More than 17 million American men are living with some form of urinary incontinence, yet the vast majority never bring it up with their doctor. For men over 60, the numbers climb sharply — and so does the silence. We sat down with a board-certified urologist who sees this gap every single day in his clinic to get his most honest, unfiltered take on why male incontinence after 60 is so common, so misunderstood, and — critically — so treatable.
What follows is a conversation shaped by real patient stories, current NIH data, and decades of clinical experience. If you've been quietly managing leaks on your own, or wondering whether what you're experiencing is "normal," this one is for you. No judgment. Just answers.
Meet the Expert: A Urologist Who's Tired of Men Suffering in Silence
Dr. Marcus Hewitt has been practicing urology for 22 years, and he'll tell you without hesitation that the most frustrating part of his job isn't the complex surgeries or the difficult diagnoses. It's the men who walk into his office and admit — sheepishly, almost apologetically — that they've been dealing with bladder leaks for three, four, sometimes seven years without telling anyone.
"I had a patient last spring — retired firefighter, 68 years old, tough as nails," Dr. Hewitt recalls. "He'd been wearing folded-up paper towels in his underwear for two years. Paper towels. Because he was too embarrassed to buy anything made for incontinence, and too embarrassed to talk to me about it. That broke my heart a little."
That firefighter's story isn't unusual. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), urinary incontinence affects roughly one in three to one in four men over the age of 60 in the United States — and the prevalence increases meaningfully with each decade of life. Yet surveys consistently show that fewer than half of men with incontinence ever discuss it with a healthcare provider. The gap between how common this condition is and how rarely it gets treated is, by Dr. Hewitt's estimation, one of the most consequential silent health crises in men's medicine today.
"It's Not Just Getting Old" — Why Male Incontinence Over 60 Deserves a Closer Look
"The first thing I want men to understand is that incontinence is a symptom, not a sentence," Dr. Hewitt says, leaning forward in his chair. "It's your body flagging something that deserves attention. Sometimes it's structural. Sometimes it's neurological. Sometimes it's as fixable as adjusting a medication. But walking away from the conversation and calling it 'just aging' — that's where men get stuck."
He's careful to emphasize the distinction between different types of incontinence, because the treatment approach varies significantly depending on what's actually happening in the body. He breaks it down like this:
Stress Incontinence
"Stress incontinence in men typically shows up as leakage during physical activity — coughing, sneezing, lifting something heavy, even laughing too hard. The sphincter muscle that controls the bladder outlet isn't sealing the way it should. In older men, this often follows prostate surgery, particularly radical prostatectomy for prostate cancer. The good news? Pelvic floor physical therapy has excellent outcomes for this type, and we have surgical options when conservative approaches aren't enough."
The American Urological Association (AUA) confirms that post-prostatectomy incontinence is one of the most common forms of stress incontinence in men and that structured pelvic floor rehabilitation significantly improves outcomes in the majority of patients who commit to it.
Urge Incontinence (Overactive Bladder)
"Urge incontinence is what most of my male patients over 60 are actually dealing with, even if they don't know the name for it yet. There's a sudden, powerful urge to urinate — and you can't hold it. Sometimes you don't make it to the bathroom. It's the bladder muscle contracting at the wrong time, and it can be triggered by everything from an enlarged prostate to neurological conditions to simply drinking coffee." Dr. Hewitt pauses. "And it's highly treatable. Behavioral modifications, bladder training, medications, nerve stimulation — we have a whole toolkit."
According to the National Association for Continence (NAFC), overactive bladder affects approximately 33 million Americans, and the condition becomes significantly more prevalent after age 60 in both sexes. In men specifically, its overlap with benign prostatic hyperplasia (BPH) makes accurate diagnosis essential.
Overflow Incontinence
"This one tends to catch men off guard because it doesn't feel like incontinence in the way they expect. The bladder never fully empties — it fills past capacity and dribbles constantly. Men describe it as always feeling a little wet, never having a strong stream, feeling like they could never quite finish. In older men, the most common culprit is an enlarged prostate blocking the outflow of urine. This is a medical situation that needs prompt attention — you don't want to leave an overstretched, underperforming bladder untreated for years."
The Isolation Nobody Talks About
Back to the retired firefighter — because his story has a second chapter. After two years of improvised paper towel solutions, his daughter noticed he'd stopped coming to his granddaughter's soccer games. He'd been avoiding situations where he couldn't guarantee immediate bathroom access. He'd turned down a fly-fishing trip with his son. He'd started mapping every restaurant and grocery store by the location of its restrooms.
"He wasn't just managing a bladder problem," Dr. Hewitt says quietly. "He was shrinking his world. And that's what incontinence does when it goes unaddressed. It doesn't stay a physical problem — it becomes an identity problem. Men start believing they're diminished. That their best days are behind them."
Research published through the NIH's National Library of Medicine consistently links untreated urinary incontinence in older adults to significantly elevated rates of depression, social withdrawal, and decreased quality of life. A 2022 systematic review found that men with urinary incontinence were substantially more likely to report feelings of shame, loss of masculinity, and reduced participation in social and recreational activities compared to continent peers.
"The isolation is real," Dr. Hewitt confirms. "And it's entirely preventable — if men would just come in and talk to us."
The Turning Point: When He Finally Walked Through the Door
The firefighter — let's call him Ray — finally made an appointment after his wife gently suggested it. Not gently in the sense of softly. Gently in the sense of firmly, and probably more than once.
"He walked into my office looking like he was expecting a lecture," Dr. Hewitt laughs. "I told him the first thing I tell every man who comes in late: there's no judgment here, and you've just done the hardest part."
