The short answer: stress incontinence is when a bit of urine escapes as your bladder gets squeezed, usually when you cough, sneeze, laugh, lift or land a jump. In men it most often follows prostate surgery, but a tired pelvic floor, heavy lifting and a few extra stone can all cause it, and for most men it improves with the right exercises.
Nobody warns you about this one. You go to pick up a bag of compost, or you laugh at something on the telly, and there it is. Not a flood, just enough to make you check your trousers. Here is what is going on, why it happens to men, and what actually helps.
What stress leaks are
The NHS describes stress incontinence as urine leaking out "at times when your bladder is under pressure; for example, when you cough or laugh". The word stress here has nothing to do with feeling stressed. It means physical pressure: anything that pushes down on your bladder faster than the muscles holding it shut can react.
Those muscles are your pelvic floor and the urethral sphincter, the ring of muscle that keeps the tap closed. When they are weakened or damaged, a sudden push wins, and a few drops get out. (NHS: urinary incontinence)
Why men get stress leaks
- Prostate surgery. By far the most common cause in men. Prostate Cancer UK calls leaking "the most common urinary problem after surgery", because removing the prostate disturbs the muscles and nerves that control your bladder. We cover this properly in why bladder leaks happen after prostate cancer treatment.
- Radiotherapy. Leaks are less common after radiotherapy than after surgery, but more likely if you have also had a TURP. (Prostate Cancer UK)
- Heavy lifting and high impact sport. Deadlifts, squats, rugby, running on tarmac. Every heavy rep pushes down on the bladder, and a pelvic floor that has never been trained can give way. More on that in lifting heavy and leaking.
- Extra weight. The NHS lists obesity as a risk factor. More weight round the middle means more constant pressure on the bladder.
- A long term cough or straining. A smoker's cough or regular straining on the loo loads the pelvic floor again and again.
- Getting older. Muscles lose strength with age, the pelvic floor included, unless you work it.
Stress leaks, urgency and after dribble: which is yours?
| What happens | What it is usually called | What helps most |
|---|---|---|
| A few drops when you cough, lift, laugh or run | Stress incontinence | Pelvic floor exercises, the squeeze before you lift |
| A sudden, strong need to go and you do not always make it | Urge incontinence or overactive bladder | Bladder training, cutting back on caffeine, a GP visit |
| A drip or damp patch a minute or two after you have finished | After dribble (post void dribble) | The urethral milking technique and pelvic floor work. See our post void dribble guide |
Plenty of men have a mix of two. That is normal, and worth mentioning to your GP.
What actually helps
1. Pelvic floor exercises
This is the big one, and the NHS puts it first. Squeeze the muscles you would use to stop yourself peeing and to hold in wind, hold, relax, repeat, several times a day. The trick is doing them properly and doing them for months, not a fortnight. Our step by step guide for men walks you through it, and there is a separate routine for after prostate surgery.
2. Squeeze before you lift
Once you can find the muscles, tighten your pelvic floor just before you lift, cough, sneeze or stand up from a chair. Physios often call it the knack. It takes a few weeks to become automatic, and it is the quickest win for lifters.
3. Take the pressure off
- If you are carrying extra weight, losing some reduces the load on your bladder. The NHS recommends it.
- Cut down on caffeine and alcohol, which make the bladder busier. Our honest guide to coffee and pints has the realistic version.
- If you smoke, stopping will ease the cough that keeps pushing on your pelvic floor.
- Do not cut back on water. Concentrated urine irritates the bladder and makes things worse.
4. Get a proper referral
Your GP can refer you to an NHS continence service or a pelvic health physiotherapist, who can check you are doing the exercises right. Plenty of men are not, and never find out.
If it does not get better
For men still leaking a year after prostate treatment, there are surgical options. Prostate Cancer UK explains that a male sling can suit men leaking a mild to moderate amount (two to three pads a day) a year after treatment, and an artificial urinary sphincter is usually for men who still leak a lot at least six months after treatment. Your urologist is the person to talk to about either. (Prostate Cancer UK)
Getting on with your day in the meantime
Exercises take weeks to months. You still have to go to work, get to the gym and sit through a long lunch. That is what Frank's Pants are for: underwear that looks and feels like normal boxers, with the absorbent layers built in, so a few drops during a heavy lift or a sneezing fit are simply not an event.
- The Active is made for the post pee dribble and the odd extra drop.
- The Everyday is for stress leaks that come and go through the day.
- The Ultra comes with three washable pads that clip in, so on long days you can swap a fresh one in.
Frank's Pants are made for light leaks. If you are leaking more than a little, see your GP or ask about an NHS continence service first.
Your first pair is covered by Frank's Word, our 60 day guarantee.
When to see a GP
Any leaking is worth a GP visit, and as the NHS puts it, it is a common problem and you should not feel embarrassed. Go sooner if leaks have come on suddenly, or come with pain, blood in your urine, a weak or stop start stream, or getting up several times a night.
Frequently asked questions
What is stress incontinence in men?
It is urine leaking when your bladder is put under sudden pressure, such as when you cough, sneeze, laugh, lift or jump. It happens because the pelvic floor muscles and the sphincter that hold urine in have been weakened, most often after prostate surgery.
Can stress incontinence in men be cured?
For many men it improves a great deal or stops with pelvic floor exercises, especially when a physiotherapist checks the technique. If leaks carry on long after prostate treatment, a urologist can talk through options such as a male sling or an artificial urinary sphincter.
Why do I leak when I lift weights?
A heavy lift sharply raises the pressure inside your abdomen, which pushes down on your bladder. If your pelvic floor cannot tighten fast enough, a little urine escapes. Training the pelvic floor and squeezing it just before each lift usually helps.
What underwear is best for stress leaks?
Washable leakproof underwear that looks like normal boxers, with the absorbent layers built in, so there is no pad to shift during movement. Frank's Pants The Active suits post pee dribbles and the odd extra drop; The Everyday suits leaks that come and go through the day.
This article is general information, not medical advice. Always follow the guidance of your GP or healthcare team.