Bladder control problems – men

Difficulties with passing urine are common as men age. One in 3 men over 50 years of age and nearly all men aged over 85 years experience some difficulty in urinating.

What bladder control problems can men have?

The way men urinate changes slowly as they get older, so at first men may not notice there is a problem. The usual changes include:

  • Difficulty or delay in starting to urinate.
    • This is common with ageing, and with prostate problems.
    • It can also be due to shyness when using a public toilet – this affects about 3 in every 10 men, who have no problems passing urine in private.
  • Stopping and starting in the middle of urinating.
  • After finishing, a bit more urine trickles out.
    • After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause a wet patch on the trousers.
    • This is due to urine pooling in the urethra (the tube the urine passes through).
    • It can be prevented by making sure there is nothing pressing on the genital area, like tight clothing or zips. 
    • The drips can be helped by using the 'milking technique' after urination.
  • A feeling of not quite having emptied the bladder.
  • Men may experience the need to urinate more often than usual (called urinary frequency) or the sudden urge to urinate (called urinary urgency)
Get the following symptoms checked out straightaway:
  • burning discomfort or pain while passing urine
  • blood in the urine.

These could be due to infection or other cause needing treatment.

What causes bladder problems in men?

The two most common causes of bladder problems in men are ageing and enlargement of the prostate gland.

Ageing 

  • As the bladder ages, the muscles within it become more likely to suddenly contract (squeeze), resulting in a feeling of urgency and having to rush to the toilet. Leakage of urine may occur before getting to the toilet.
  • With older age, the body tends to store fluid during the day and gets rid of it at night while lying flat. This results in extra urine production at night.

Enlargement of the prostate gland

  • The difficulties men experience with passing urine are often due to non-cancerous enlargement of the prostate gland. This condition is called benign prostatic hyperplasia (BPH) and is caused by a change in hormones. It is considered a normal part of ageing. 
  • Prostate growth can also be the result of cancer. Prostate cancer, is much less common than BPH.
  • An overactive bladder may also occur if the bladder has to work harder to empty, for instance, if the outlet is narrowed by an enlarged prostate, or it may be worsened by the bladder not emptying completely.

Other causes include:

  • medical conditions such as urinary tract or bladder infection
  • surgery such as spinal surgery or prostate surgery
  • medications such as diuretics (water tablets). 

What are the treatment options for bladder control problems?

Problems with bladder control can be annoying but, generally, if they are mild they will not affect your health and may be improved by following the self care measures below. Talk to your doctor if you are concerned about your symptoms. They will be able to let you know whether medication, surgery or prostate cancer testing is right for you. 

Self care

Some men may be able to improve their bladder control by simple measures such as:

  • Reducing intake of coffee, tea, alcohol and other chemicals that irritate the bladder such as fizzy drinks, fruit juices and artificial sweeteners.
  • In men who have the problem where a bit more urine trickles out after they have finished urinating, the milking technique is helpful to prevent dribble.
  • Pelvic floor muscle exercises (called Kegel exercises) can strengthen the muscles that empty the bladder.
  • Bladder training can help the bladder to hold more urine without leaks.
  • The use of continence products to help you cope with urine leaks.

Read more about the milking technique, Kegel exercises and bladder training.

Medication

Medication may be an option, depending on the cause of your bladder control problems. If you have troublesome symptoms caused by an enlarged prostate (BPH), your doctor may prescribe one of the following medicines:

  • Alpha-blockers
    • These are a group of medicines that relax the muscles in the prostate so it causes less blockage and allows the bladder to empty more easily such as doxazosin, tamsulosin and terazosin.
  • Finasteride
    • This medication blocks the effect of the male hormone testosterone on the prostate, causing it to shrink in size thereby reducing blockage and improving urine flow.

If your symptoms are due to an overactive bladder then a different option may be used:

Sometimes, both BPH and overactive bladder may be present, so two different medications can be used. If medicines are not helpful then you may be referred to a urologist (a doctor who specialises in urinary tract problems).

Surgery

Some people may require surgical treatment, depending on the cause of their bladder control problemFor BPH, surgery often involves removing excess prostate tissue to improve the flow of urine through the urethra. About 1 in 4 men with BPH will require this type of surgery.

Learn more

Urinary symptoms in men NZ Continence Association, 2015
Continence information – adults NZ Continence Association, 2015
Promoting good bladder and bowel health  NZ Continence Association, 2015

Credits: Original content provided by Continence NZ, adapted for Health Navigator, Oct 2015. Reviewed By: Health Navigator Team