Incontinence

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Questions Received:

  1. Does male incontinence affect sexual function and can it be transferred to your partner? What can be done to stop incontinence?

  2. I am 19 years old and had spinal surgery in 1998 for correction of scoliosis. However, shortly after the 2nd operation which involved the insertion of harrington rods, I lost the movement in my legs and control of my bladder. I have now regained the movement in my legs (although I cannot do various things such as run) but am still suffering incontinence. I have tried drugs (detrusitol), electrical stimulation, bladder emptying techniques etc. but I still suffer from frequency and urgency incontinence. Is there anything left that I can try so that I do not have to continue to suffer for the rest of my life? I look forward to hearing from you. Thank you.

Responses:

Does male incontinence affect sexual function and can it be transferred to your partner? What can be done to stop incontinence?

(3rd March 1999)

Whether incontinence interferes with sexual function or not will depend upon the type of incontinence and the degree to which it is being experienced. Also the extent to which a partner is prepared to accept the problem will need to be taken into account.

Faecal incontinence may not interfere with sexual function unless the problem is extreme, because regular bowel management can help to ensure that the rectum is kept empty of faeces. Incontinence would be less likely to occur during intercourse if, for example, the bowel had been emptied previously. Also incontinence tends to occur at specific times during the day, for example: following a meal as a result of the gastro-colic reflex. Sexual activity should therefore be avoided around these times.

Urinary incontinence may not preclude sexual activity, again providing that it is not severe. A condom will lessen the problem and can be used, providing of course an erection is possible and can be maintained. For some people self catheterisation can be taught and practiced. Emptying the bladder in this way before sex might help to lessen the problem.

Incontinence cannot be transferred to a partner. However, if the underlying cause of the incontinence is infection then of course their is a significant risk of such an infection being transmitted to the partner. Urinary tract infections can arise through sexual contact and as a result cause frequency of micturition and, if severe enough, produce incontinence.

Anyone who develops incontinence should report the matter to their doctor. Invariably there is an underlying cause of incontinence. Attempts will be made to uncover the underlying cause and offer treatment. Anyone who develops incontinence will be offered skilled help. Unless a person has permanent nerve damage to the groups of muscles that maintain continence there is a good chance that the problem can be either cured, or modified. Many hospital departments now have a Continence Clinic to help those who experience incontinence problems and a Continence Nurse Advisor who can see people both in hospital and at home.

Male Pelvis< Male Pelvis

Diagram showing arrangement of male pelvis: urinary continence is controlled mainly by the external urethral sphincter, and faecal continence by the anal sphincter. Both sets of sphincteric muscle are under voluntary control.

 

 

 

 

 

 

 

 

 

 

I am 19 years old and had spinal surgery in 1998 for correction of scoliosis. However, shortly after the 2nd operation which involved the insertion of harrington rods, I lost the movement in my legs and control of my bladder. I have now regained the movement in my legs (although I cannot do various things such as run) but am still suffering incontinence.

I have tried drugs (detrusitol), electrical stimulation, bladder emptying techniques etc. but I still suffer from frequency and urgency incontinence. Is there anything left that I can try so that I do not have to continue to suffer for the rest of my life? I look forward to hearing from you. Thank you.

18th June 1999

(an unstable or overactive bladder presents with symptoms of frequency - more than eight urinations in 24 hours, urgency - the sudden, overwhelming urge to urinate, or urge incontinence - sudden and total involuntary loss of urine)

It would appear that the functioning of your spinal cord was affected by the second operation, with the result that voluntary control of urination and leg movements became reduced. This suggests that several nerve pathways within the spinal cord were compromised and for a while your brain could no longer influence the activity of your bladder and legs. Happily, much of the control of movement of your legs has returned, and it is still possible that some improvement in voluntary control of urination will also occur. It sounds as if at present your bladder is functioning more like it did when you were a baby - an emptying reflex is being initiated when it fills beyond a certain point, whether you ‘want’ to urinate or not. You are probably being given help by a consultant urologist and continence advisor who will recommend the appropriate urodynamic studies and determine the best treatment and care regime. In the meantime it is important to avoid constipation and bladder infections as these can aggravate the problem. The risk of infection can be reduced by regular vulval and perineal hygiene and by avoiding dehydration.

There are many drugs available for treating bladder hyperactivity (see for example Andersson, 1988; Wall, 1990). Since bladder contraction is largely controlled by the parasympathetic nervous system which uses acetylcholine as a neurotransmitter, anticholinergic drugs are most commonly used to inhibit bladder activity. Unfortunately, these drugs have unwanted side effects on parasympathetic control throughout the body, and can produce a dry mouth, constipation, drowsiness, blurred vision, headache, and gastrointestinal pain in addition to the desired effect on the bladder. Oxybutynin is an anticholinergic drug but also has a direct effect on the detrusor muscle of the bladder and this tends to increase its effectiveness whilst reducing side effects (Yarker, Goa, and Fitton, 1995). The drug you have tried already, detrusitol (tolterodine tartrate) is a relatively new treatment, being first introduced in Sweden in October 1997 and then in the United Kingdom and Germany in March 1998. It is also anticholinergic, and is reported to signficantly reduce the number of micturitions and incontinence episodes per day (Guay, 1999). It is unfortunate that detrusitol has not been helpful in your experience. When you next see your doctor it may be worth enquiring about the new extended-release version of oxybutynin called OROS oxybutynin which appears to further reduce some of the unwanted anticholinergic side effects (Goldenberg, 1999).

Electrical stimulation applied either externally to the anal sphincter or via implanted electrodes has been found in some patients to reduce bladder spasticity and enabled bladder capacity to be increased (Godec, Cass, and Ayala, 1975; Van Kerrebroeck, 1998; Kralj, 1999). However, as you have found, this treatment is not suitable in all cases. The only other suggestion we have is FemAssist, which is a urethral occlusive device that has been found useful in some types of incontinence (Moore et al, 1999).

References

Our thanks to Mrs. Jane Sawyer, Continence Advisor at Wonford, Exeter, for her help with this reply.

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