When urinary leaks show up, a fair question comes to mind: what medical condition could be causing them? That concern is completely understandable, but it is important to know that not every leak points to a serious illness. Sometimes it is linked to a benign condition that can be treated, and sometimes it is simply the result of normal, age-related changes in certain organs.

Urinary incontinence is not a disease in itself, but a symptom that can be linked to a range of underlying causes. Understanding the possible medical reasons helps guide diagnosis, tailor treatment, and choose the most suitable protection. From prostate conditions to neurological disorders and medication side effects, here is an overview of the different health issues that can lead to urinary leaks in men.

Prostate conditions and choosing the right men’s incontinence boxers

Benign prostatic hyperplasia: the leading cause in men

Benign prostatic hyperplasia (BPH) affects around 50% of men in their 60s, with prevalence rising to as much as 90% of men in their 80s. This natural increase in prostate size is not cancer, hence the term “benign”. Because the prostate surrounds the urethra, it can gradually compress the urinary channel and create an obstruction to normal urine flow.

This obstruction can lead to two sets of symptoms. First, difficulty urinating: the stream becomes weaker and more hesitant, you may need to wait before urine starts flowing, and the feeling of incomplete emptying can persist. Second, the bladder may become overactive as it tries to push against the blockage: more frequent and urgent urges, multiple night-time trips to the toilet, and sometimes urge-related leaks. In advanced cases, an overfilled bladder can “overflow”, causing overflow incontinence.

To manage these moderate daily leaks, men’s washable incontinence boxer briefs offer discreet, effective protection, helping you stay active while BPH is being treated.

Prostate cancer and its treatments

Contrary to popular belief, prostate cancer itself rarely causes incontinence. It is mainly its treatments, especially radical prostatectomy, that can trigger leaks. According to clinical studies, the incidence of persistent incontinence beyond 6 months varies, with around 3% to 5% of patients experiencing severe long-term incontinence.

During prostate removal, the urethral sphincter can be weakened or injured, temporarily or permanently reducing urinary control. Radiotherapy, another treatment option, can also irritate the bladder and cause inflammatory urgency and leaks. These side effects can be challenging, but they are part of the process of treating cancer effectively, and practical solutions exist to support you during recovery.

Prostatitis: painful inflammation

Prostatitis is inflammation of the prostate and can be acute or chronic. Acute prostatitis is usually bacterial and appears suddenly with fever, significant pain, and major urinary symptoms. Leaks may occur alongside burning sensations when urinating and an overall feeling of being unwell.

Chronic prostatitis is more gradual and can cause ongoing pelvic discomfort and fluctuating urinary issues. It more commonly affects men aged 30 to 50, unlike BPH which is more typical in older men. When prostatitis is bacterial, appropriate antibiotic treatment usually resolves the urinary symptoms, including leakage.

The prostate is involved in roughly 60% of male incontinence cases, but the underlying cause is rarely dangerous and is often treatable with the right medical or surgical approach.

Neurological conditions affecting bladder control

Parkinson’s disease: when the brain loses control

Urinary symptoms are common in people with Parkinson’s disease. This neurodegenerative condition affects dopamine pathways that influence not only movement, but also bladder regulation.

Many people with Parkinson’s develop an overactive bladder and experience urge incontinence, with sudden, intense urges. The bladder can contract unpredictably, sending urgent signals even when it is not full. This can lead to frequent trips to the toilet (sometimes more than 10 times per day) and leaks if a toilet cannot be reached in time.

For these situations, appropriate men’s incontinence brief protection tailored to your needs can help maintain comfort and confidence.

Stroke and its aftereffects

After a stroke, around 40% of patients experience urinary leaks in hospital, and in some cases symptoms can persist for an extended period. A stroke can damage the brain areas responsible for bladder control and disrupt the signals between the brain and bladder.

Recovery depends on where the stroke occurred and how extensive the damage is. Some people regain normal continence within weeks, while others are left with long-term effects. Neurological rehabilitation and pelvic floor therapy can be important for improving bladder control.

Multiple sclerosis: symptoms that fluctuate

Multiple sclerosis attacks the myelin sheath around nerves, disrupting the transmission of nerve signals. Around 80% of people with MS develop urinary symptoms at some point. These can include overactive bladder with urgency, urinary retention due to poor bladder contraction, or a mix of both.

Because MS often progresses in flare-ups, urinary symptoms can improve and worsen unpredictably, which may require ongoing adjustment of treatment and protection.

