Is there a problem that is more embarrassing for a man to admit to than not being able to get an erection? Many men reckon there is — incontinence. But far from being the last taboo, this is a common problem that can usually be treated.

 'I wet myself last night,' my friend Pete said.

Handing him a coffee and two Nurofen, I agreed that the previous evening had been a laugh. 'No,' he said. 'I really did'. Then he broke down in tears.

Men experiencing urinary incontinence rarely seek help, choosing instead, like Pete, to adapt their lives to live according to the close proximity of toilets. 'Men will just not talk about it, so no-one really knows the true extent,' says Gordon Muir, Consultant Urologist at King's College Hospital, 'but it's an unrecognized and embarrassing problem which can ruin lives'.

Incontact, an organisation providing information and support on bladder problems, estimate that 3% of men between 15 and 44 are affected but, Muir believes, if more came forward seeking help, that figure could be dramatically higher.

While the likes of Pele, Stirling Moss and even Jerry Hall have promoted open discussion on erectile dysfunction, the issue of adult male incontinence is still cloaked in whispers. As Pete said, in explaining why he hadn't sought help, 'Mate, I'd rather tell someone I can't get it up than admit I wet myself.'

Over coffee (a diuretic apparently) I learned that Pete's incontinence was no isolated incident, but something that he'd been experiencing for four years since his late twenties. He now planned outings around short car rides due to frequent urges to wee; he got in trouble at work for frequently not being at his desk; his social life withered (because he was paranoid that he smelt); he had quit rugby; and he even shied from sex. But he actually preferred living that way than talking about it.

According to Incontact's Executive Director Lesley Woolnough such an attitude is typical. Through a psychological bundle of embarrassment, shame, and the misconception that what's happening is just a natural part of aging, men's distress remains unspoken.

'Like asking for directions when lost,' says Lesley 'men consider discussing incontinence unmanly, so instead struggle to live around it. But they really don't have to — help is available.'

It's estimated that twice as many women as men experience incontinence — though this may be due to our reluctance to admit the problem - which explains the wider female support structure available.

Various women's help groups and initiatives are out there such as 'Three Steps to TRIumph' championed by ex-Blue Peter presenter Janet Ellis, campaigning to get women discussing the issue and securing sound advice. The three steps are Acknowledging, Sharing and seeKing help or ASK. But if women, who tend to be more open to discussing health problems, struggle to talk about it, what chance do men have?

The key, says Lesley, is for everyone - male or female - to realise that there are large numbers of others out there in the same boat, and to know that with proper attention the problem can be successfully addressed. Incontinence is not a disease, but is symptomatic of an underlying medical concern. By treating that concern, incontinence can be conquered and conquered relatively easily — starting with a simple chat.

What can you do about it?

You can talk to an organisation like Incontact or a GP. (It certainly won't be new to your GP and only the most foolish health professional will find it embarrassing). Once the the medical reason is established, appropriate treatment can be launched.

The commonest type of incontinence in young men is known as Overactive Bladder Syndrome (OBS). It really is very common. Probably more common than diabetes.

In OBS the bladder muscle contracts suddenly, as if in spasm, even with little urine present, causing desperate and unstoppable urges. There are several possible causes including a neurological problem, a reaction to a particular medication or a prostate gland inflammation (in younger men this can occur with either bacterial infection or accumulation of natural secretions).

Medication to relax the bladder muscle is very effective in over two thirds of cases (although there can be side effects such as headaches and a dry-mouth).

Other types of incontinence are rare in otherwise healthy young men, but can result indirectly — after a spinal injury for example.

In Stress Incontinence, urine is forced through the weakened bladder valve when pressure is exerted through impact, coughing, laughing or similar. Medical solutions include muscle-tightening drugs, or in an extreme case a simple operation such as to lift the valve and relieve pressure.

In Overflow Incontinence, attempts to urinate are uncomfortable and, despite strong urges, ineffective. As a result urine accumulates until it forces itself through the bladder valve involuntarily. This usually results from a blockage, which in severe cases can be addressed by surgery. This surgery is not invasive (ie no cutting is involved) and, with current techniques, it is relatively stress-free. However, it is still only considered once simpler incontinence management methods (detailed below) have been exhausted.

The vast majority of incontinence cases require neither medication nor surgery.

Significant impact, within a week sometimes, can be made simply by adopting self-care measures like reducing aggravating factors such as liquid intake (particularly alcohol and caffeine), smoking, stress and body weight.

Further improvement will come, over a slightly longer period, with regular exercises to strengthen weak muscles (eg pelvic muscle 'pull-ups') and/or routines to 'train' the bladder (eg consciously peeing at pre-set, gradually increasing, intervals regardless of the urge to or not).

 If necessary, there are also effective ways to manage remaining symptoms through over 5,000 discreet incontinence control products, including sheaths, pads, bedding, alarms, specialist sports clothing, and skin-care treatments. The variety available is evidence that this is a very common problem. Professional health care advice may be required to find the most appropriate solution.

The fact is that adult urinary incontinence is beatable — more importantly, it can be easily beatable, whether through lifestyle modification or, worst case scenario, simple surgery. 'Suffering in silence really isn't worth it,' says Lesley, 'not when treatment is so straightforward'.

And now to a happy ending.

Pete's emotional outpouring that morning did lead him, with support, on a successful journey. It took some honest chat for him to soon realise he wasn't alone, he didn't have to suffer, and he could have his old life back. I'm really glad that he told me — and so's he. It was quite a relief.

See also: Peeing FAQs

Useful Links

• The Continence Foundation 
• National Association for Continence : 
• Gordon Muir's website
• International Continence Society
• Education and Resources for Improving Childhood Continence

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