Urinary incontinence in male workers: a critical analysis in light of Raewyn Connell’s theory of masculinitiesAbstract
This essay examines the psychosocial and symbolic repercussions experienced by working men with urinary incontinence, through the lens of Raewyn Connell’s theory of masculinities. Male urinary incontinence emerges as a significant challenge in professional contexts, particularly in environments that prize productivity, physical endurance, and the absence of vulnerability. In such settings, men with urinary incontinence may face feelings of inadequacy, stigma, and marginalization. These effects, intensified by rigid gender norms and organizational cultures that show little sensitivity to health needs, undermine self-esteem and professional performance. Consequently, there is a clear need for institutional policies and management strategies that reconcile workplace demands with comprehensive health care. Grounded in the theory of masculinities, the analysis seeks to denaturalize the experience of urinary incontinence in the labor market and points to interventions that foster more inclusive work environments, thereby safeguarding the dignity and well-being of working men with urinary incontinence.
Keywords
Urinary Incontinence; Masculinity; Men’s Health; Job Market; Occupational Health
Resumo
Este ensaio explora as repercussões psicossociais e simbólicas que impactam homens trabalhadores com incontinência urinária, à luz da teoria das masculinidades de Raewyn Connell. A incontinência urinária masculina configura-se como um desafio em contextos laborais, especialmente em ambientes que valorizam a produtividade, a resistência física e a ausência de vulnerabilidade. Nesses espaços, homens com incontinência urinária podem vivenciar sentimentos de inadequação, estigma e marginalização. Tais efeitos, agravados por normas de gênero rígidas e contextos organizacionais pouco sensíveis às demandas de saúde, comprometem a autoestima e o desempenho profissional. Diante disso, evidencia-se a necessidade de políticas institucionais e de estratégias de manejo que conciliem as demandas do trabalho com o cuidado integral à saúde. A análise, pautada na teoria das masculinidades, permite desnaturalizar a experiência da incontinência urinária no mercado de trabalho e aponta intervenções que promovam ambientes laborais mais inclusivos, preservando a dignidade e o bem-estar dos homens trabalhadores com incontinência urinária.
Palavras-chave
Incontinência Urinária; Masculinidade; Saúde do Homem; Mercado de Trabalho; Saúde do Trabalhador
Introduction
Male urinary incontinence (UI) falls within the spectrum of non-neurogenic lower urinary tract symptoms and is defined as the involuntary loss of urine. Its manifestations include stress urinary incontinence (SUI), common after prostatectomy, urge urinary incontinence (UUI), and the mixed form1, which can be exacerbated by comorbidities such as diabetes, neurological diseases, and anatomical abnormalities2.
It is estimated that UI affects approximately 300 million people worldwide, corresponding to about 5% of the global population, with repercussions on quality of life and a burden on healthcare systems2. In Brazil, although epidemiological data remain limited, it is estimated that more than 10 million people live with this condition, with a lower prevalence among men3.
However, in the post-radical prostatectomy setting, UI can occur in between 2.5% and 90% of cases, varying according to follow-up duration and diagnostic criteria. It is estimated that moderate to severe forms persist in up to 19% of men in the first six months and in 13% six years after surgery, with adverse effects persisting even beyond this period4.
Sexual and gender minorities, such as gay and bisexual men and transgender women, also experience prostate cancer and its repercussions, including urinary outcomes, and frequently face barriers to access, stigmatization, and inadequate healthcare services. Furthermore, these groups tend to have poorer quality-of-life outcomes after treatment and remain underrepresented in the scientific literature5. Broadening the perspective to include the diversity of experiences becomes essential, given the health disparities faced by these populations and the need for a more inclusive and equitable approach that encompasses an understanding of the social impacts of illness5.
Beyond clinical implications, male UI takes on significant social dimensions, particularly in the workplace. In societies marked by a focus on productivity, masculinity is historically associated with physical performance, autonomy, and financial provision, which influences not only social roles but also the ways in which illness manifests and suffering is managed6.