Spinal cord injuries: disrupted signalling

Spinal cord damage, whether due to trauma or congenital conditions such as spina bifida, can lead to neurogenic bladder. Communication between the brain and bladder is interrupted, which may cause a spastic bladder that contracts erratically, or a flaccid bladder that does not contract effectively.

These situations require specialised neuro-urology care, sometimes including intermittent self-catheterisation or surgical options to manage continence.

Alzheimer’s disease and other dementias

In advanced dementia, incontinence can affect up to 90% of patients. This is often not a bladder issue as such, but “functional” incontinence: the person may not recognise bladder signals, may forget where the toilet is, or may not manage clothing quickly enough. Environmental adjustments and caregiver support become essential.

Diabetes and urinary complications with absorbent underwear for men

Diabetic neuropathy: nerve damage

Diabetes can affect many body systems, including bladder function. Persistently high blood sugar can damage the nerves that control the bladder, a problem that often develops after 10 to 15 years of poorly controlled diabetes.

When these nerves are affected, signals between the bladder and brain may be disrupted. Two patterns can occur: the bladder becomes less sensitive and fails to signal fullness (leading to retention and overflow leaks), or the bladder becomes unstable and overactive, with unpredictable contractions that cause leaks.

Recurrent urinary tract infections

Diabetes can increase the risk of urinary tract infections through several mechanisms. Sugar in the urine can encourage bacterial growth, immune defences may be reduced, and incomplete bladder emptying due to neuropathy can lead to urine stagnation.

Repeated infections can irritate the bladder and worsen leakage. Good hygiene and regular changes of protection help reduce irritation and discomfort and can support daily management alongside medical care.

Diabetic polyuria

When blood sugar is poorly controlled, the kidneys work to eliminate excess glucose through urine, pulling water with it. This leads to excessive urine production (polyuria) that can overload the bladder and create strong urgency. Some people may pass several litres per day, with multiple night-time awakenings and leaks if urgency is hard to control.

Good diabetes management is one of the most effective ways to prevent these urinary complications. Regular monitoring and adherence to treatment make a real difference.

Medications that can contribute to incontinence

Diuretics: predictable urgency

Diuretics are commonly prescribed for high blood pressure and heart conditions. They intentionally increase urine production to help reduce fluid load and blood pressure. This can create urgency and higher urine volumes that are harder to manage, especially in older adults.

Adjusting timing (typically taking them in the morning rather than the evening) and using appropriate protection during peak effect can help manage this side effect while still benefiting from the medication.

Psychotropic medicines: changes in muscle tone and awareness

Antidepressants, anti-anxiety medicines and sleeping tablets act on the central nervous system and can affect bladder control. Some antidepressants can contribute to urinary retention, which may lead to overflow leakage. Benzodiazepines can reduce muscle tone, including the urethral sphincter, and can also deepen sleep, increasing night-time leak risk.

Antipsychotic medicines can have varied effects, sometimes contributing to both retention and urgency, depending on the person and the medication.

Alpha-blockers: a therapeutic trade-off

Alpha-blockers (such as tamsulosin or alfuzosin) are often used for BPH to relax smooth muscle at the bladder neck and prostate, improving urine flow. In some men, that relaxation can contribute to leakage, particularly during movement, exertion, or position changes.

Finding the right balance often involves dose adjustment and should be done with the prescribing doctor.

Other medicines to keep in mind

Other medications can also influence continence. Some medicines can cause urinary retention, while others can trigger a chronic cough (which worsens stress incontinence). Antihistamines may disrupt urination in some people, and opioid pain medicines can alter awareness of bladder signals.

Never stop or change medication without medical advice. If you suspect a medication is making symptoms worse, speak with your doctor about alternatives or adjustments.

Other health issues that can lead to leaks with men’s anatomical protection

Heart conditions and oedema

Heart failure can cause fluid to build up in tissues, especially the legs (oedema). At night, when lying down, this fluid can return to the bloodstream and be processed by the kidneys, increasing night-time urine production (nocturia). This can lead to multiple trips to the toilet and a higher risk of leaks if urgency is hard to manage.

Treating the underlying heart condition often reduces these urinary symptoms, but anatomical protection can be helpful during periods of adjustment.

Severe obesity: constant pressure

Severe obesity increases pressure on the bladder and can weaken pelvic floor support. Leaks may occur during exertion, even with everyday movements such as standing up from a chair. Extra weight can also contribute to a cycle: reduced activity leads to weight gain, which worsens incontinence, which then further limits activity.

