What happens during a physical exam for urinary incontinence in men?

Anthony L. Komaroff, MD
Internal Medicine
During a physical exam for urinary incontinence, your clinician places more focus on your nervous system, abdomen, and genital area than during a standard physical. The clinician checks your reflexes, assesses your muscle strength, and observes whether you can distinguish the touch of something sharp from something dull. To test nerves in the genital area, the doctor may stroke the skin near your anus and watch for a normal muscle contraction. In women, the doctor gently taps the clitoris and looks for a subtle muscle contraction of the anus, which is a normal reflex.

None of these tests is painful or uncomfortable. If the doctor observes problems with any functions that rely on the same nerves as those that control urinary continence, it can mean that these nerves are involved in your bladder symptoms.

During the abdominal exam, the doctor presses on your abdomen to feel your bladder and check other areas for hernias, tenderness, or any signs of tumor, infection, scarring from previous surgeries, or an impacted bowel.

Both men and women provide a urine sample, which is checked immediately for blood, sugar, or large amounts of bacteria (normal urine is sterile). Blood can indicate irritation of the urinary tract. If there is such irritation, the cause must be determined. If sugar is detected, your physician might suspect diabetes, which can increase your urine volume and make incontinence more likely. Bacteria indicate possible infection. As a more specific test, a urine sample may be sent to a laboratory to be cultured; if harmful bacteria are detected, a sensitivity test can identify the appropriate antibiotic to treat the infection.

For men, the doctor examines your penis for signs of constriction of the foreskin or an abnormal narrowing, or stenosis, of the urethra, which can result from scarring or infection. The doctor conducts a digital rectal exam, which involves inserting a gloved finger into your rectum to feel the size and texture of the prostate gland and assess the strength of your pelvic muscles. You may be asked to contract your muscles as if you were trying to avoid urinating or passing gas.
Gladys Y. Ng, MD
For a physical exam to evaluate urinary incontinence in men, a doctor will examine the genital urinary area and look at the penis to look for any strictures or scar tissue, especially at the tip. Sometimes, inflammatory skin conditions can start at the tip of the penis and block the urinary channel going backwards. That can cause a backup to the bladder, causing overflow incontinence or urgency because the bladder is not emptying completely.

Your doctor will also check to see there are any neurologic signs, which could be indicated if a man comes in with a walker or a cane or if one side is weaker than the other. Your doctor will also assess your reflexes, such as the bulbocavernosus reflex, and the tone of the rectum via a rectal exam. This is done for two reasons: to feel the size of the prostate if it's still there, and to get a sense of the neurologic and muscular tone of the rectum. Your doctor will also assess if there is constipation because the bladder and the bowels share the same space in the pelvic cavity. A lot of urge can be due to being constipated, with the bowels kind of crowding out the bladder and the bladder not having enough space to expand and fill up.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.