From childhood, men are socialized to suppress emotions and internalize patterns of strength, courage, and heteronormativity, hindering the expression of emotions and the recognition of their own vulnerabilities. The norms underpinning hegemonic masculinity, reinforced in multiple social contexts, shape interpersonal relationships marked by emotional silence and the denial of psychological suffering7.
It is noteworthy that work is central to men’s lives in androcentric and macho societies, serving as a source of income, status, and identity8. In addition to offering recognition and a sense of belonging, it imposes pressures regarding performance, availability, and the denial of vulnerabilities, which hinders health care and the establishment of boundaries. This centrality also reinforces hierarchies and regulates social morality, distinguishing men considered “respectable” from others9,10.
For men living with UI, these factors become even more complex. The condition, often associated with stigma and a perception of fragility, directly challenges the ideal of self-control and invulnerability valued in the workplace. Many avoid seeking support or adapting routines for fear of discrimination or loss of opportunities, which can exacerbate the physical and emotional impact. This overlap between work demands and symbolic barriers imposes additional challenges on health, self-esteem, and job retention, highlighting the need for more inclusive labor policies and practices that are sensitive to men’s health issues11.
This essay is grounded in the perspective that the analysis of workers with UI can benefit from theoretical frameworks that consider the plurality of masculinities, beyond the hegemonic norm. In this sense, Raewyn Connell’s theory of masculinities is adopted as a reference aiming to explore the psychosocial and symbolic repercussions that impact working men with UI.
Theoretical Reference and Guiding Question
To deepen our understanding of male UI in the workplace, we draw on the theory of masculinities proposed by Raewyn Connell, an Australian sociologist, professor emerita at the University of Sydney, and a transgender woman, recognized as one of the pioneers in gender studies. Her academic career, influenced by social movements such as feminism and the gay liberation movement, allowed her to expand feminist thought beyond women’s experiences, incorporating men and the power structures that sustain gender hierarchies12.
The concept of hegemonic masculinity refers to the culturally dominant model of being a man, characterized by attributes such as strength, stoicism, autonomy, invulnerability, and control over the body and emotions. It is a symbolic construction that occupies a position of primacy within a given gender order, understood as the social structure responsible for organizing relations between genders13,14.
From this perspective, Raewyn Connell proposes that masculinities are multiple and organized into a relational hierarchy, comprising hegemonic, subordinate, complicit, and marginalized masculinities. Embedded within this hegemonic structure, subordinate masculinity expresses specific relations of domination among groups of men, as occurs, for example, in the historical subordination of gay men in contexts marked by heterosexual normativity, frequently associated with hegemonic masculinity and the femininity of homosexuality13.
Complicit masculinity, on the other hand, refers to men who, although they do not fully conform to hegemonic normative standards, benefit from the so-called patriarchal dividend, insofar as men, in general, benefit from the subordination of women. Many of these individuals, however, maintain respectful relationships with women and share in domestic responsibilities and household income, without structurally challenging the prevailing gender order13.
In turn, marginalized masculinity refers to forms of masculinity constructed in contexts marked by inequalities of class, race, and ethnicity, in which certain groups of men remain structurally excluded from hegemonic masculinity. Although they may express socially valued attributes of “being a man,” these masculinities receive neither social legitimacy nor access to institutional power, being defined relationally and dependent on the position of the dominant group13.
This perspective allows us to understand that male experiences are not monolithic and that different ways of being a man coexist and interact in terms of power and social recognition. Based on this understanding, it becomes possible to examine the effects of social pressures that demand men perform a hegemonic masculinity, especially when considering health conditions that challenge these ideals, such as UI13,14.
Based on this theoretical approach, it can be presumed that men with UI in the workforce would tend to feel pressured to maintain the same pace and performance, even in the face of physical limitations or discomfort. This scenario may be associated with the silencing of health-related demands and the adoption of concealment strategies, to the detriment of adequate care and a more inclusive work environment11.
Qualitative studies suggest that many men report feelings of shame, stigma, and the need to hide their symptoms, avoiding seeking support for fear of judgment15-17. This situation may compound inequalities in access to and provision of health services for men with UI, as demonstrated in a Brazilian study18, contributing to the invisibility of the condition and the difficulty in making it a legitimate issue in social and workplace contexts.
