Male incontinence: How to address it

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Elizabeth Newman
Elizabeth Newman

In general, I am loathe to make too much of differences between men and women, but that's especially true it comes to long-term care. After all, no matter who you are, chances are quality of life, dignity and proper treatment are important to residents and their families.

But I will admit that when it comes to incontinence, we may need to take a different look at how we're approaching the topic.

For better or worse, women generally are more familiar with incontinence and wearing more than underwear. It's estimated that among the 13 million Americans with incontinence, 85% of cases are women. Childbirth often leads to pelvic floor challenges and the popular “I pee when I sneeze” conundrum. Even for the non-childbearing, many women will have worn some type of product during menstruation. While there's a wide gulf between a sanitary napkin and adult diaper, the general concept of protection is unlikely to be shocking to your elderly female residents.

That's obviously a different story for male residents, who may for the first time be experiencing urinary incontinence. Essity's Tony Forsberg, RN, BSBA, WCC, CSPHA, National Clinical Director, says men may question their virility and health when incontinent in a way that women simply don't.

“Men are more ashamed and less accepting of having a little bit of dribbling,” he told me.  One UT Southwestern study looked at 572 men being evaluated for anti-incontinence surgery over 10 years. It found the median length of time men had waited to seek treatment was 32 months, with almost a third having waited for more than five years. Men in their 80s had waited an especially long time, with a median of more than seven years.

There are options in the market: Essity recently released Tena for Men, which is shaped like an athletic cup. In 2016, Depends used former NFL defensive tackle Tony Siragusa to advertise its line of shields and guards for men. Prevail is also among companies offering a male guard.

But along with choosing a product for male incontinent residents, providers may need to re-examine how they frame the question. Forsberg recommends using the phrases of “do you ever experience unexpected leaking?” or “do you ever have dribbling right after you go to the bathroom?”

While it's not atypical for older men to have an enlarged prostate causing incontinence, but men may fear the worst. A provider can start by reassuring men that it's a common issue, and that there are strategies to help. 

One, men can be encouraged to do a “double void,” where after they urinate they are encouraged to sit down and void again. Clinicians can work on helping men relax their muscles and express urine into the toilet. And finally, Kegels aren't just for women, but work for men.

“It's not overnight but it can be effective for men with dribbling,” Forsberg said.

Men may use humor, such as saying they "jiggle and wiggle" to handle the issue, or that "urine luck" when it comes to dealing with it. Ultimately, as tough as it can be to have men discuss their urinary challenges, it's not an issue professional caregivers can afford to blow off. Men may be reluctant to ask for help and instead use a washcloth or sock to catch urine, he said.

“It can be so problematic because there's an odor. But they don't realize other people can notice,” he said. “They've become nose blind.”

Follow Senior Editor Elizabeth Newman @TigerELN.



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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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