ASK DR. BAUGHAN                                                         March 19, 1999

LEAKY DOODLES

After last week’s column on treatments for female incontinence entitled “Leaky Bladders,” an anonymous woman called my office and insisted I write about leaky men.

It is difficult to call urinary leakage in men a health problem because it is a universal phenomenon in all men.  Every man leaks.  Therefore, it must be Nature’s intent, so how can it be a problem?  If you doubt this, complete the following rhyme:  “No matter how you jiggle and how you dance, . . . .”  If you do not know the rest, you are undoubtedly a woman.  Every man knows.  It is one of those male-bonding, father-to-son, older brother to younger sort of things.

You see, from early childhood, boys have a very different attitude toward bladder function.  Girls are taught bladder control as a private personal hygiene matter.  Their sense of development is rewarded by control, comfort and cleanliness.  For boys, though, bladder control conveys a sense of power, and power needs an audience.  The arc!  The distance!  The duration!  These are all features to marvel at and to improve through careful practice.  They must be shared and compared with close friends.  What boy has not felt like a master of the universe with  the unerring accuracy of a laser dowsing a fly or spider in the toilet bowl?

Then the suffocating constraints of emasculating civilization close in.  What nature intended the male to use as a way to mark territory and claim personal space becomes associated with being “dirty and unclean.”  Urine is sterile.  There are no germs in it.  As Shakespeare wrote, “Wherefore base?”  What greater sense of freedom and harmony with Nature than boys by the edge of the ballfield or on the trail, Zip! Let it flow!  What greater relief?

With Nature thus so misdirected, it is no wonder that the guidelines between health and illness in bladder function in men are blurred.  Some seek medical attention because society objects to the organic scent of “Eau de urea” and instead insists on the poofy aromas of Madison Avenue.  Two physical mechanisms may be in play.  If the bladder muscle has become irritable with age, injury or surgical effects, a medicine (such as Detrol or Ditropan) may help prevent unpredictable contractions.  If the prostate has enlarged and increased the resistance to voiding, medicines can help relax the opening of the bladder (such as Flomax, Cardura or Hytrin) and allow more complete emptying.  This is helpful when the man is troubled by frequent urges and post-void dribbling of more than five minutes.

There are two last ditch efforts to help contain the bladder’s dew when the dew lasts all day.  Women now have a cork in the product FemSoft; men for 40 years or more have had a clamp.  The Cunningham Clamp is essentially a padded clothes pin worn, shall we say, “externally.”  And finally, there is the Mason jar or the empty tennis ball can.