Thus, in light of Raewyn Connell’s theory of masculinities, it can be understood that the experience of UI tends to challenge the hegemonic ideal of bodily self-control, virility, and productivity, central attributes in the social constructions of masculinity and reinforced by global norms of gender and performance13,14. By exposing physical vulnerabilities and requiring specific care, this condition can strain culturally assigned expectations of men, with possible repercussions on professional identity and workplace interactions15.
Given this scenario, the following guiding question emerges: how can Raewyn Connell’s theory of masculinities contribute to our understanding of the experience of UI among working men?
Implications of UI in the workplace
Work, as a social and rational activity, can be understood as a structuring element of human life, being fundamental to subsistence, well-being, and the development of society. Beyond its productive function, it can also be interpreted as a space for identity formation and the reproduction of inequalities, influencing the organization of social and institutional relations19.
Its etymology, derived from the Latin tripalium (an instrument of torture), highlights the historically negative connotation associated with labor, especially with manual labor, traditionally linked to pain, subordination, and devaluation, as observed in Greco-Roman societies19.
In contemporary times, work can be considered to have an ambivalent character: it can promote human development as well as contribute to physical and psychological degradation. The growing flexibility of labor relations and the precariousness resulting from the capitalist model may be related to the rise in unemployment, informality, and adverse working conditions19,20. In this scenario, it is possible that such dynamics contribute to workers’ ill health and the emergence of new forms of social exclusion.
In light of this theoretical approach, UI may pose an additional challenge for men of working age. In organizational environments characterized by an emphasis on productivity, physical endurance, and the denial of vulnerability, it can be assumed that men with UI would tend to experience feelings of inadequacy, marginalization, and stigmatization, and may be perceived as less capable of performing professionally13,14. In this sense, the fear of discrimination or ridicule can impact mental health, engagement, and attachment to work21.
From a physical standpoint, it can be considered that UI tends to have a cumulative impact on occupational functionality and safety. Recurrent episodes may contribute to dermatitis and infections in the perineal region, while strategies such as fluid restriction, sometimes adopted to control symptoms, may increase the risk of dehydration, headaches, constipation, and urinary tract infections. In addition, symptoms such as nocturia and increased urinary frequency can compromise sleep quality, contributing to fatigue and a potential increase in the likelihood of errors and workplace accidents11,18.
Activities that require intense physical exertion or that hinder access to restrooms can exacerbate these conditions. In certain contexts, particularly when considering bodies marked by specific biomedical trajectories, UI may also be associated with changes in sexual function, such as pelvic pain or erectile dysfunction, which can intensify experiences of stress and social isolation. In older workers, nocturia may be related to an increased risk of falls, while prolonged use of absorbent devices can contribute to skin irritations and musculoskeletal discomfort, with possible repercussions on presenteeism and absenteeism11,18.
The stigma associated with chronic health conditions, such as in the case of UI, tends to hinder entry into and retention in the labor market. Even in contexts where adaptation or flexibility policies exist, their implementation may be limited by organizational cultures that interpret such measures as concessions rather than rights22.
Furthermore, the prevailing gender order tends to associate self-care with the female sphere, which can restrict men’s ability to express health needs in the workplace, favoring the isolated management of the condition. This combination of objective and symbolic barriers can complicate the negotiation of accommodations, with potential compromises to performance and well-being23.
Identity negotiation and the plurality of masculinities
The relationship between men and work is fundamental to understanding society and the constitution of human identity. From a dialectical perspective, work, as material production, tends to shape social structure, interpersonal relationships, and individual consciousness. Although trans-historical, mediating human interaction with nature, work takes on unique characteristics in each social system. Its historical manifestation ranges from prehistoric collectivism to the commodification of labor under capitalism, suggesting the decisive influence of the mode of production on labor experience24.
From this perspective, one can consider that masculinities are multiple, dynamic, and historically situated, such that not all men passively adhere to the prescribed standards associated with hegemonic masculinity25. In the case of UI, some men may be positioned or position themselves within forms of marginalized masculinity, especially when other social markers, such as race, class, or disability, intersect, amplifying processes of exclusion26.
