This one is for the boys
April 2, 2014 9:17 AM   Subscribe

My hubby is complaining of mild incontinence. Please help us figure out what to do about it.

He is 39, and in reasonably good health. He does however have moderate back pain (which was caused by a sports injury a few years ago). Because of the back pain he usually sits to pee. He says that when he feels finished and stands up, often a bit more pee will dribble down his leg. Sometimes up to a teaspoon worth. He says this has been going on for at least a couple of years.

Fwiw, he doesn't have any ED symptoms. He doesn't take any medications, other than multivitamins. Is it possible that his pelvic floor or bladder control has been weakened by not standing to pee? Could it be as simple as that?

He's been to far too many doctors over the last couple of years for his back problems, and I know he will be completely overwhelmed if he has to add more doctor visits for a new issue. And knowing our sucky HMO doctor, she will dismissively tell him that he is just going to be on meds for the rest of his life, without recommending anything to actually help him resolve the issue.

So, hivemind, can you recommend some simple things he can try (exercises or even perhaps herbal supplements) first, before we go the doctor route? For example, for a woman, we would do kegels for a while to see if that helped.
posted by vignettist to Health & Fitness (18 answers total) 2 users marked this as a favorite

He could try to strengthen his abdominal area and try to do pelvic floor exercises.

But he should also, you know, see a doctor to rule out the NUMEROUS possibilities outside of getting older that could cause this. He could also then get a referral to a PT for pelvic floor help as well.
posted by zizzle at 9:27 AM on April 2, 2014 [2 favorites]

Going to doctors sucks, but that's just what has to happen.

Start with your GP and ask her for a referral to a urologist. Don't LET her brush you off.

The internet can't diagnose your husband. Doctors can.

Good Luck!
posted by Ruthless Bunny at 9:28 AM on April 2, 2014 [4 favorites]

Mod note: This is an answer from an anonymous commenter.
I don't think it's incontinence, I think it's just the way guys work. The urethra has a fair distance where pee might just sit because it doesn't tighten effectively. Guys who stand to pee will just have this slowly leak out after they finish as they move around (I remember my mom cursing about the bleach she had to use for my dad's and my tightie whiteys). That or else this is mild incontinence and it runs in my family. I remember in shorts season, the thing to do in high school was apparently make fun of someone's wet spot at the front of their shorts. If someone just went pee and didn't have a shirt that covered it, they had one. So it might run in a lot of families.

I also sit to pee (less total mess). When I'm done, I'll do a fake test stand while aimed towards the bowl; this will tighten all the muscles in a different way then my previous tightenings while trying to clear the line. If a lot comes out, I'll to a second test stand. Then I'll take about 3 sheets of TP, fold them to an eighth (rectangular) of a single sheet, and hold that against the end of my urethra when I stand so I don't moisten the floor. Voila, no mess.
posted by cortex (staff) at 9:44 AM on April 2, 2014 [4 favorites]

If he has a back injury and is having mild-moderate incontinence issues, he needs to get to a doctor ASAP! This could be disc/nerve related. This is not a matter of doing Kegel exercises.

I have back problems and have been to at least 6 different doctors trying to get it fixed. If one is dismissive, I find one who listens to me. Don't wait on this.
posted by ATX Peanut at 9:44 AM on April 2, 2014 [9 favorites]

To be honest this sounds normal. I'm a young man in my prime and this happens to me (as well as anonymous commenter). Sorry for the personal info, but sometimes after I defecate the exact same thing happens to me. I think it just has to do with gravity, the shape of your body, and normal biology.

Unless he starts to experience this outside and away from the bathroom, or in non-trivial amounts, I say it's almost certainly nothing. He has probably always been this way, but just never noticed before because he stood.

This is NOT medical advice, but as someone who has grown up with a family of physicians this SEEMS to me like the type of issue that a doctor will just say "It's probably nothing, humans are all different, tell me if it gets worse."
posted by jjmoney at 9:57 AM on April 2, 2014

First, of course he should see a doctor before self-diagnosing. But it sounds just like the issue I've had since my early thirties. Definitely it's exacerbated by sitting, but even standing I need to be careful. My doctor at the time called it "post-void dribble," and reassured me that it's common. He recommended magnesium pills and saw palmetto. Neither did squat for me.

What works for me is this: before standing, press up on a spot behind the scrotum. It pushes out the rest of the urine. Then stand and repeat (ya never know) and shake. That almost always takes care of the problem.