Ray's workup revealed a combination of BPH-related overflow incontinence and a secondary urge component. His treatment plan included medication to manage prostate-related obstruction, a bladder-retraining protocol, and a referral to a pelvic floor physical therapist. But there was also a more immediate, practical step — because treatment takes time to work, and Ray needed to live his life in the meantime.
"Part of what I do with patients is help them bridge the gap between starting treatment and seeing results," Dr. Hewitt explains. "That means talking honestly about protective products — and making sure they know that modern options are nothing like what they're imagining." He often recommends that patients look into washable, reusable incontinence underwear rather than disposable options, citing both comfort and the dignity factor. Products like Orykas washable incontinence underwear come up in those conversations because they're designed to look and feel like regular underwear — not medical gear.
"When Ray came back a month later, he'd been to his granddaughter's soccer game. He'd gone fishing with his son. He looked like a different man — and his incontinence hadn't even fully resolved yet. He just had the right support in place while we worked on the underlying issue."
"Treatable at Any Age" — What Dr. Hewitt Wants Every Man Over 60 to Hear
"I cannot stress this enough: there is no age at which incontinence becomes untreatable. I have patients in their 80s who responded beautifully to pelvic floor therapy. I have patients in their 70s who had surgical procedures that gave them their lives back. The idea that this is just what happens when you get older and you have to accept it — that idea costs men years of unnecessary suffering."
The Mayo Clinic echoes this directly in its patient resources on urinary incontinence, noting that lifestyle changes, behavioral techniques, medications, medical devices, and surgery are all options depending on the type and severity of incontinence — and that most patients experience significant improvement with treatment.
Dr. Hewitt's evidence-based recommendations for men over 60 who are experiencing any form of urinary leakage:
- Talk to your primary care physician or a urologist. A basic workup — urinalysis, a bladder diary, post-void residual measurement — can clarify what type of incontinence you're dealing with within a single visit.
- Don't restrict fluids. Many men cut back on water hoping to reduce leaks. This backfires: concentrated urine is more irritating to the bladder and can worsen urgency.
- Limit bladder irritants. Caffeine, alcohol, carbonated beverages, and artificial sweeteners can all worsen overactive bladder symptoms.
- Start pelvic floor exercises. Even before seeing a specialist, Kegel exercises (contracting and releasing the pelvic floor muscles) can improve sphincter control with consistent practice.
- Use the right products. Protective underwear isn't a defeat — it's a tool. Washable options like Orykas allow men to manage leaks discreetly and comfortably while they pursue treatment.
- Follow up. Incontinence treatment is rarely a one-visit fix. It's a process, and the men who do best are the ones who stay engaged with their care team.
Where Ray Is Now
Eighteen months after his first appointment, Ray's overflow incontinence resolved significantly following a minor outpatient procedure to address his prostate obstruction. His urge symptoms improved with medication and behavioral therapy. He still does his pelvic floor exercises most mornings — "before coffee," he told Dr. Hewitt, with apparent pride.
He also went on that fly-fishing trip. Twice.
"That's what I want for every man who's reading this and recognizing himself in Ray's story," Dr. Hewitt says. "Not just drier underwear — although that matters enormously. I want their lives back. Because that's what good incontinence care actually delivers."
Frequently Asked Questions
Is urinary incontinence normal for men over 60?
It's common — affecting roughly one in four men over 60 according to NIDDK data — but "common" doesn't mean it should be accepted without evaluation. Urinary incontinence is a symptom with identifiable causes, and in the majority of cases it can be significantly improved or resolved with appropriate treatment. Normalizing it as inevitable aging discourages men from seeking care that could meaningfully improve their quality of life.
What are the main types of male incontinence, and how do I know which one I have?
The three main types are stress incontinence (leakage during physical exertion like coughing or lifting), urge incontinence (a sudden, intense urge followed by involuntary leakage), and overflow incontinence (constant dribbling due to incomplete bladder emptying). Mixed incontinence — a combination of types — is also common. Determining which type you have requires a clinical evaluation, typically including a medical history, bladder diary, and possibly imaging or urodynamic testing. This distinction matters because treatment approaches differ significantly by type.
Can pelvic floor exercises really help men with incontinence?
Yes — and the evidence is strong. The AUA and Mayo Clinic both recognize pelvic floor muscle training (Kegel exercises) as a first-line, evidence-based intervention for stress and urge incontinence in men. Studies show that men who perform structured pelvic floor exercises consistently — ideally guided by a pelvic floor physical therapist — experience meaningful reductions in leakage episodes. Results typically develop over six to twelve weeks of regular practice.
What's the difference between disposable incontinence products and washable options like Orykas?
Disposable incontinence pads and briefs are convenient for single use but can be bulky, costly over time, and environmentally significant. Washable incontinence underwear, like the products offered by Orykas, are designed to look and feel like regular underwear while providing discreet, built-in protection. They're reusable, more economical over time, and for many men represent a more dignified everyday solution — particularly during the period when treatment is underway and results are still developing. The right product depends on absorbency needs and personal preference.
At what point should I see a doctor about bladder leaks?
If you're experiencing any involuntary urine leakage — regardless of frequency or severity — it's worth a conversation with your doctor. You should seek prompt evaluation if you notice blood in your urine, experience pain during urination, have difficulty starting urination or feel like your bladder never fully empties, or if leakage is affecting your daily activities or sleep. These symptoms can point to conditions beyond simple incontinence that warrant timely diagnosis, including BPH, bladder infections, or less commonly, bladder or prostate cancer.
Share:
5 Sports-Safe Strategies for Men With Bladder Leaks
The Psychological Impact of Incontinence in Men — and How to Cope