From Our 2010 Archives

Depression Linked to Urinary Incontinence in Men

Nearly 5% of American Men Suffer From UI, Study Finds

By Charlene Laino
WebMD Health News

Reviewed By Laura J. Martin, MD

June 2, 2010 (San Francisco) -- Major depression, hypertension, enlarged prostates, and older age are all associated with an increased risk of moderate to severe urinary incontinence (UI) in men, a large study suggests.

The findings, which provide one of the first national snapshots of urinary incontinence in men, may help improve doctors' ability to identify men who are suffering from the condition, says study head Alayne D. Markland, DO, MS, of the University of Alabama at Birmingham.

Put simply, UI is uncontrollable leaking of urine from the bladder.

Overall, 4.5% of American men suffer from moderate to severe urinary incontinence, which corresponds to having leakage at least once a month, the study shows.

"It's enough to potentially interfere with their quality of life," Markland tells WebMD.

The rate increases with age, from 0.7% in men ages 20 to 34 to 16% in men age 75 and older, the study showed.

The findings were presented at the annual meeting of the American Urological Association.

Urinary Incontinence Less Common Among Men

Studies suggest urinary incontinence is less common among men than women, but there is a paucity of data on UI rates and risk factors in men, Markland tells WebMD.

So she and colleagues analyzed data from 5,297 men aged 20 and older who participated in the National Health and Nutrition Examination Survey, a nationally representative survey of the U.S. population.

Men were interviewed in their homes, and UI was assessed using the 12-point Incontinence Severity Index in which participants are asked if they leak and if so, how much and how often. Moderate to severe UI was defined as a score of 3 or higher.

Among all the men, major depression and hypertension were associated with a 2.6-fold and a 30% increased risk of moderate to severe UI, respectively.

Each 10-year increase in age was associated with an 80% increased risk.

Among the 3,010 men aged 40 and older, enlarged prostate -- called benign prostatic hyperplasia (BPH) -- was associated with a 20% greater chance of having moderate to severe UI.

The rate of moderate to severe UI did not differ by race or ethnicity.

A total of 49% of the men had what is known as urge urinary incontinence, in which you feel like you have to go but can't get to the bathroom in time, Markland says. Thirteen percent had stress urinary incontinence, which occurs when an activity, such as coughing or sneezing, causes a small amount of urine to leak. The rest had a combination.

BPH a Known Cause of Urinary Incontinence

BPH is a well-known cause of UI, says Ira Sharlip, MD, clinical professor of urology at the University of California, San Francisco.

Nightly bathroom runs may be the first sign of an enlarged prostate, he tells WebMD. Other symptoms may include trouble starting a stream of urine, leaking, or dribbling, says Sharlip, who was not involved with the study.

That's because an can press against the urethra (the tube that carries urine out the body) and block the flow of urine. This causes the bladder wall to become irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.

More research is needed to find out why depression and hypertension are associated with higher rates of UI, Markland says.

Medications called diuretics that are often used to treat may play a role, she says. They flush excess fluid from the body and can cause frequent urination.

Some of the drugs used to treat depression may also cause UI, Sharlip says.

"Urinary incontinence is something people don't want to talk about," says Lauren P. Wallner, PhD, MPH, a research fellow in the department of urology at the University of Michigan in Ann Arbor.

"If you're having symptoms, bring it to the attention of your health care provider as it can be treated with medication, behavioral therapy and, in severe cases, surgery," she tells WebMD.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES: 105th annual meeting of the American Urological Association, San Francisco, May 29-June 3, 2010.

Alayne D. Markland, DO, MS, assistant professor, division of gerontology and geriatric medicine, University of Alabama, Birmingham.

Lauren P. Wallner, PhD, MPH, research fellow, department of urology, University of Michigan, Ann Arbor.

Ira Sharlip, MD, department of urology, University of California, San Francisco.

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