I never bothered to look up why it works, but here's something I just found while googling:
posted by StockingMarionette at 9:58 AM on April 2, 2014 [1 favorite]

I am frankly disgusted by men who seem to believe that the correct response to the perfectly predictable consequences of owning a capacious urethra whose controls are at the upstream end is to shake the thing about until the contents have been fully spattered all over whatever happens to be near them at the time.

TOILET PAPER, people. Fold, apply to tip, stand, squeeze, turn, drop, done.

not cocket science
posted by flabdablet at 10:47 AM on April 2, 2014 [7 favorites]

I'm not a medical professional but I think this is a normal or at least not uncommon structural reality. I think when men sit the urethra can have a dip in it, so the last bit of pee has to fight gravity to come out. When the man stands up, the dip is no longer there and gravity allows the pee to flow out more easily. I don't think it's something to worry about (although there could be other factors, for example an enlarged prostate is something that should always be medically monitored), it's just a matter of how he wants to manage release of that last bit of pee.
posted by Dansaman at 10:58 AM on April 2, 2014 [1 favorite]

Has he had his testosterone level checked?
posted by brujita at 11:48 AM on April 2, 2014

Sometimes up to a teaspoon worth

A teaspoon is about 5ml = 5,000(mm)3, and the relevant bit of physiological tubing will be roughly 15cm = 150mm long. To fit that much liquid into that length of tubing requires an average areal cross section of 5,000(mm)3 ÷ 150mm = 30(mm)2, which if it's a round tube would be a diameter of 2 × √(30(mm)2 ÷ π) = 6mm, well within the bounds of plausibility especially given the tendency of all that plumbing to relax and spread a bit with age.

actual cocket science
posted by flabdablet at 11:48 AM on April 2, 2014 [3 favorites]

Response by poster: Has he had his testosterone level checked?

What would out-of-normal range T levels indicate in a case like this?
posted by vignettist at 1:05 PM on April 2, 2014

I was told recently that low T levels can be a cause of incontinence.
posted by brujita at 2:09 PM on April 2, 2014

As a long-time chronic back-pain/ruptured-disc/back-surgery veteran, I have to say that, if he's sitting to pee because of back pain, he seriously needs to get that pain addressed. Standing the brief time it takes to pee isn't something that should normally cause pain bad enough to make a guy sit to pee.

That said...He probably needs to get his prostate checked.
posted by Thorzdad at 2:31 PM on April 2, 2014

Response by poster: Thanks for all of the good answers. It's good to know that this is a thing that happens for some guys, and it isn't completely weird or unheard of.

I'm sure he will pursue medical attention at some point if it can't be addressed with minor adjustments or exercises. The back injury thing, yeah, I think this all started independent of that, he's been to more doctors than I can count on that issue and it hasn't been an area of concern for any of them.

As for the low T, I spent some time with Dr. Google this afternoon on that and this was all I could come up with:
Signs and symptoms of low testosterone include: Decreased sex drive, Erectile dysfunction, Reduced energy level, Reduced strength and endurance levels, Sleep problems, Emotional problems including sadness, irritability, difficulty concentrating, and depression, Increased breast size and tenderness, Decrease in the amount of body hair, Decreased penis or testicle size, Loss of muscle mass;

No mention of incontinence, but in the end I guess it won't hurt for him to have his levels tested.
posted by vignettist at 4:47 PM on April 2, 2014

Just to be perfectly clear about this: incontinence is where the valve(s) that keep urine inside the bladder (there are two of these, the more upstream of which is not under conscious control and either of which can be affected by prostate trouble among other things) become less effective at doing that.

The dribbly consequence of both of those valves being located upstream of a fairly substantial length of tube, the distribution of squeeze along the walls of which in some physical postures being such that it doesn't fully drain after the upstream valves are closed: totally not incontinence, no medical intervention required. Treatment aimed at improving valve function is going to do absolutely squat for ordinary shilling spot. All that needs is toilet paper, standing up, and a bit of milking action.

If you ever see shilling spot at any time other than right after taking a leak, that's the time to think about valves.
posted by flabdablet at 8:51 PM on April 2, 2014

This may be normal for men in general, but the fact that he's brought it up now means it's not normal for this man; time for a urologist.

With the back pain, this could be kidney problems or nerve damage or prostate trouble, but the best doc to tell the difference is a urologist.

When things change, they're asking for your attention - so sez me.
posted by aryma at 9:04 PM on April 2, 2014

The person who told me about the low t/incontinence connection said his Dr. told him this might be the cause of his.
posted by brujita at 1:39 PM on April 3, 2014

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