Transcription:

Scott Webb: Welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And in the last of a three- episode run with Dr. Kevin Ostrowski, a physician at EvergreenHealth Urology and Urogynecology care, we are discussing male stress incontinence. And doctor, great to talk to you again. What is male stress incontinence?

Dr. Kevin Ostrowski: Incontinence gets broken up into two different types. There's urge incontinence, which is basically can't make it to the bathroom and we're not talking about that today. We're talking about male stress incontinence, which is incontinence that we see with cough, laugh, sneeze. Traditionally, that is normally seen in females after childbearing and those sorts of things. But we also see it in men who've had surgery or radiation or things like that to their prostate or to that area. And it can be a major impact on quality of life.

Scott Webb: Yeah, it definitely can. And what are the symptoms of male stress incontinence?

Dr. Kevin Ostrowski: For most guys, those symptoms are a little bit or a decent amount of leakage with cough, laugh or sneeze. Your everyday usual activities. They'll notice that maybe they leak a little bit or a decent amount. And so they're having to wear either a safety pad or a full pad or changing pads multiple times a day in order to prevent themselves from getting their pants wet. And the key part about that is really it's with that exertion, anything that's causing that exertion, you're getting a little bit of leakage.

Scott Webb: And doctor, you touched on this a little bit, but let's talk about the causes and how you diagnose male stress incontinence.

Dr. Kevin Ostrowski: The number one cause is surgery done on the prostate, which is most commonly the robotic or an open prostatectomy, which is where they remove your prostate for cancer. And then, after that, we know that there's going to be a little period of time where you're going to have some leakage, but that should get back up to normal. If it doesn't get back up to normal or to a minimal amount of pad usage, that is when we know that there's something going on, that we have the options of fixing potentially. Other kinds of surgeries that are down in the pelvis, whether it's GI surgery for colon cancer or radiation or things like that can also impact the sphincter muscle or impact the ability for your body to keep the urine in there at those times.

We diagnose it with a series of evaluations. The first is just talking to you about your history and physical examination in the office. But we can do some of it obviously through telehealth now. And then we sometimes we'll put a little scope in called a cystoscope where we look at where the surgery was done and what that looks like. And then see how well the sphincter muscle is working. There are some kind of more involved tests where we evaluate how well your bladder works and those sorts of things if we need to.

Scott Webb: Yeah. From what I understand, there are a number of treatment options. So let's go through those.

Dr. Kevin Ostrowski: Behavioral modifications is where we start first. And that's first of all, strengthening that sphincter muscle. So there are exercises and we can even send you a sometimes if we need to a physical therapist so you're going to work on strengthening that sphincter muscle. Those are called Kegel exercises and that's for guys out there, it's when you're having a stream and you're trying to stop that stream, that's the muscle that you're trying to tighten. And so that's one of the first things that we can do.

Behaviorally, we also can give you medications to help relax your bladder or do you things that's going to help you hold the bladder longer if we need to work on bladder capacity. Non-invasive treatment options basically get down to things like clamps or adjusting your behavior to help decrease the amount of leakage you have. The problem with those is that they, work well for short periods of time, but they don't fix ultimately the problem. And so guys often still are using pads or other things they may work to go out, let's say to go to dinner or just do something active that they want to do. But it isn't going to be like a long-term solution.

Pharmaceutical options, there are some that can help, but most of those actually work at relaxing the bladder and helping the bladder relax. What that does basically is if your bladder capacity is an issue from like radiation or depending on the surgery you had done, those medications basically help that bladder relax to store more urine, but they don't ultimately fix the problem of that kind of sphincter muscle and that isn't holding things in the way that we want it to.

Realistically, the two main and kind of gold standard options come as options to basically help with that sphincter muscle. And that comes in two ways for guys with lower level of leakage. That option is something called a male sling, which is basically a little mesh hammock that goes underneath the urethra and hold up on the urethra so that when you cough, laugh, sneeze and move around, that it doesn't move as much and creates a better closure of that urethra to either decrease or completely eliminate the number of pads that you have to use. If you're leaking a lot or have had radiation or things like that, then we sometimes talk about an artificial urinary sphincter.

Basically, it has three parts to it. It has a little cuff that goes around the urethra that is like a new sphincter that gets connected to a little pump in the scrotum and that gets connected to a little reservoir. So that in one kind of self-contained device, it's all inside of your body. You're in control over opening and closing that urethra. and it allows you to have a normal level of continence.

Scott Webb: Yeah. And good to know that there are options and that's something that I've taken from the episodes that I've done with you is that many guys have issues and a couple of things we need to talk about those issues. And when necessary, we need to seek treatment. And at least with what we've talked about with Peyronie's and ED and male stress incontinence, there are treatment options, which is good to know. So is there anything else you want to tell people about male stress incontinence before we close up shop?

Dr. Kevin Ostrowski: Male stress incontinence is something that we see after surgery is done in the prostate or in the pelvis. There are treatment options, both behavioral modifications and if we need to do surgery. And that those options really have great success and those patients are honestly some of the happiest patients that I have.

Scott Webb: The other thing we've talked about when we've gone through these episodes is it really comes back to quality of life. And that's what we're after. That's what you're after, trying to help men talk about things and treat the issues that they have and improve their quality of life. And we hope that men have enjoyed and gotten a lot out of these episodes. Thank you so much for your time and you stay well.

Dr. Kevin Ostrowski: Thank you so much. You too.

Scott Webb: And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to our website at EvergreenHealth.com for more information and to get connected with one of our providers. And please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.