Even modest weight loss (around 5 to 10 kg) can reduce leakage for many men. Comfortable protection can help you stay active while you work on sustainable changes.

Pelvic cancers and their treatments

Cancers involving the bladder, bowel, or nearby pelvic organs can contribute to incontinence through compression, invasion of nerves or muscles, or treatment side effects. Pelvic surgery can affect nerves involved in bladder control, and radiotherapy can cause long-term irritation (radiation cystitis) with urgency and leaks.

In these cases, higher-capacity protection may be needed during and after treatment.

Chronic constipation: an aggravating factor

Constipation is more often a factor that worsens symptoms than a direct cause. A full rectum can press on the bladder, reducing its capacity and raising pressure. Straining can also weaken pelvic floor support over time. Constipation is often linked with lifestyle factors such as low fibre intake, dehydration, and inactivity, which can also affect bladder health.

Improving bowel habits through fibre, hydration and regular movement can reduce both constipation and related urinary symptoms.

How to identify the cause of your leaks

Initial checks with a doctor

Identifying the cause begins with a thorough consultation. Your doctor will ask about symptoms, medical history, and medications. A urine test can look for infection or glucose (suggesting diabetes). Blood tests can assess kidney function, blood sugar, and other markers. A digital rectal examination may be performed to assess the prostate.

A urine flow test is a simple, non-invasive assessment that measures stream strength and flow rate, helping identify obstruction or a weak bladder.

Further investigations

If initial checks do not provide enough answers, additional investigations may be recommended. An ultrasound of the bladder and prostate can assess prostate size, measure residual urine after voiding, and detect bladder abnormalities. Urodynamic testing, while more involved, provides detailed information about bladder and sphincter function.

If a neurological cause is suspected, imaging such as MRI of the brain or spine may be requested. Cystoscopy (a camera examination of the bladder) is usually reserved for more complex cases or when investigating bleeding or suspected tumours.

The value of a bladder diary

Keeping a bladder diary for 3 days is extremely helpful. Record timing and volume of urination, when leaks happen and what you were doing, and how much protection you used. This information often makes diagnosis clearer and helps guide the right treatment approach.

A precise diagnosis supports more targeted and effective treatment, so it is worth seeking help rather than letting embarrassment delay care.

When should you be concerned?

Warning signs that need prompt medical attention

Some symptoms should be assessed within days. Sudden onset of incontinence without an obvious trigger can indicate an acute problem. Blood in the urine (haematuria) is never normal and should be checked. Significant pain with urinary symptoms can signal infection, urinary retention, or another condition that needs treatment.

Fever with urinary symptoms suggests a possible upper urinary tract infection (such as pyelonephritis) and needs urgent medical care. Complete inability to pass urine is a medical emergency. New neurological symptoms (leg weakness, numbness, confusion) can indicate spinal cord compression or stroke and require immediate assessment.

Less urgent situations that still deserve follow-up

Other changes are not emergencies, but still warrant a planned appointment. Gradual worsening over weeks or months should be assessed to identify the cause. If incontinence affects quality of life, limits activities, or disrupts sleep, it is worth seeking medical advice.

If simple measures (pelvic floor exercises, fluid adjustments) do not help after several weeks, a medical review can open the door to more effective options.

Conclusion

Urinary incontinence can be linked to many different conditions, from the most benign to more serious issues. Prostate conditions such as BPH, prostatitis, or treatment after prostate cancer remain the most common causes in men. Neurological conditions such as Parkinson’s disease or stroke can affect bladder signalling. Diabetes can damage nerves and contribute to urinary problems. Many medications can influence continence. Other factors, including heart conditions, obesity, and constipation, can also play a role.

Severity varies widely. Often, the cause is benign (such as BPH) or linked to medication side effects that can be adjusted. In other cases, incontinence can reveal a condition that needs specific treatment. The most important step is identifying the cause so care can be properly tailored.

There is always room for improvement. Many causes of incontinence can be treated or at least significantly reduced. Medical treatment, rehabilitation, and sometimes surgery can help many men regain satisfactory continence. Even when leaks persist, modern solutions can support an excellent quality of life.

Incontinence is a symptom, not a disease on its own. Once the cause is identified, treatment can be targeted and far more effective. Whether the issue is a straightforward prostate enlargement or a more complex neurological condition, solutions exist to help you regain comfort and dignity. Do not wait for symptoms to worsen. Speak to a healthcare professional to identify the cause and access appropriate treatment. In the meantime, modern discreet protection can help you continue living normally, without stress or limitation.

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