Severe urinary incontinence is involuntary leakage of urine to an extent that seriously affects daily life; in men it can occur particularly after prostate surgery. Methods such as exercises, bladder training and medication work for mild leakage but are often not enough for severe incontinence. In suitable patients, the artificial urinary sphincter is a surgical option regarded as the standard, offering a long-term solution.
Severe urinary incontinence is not only a physical problem. Worrying about changing pads, concern about odour and broken sleep can pull people away from social life and affect their self-confidence and mood. That is why, rather than putting up with it as "part of getting older", the cause needs to be investigated.
Causes
In severe incontinence there is usually a marked problem with the muscles that hold urine in, the nerves or the bladder's control mechanism:
- Damage to the sphincter muscle after prostate surgery
- Impairment of the bladder control mechanism
- Nerve damage due to neurological conditions
- Age-related muscle weakness
- Previous pelvic surgery
- Advanced bladder dysfunction
In men, one of the most common causes is incontinence that develops after radical prostatectomy for prostate cancer.
Impact on Daily Life
What patients describe is often similar: avoiding social situations, loss of self-confidence, anxiety and low mood, disturbed sleep, restricted daily activities and difficulties with hygiene. The aim of treatment is not only to reduce leakage but also to remove these restrictions.
Treatment Options
Treatment is decided according to the severity and cause of the incontinence. Non-surgical methods are used first:
- Pelvic floor muscle exercises (Kegel exercises)
- Bladder training
- Medication
- Lifestyle changes
- Adjusting fluid intake
In severe incontinence these methods are often not enough, and surgical options are considered. One of these options is the artificial urinary sphincter.
The Artificial Urinary Sphincter
The artificial urinary sphincter is a mechanical device implanted inside the body to restore bladder control. It is one of the methods regarded as standard for severe incontinence after prostate surgery. The system has three parts:
- A cuff that surrounds the urethra
- A pressure-regulating balloon (reservoir) placed in the abdomen
- A pump that the patient operates
When you want to pass urine, you press the pump; the cuff opens for a short time and urine flows. The system then closes by itself. For details of the device and the operation, see the artificial urinary sphincter page.
Who Is It Suitable For?
An artificial sphincter is not suitable for everyone; the decision is made after a detailed assessment. It is usually considered for:
- People with severe urinary incontinence
- Those who develop persistent incontinence after prostate surgery
- Those who have not benefited enough from other methods
- Those with the manual dexterity to use the pump
In suitable patients it can markedly improve comfort in daily life and offers a long-term solution. That said, training is needed to use the device, regular check-ups are essential and expectations need to be discussed openly before surgery.
With an accurate diagnosis and careful patient selection, urinary incontinence can be brought largely under control.
