floor

  • Pubococcygeus - elevates the pelvic floor

  • Levator prostate - elevates the prostate

Stability related muscles

  • Superficial transverse perineus - fixes and stabilizes the perineal body

  • Deep transverse perineus - fixes and stabilizes the perineal body

  • Internal obturator - laterally rotates and abducts the thigh

  • Piriformis - laterally rotates and abducts the thigh

Sexual performance related muscles

  • Ischiocavernosus muscle - helps maintain penile erection and stabilizes the erect penis, by retarding blood from flowing out of erectile tissue

  • Bulbospongiosus - expels semen during ejaculation and expels the last drop of urine from the urethra

Nerve supply to pelvic muscles

Pudendal nerve

The pudendal nerve is the main nerve of the perineum. It carries:

  • Sensation from the external genitalia and the skin around the anus and perineum

  • The motor supply to various pelvic muscles

It's branches include:

  • The rectal nerve (inferior anal nerve)

  • Superficial perineal nerve

  • Deep perineal nerve

  • Dorsal nerve of the penis

  • Posterior scrotal nerves

These branches of the pudendal nerve innervate most of the pelvic floor muscles.