On the other hand, it is possible that some individuals construct alternative or hybrid masculinities, through which the experience of vulnerability can be reframed, as can the socially assigned meanings of “being a man.” In such cases, these individuals would tend to more actively negotiate adaptation strategies, support networks, and potentially more inclusive working conditions26.
In this sense, in light of Raewyn Connell’s contributions, gender can be understood as a historical and dynamic social structure that organizes power relations, work, and cultural practices, not limited to an individual or biological attribute. In this approach, gender can be considered to vary according to contexts and operate on multiple levels (individual, interactional, institutional, and global), intersecting with inequalities such as class, race, and sexuality14.
This theoretical approach makes it possible to expand the analysis of masculinities beyond hegemony, recognizing the plurality of gender identities and sexual experiences as constitutive dimensions of social relations. Thus, it can be suggested that different individuals, including trans men and those experiencing sexual dissidence, tend to experience health, illness, and labor market participation processes unequally14.
Based on this understanding, it can be considered that masculinities are not homogeneously configured, being mediated by material conditions and social positions that can influence access to care and ways of coping with illness. In contexts of greater precariousness, it is possible to assume that such inequalities tend to intensify13,14.
Certain expressions of masculinity associated with sexual dissidence may occupy subordinate positions in the gender hierarchy, often related to attributes symbolically excluded from the hegemony and historically associated with femininity13,14. These processes can have repercussions on health, the experience of UI, and career trajectories, while also highlighting structural tensions in the foundations of the gender order.
Men in situations of UI within contexts of socioeconomic vulnerability tend to face even more complex challenges, highlighting the interplay between gender hierarchies and material inequalities. Frustration over the inability to fulfill the role of provider can trigger intense psychological distress, often rendered invisible or delegitimized by psychosocial services that reinforce the same normative ideals6. In these contexts, the productive body tends to be valued as a central symbol of masculinity, while illness is associated with inactivity, sadness, and isolation27.
Aging and health conditions can be experienced as a loss of strength, autonomy, and freedom, which tends to strain traditional models of masculinity. Among these conditions, UI stands out for imposing physical limitations and social constraints that can directly affect participation in work and community life, potentially reinforcing stigmas associated with male vulnerability27.
At the same time, such conditions can reveal inequalities in employment opportunities and social protection, making the need for inclusive and adapted work environments even more evident. This scenario may also open space for possible reframings/resignifications, especially among older workers who, when dealing with UI, may come to integrate biomedical and folk knowledge to manage the condition, redefine experiences of autonomy, and negotiate alternative ways of living and working27.
Although there are initiatives aimed at promoting men’s health, such as the National Policy for Comprehensive Men’s Health Care (PNAISH), it can be argued that obstacles to its implementation persist, particularly regarding the intersection between health and the world of work28. In this context, the lack of access to work and income can profoundly affect men from lower socioeconomic classes, for whom unemployment may be experienced not only as an economic reality but also as a subjective experience of devaluation and suffering6.
In this framework, understanding the relationship between gender, health, and the economy is relevant for formulating care strategies that are more sensitive to male-specific characteristics. When included in this debate, UI can highlight tensions between bodily vulnerability and hegemonic ideals of masculinity, which tend to value strength, autonomy, and physical control6.
For men in occupations marked by precariousness, UI can be experienced not only as a clinical condition but also as a factor of stigmatization and insecurity at work, with possible direct impacts on income, self-esteem, and social participation. This issue becomes particularly urgent in face of changes in the world of work and persistent inequalities that can influence access to care resources and decent working conditions6.
Considering this, we suggest the need to advance the formulation of public policies, occupational health programs, and institutional strategies that recognize male UI as a matter of health and labor rights, promoting the creation of more inclusive and protective work environments, potentially capable of reconciling productivity and workers’ well-being.
Study Limitations
The main limitation of this study is the absence of data from interviews or direct observations, as it is restricted to theoretical analysis and a literature review. While this approach allows for a well-founded critical reflection, it does not fully capture the subjective and contextual complexity of individual experiences, particularly regarding the daily experiences of men with UI in the workplace.
Furthermore, it is acknowledged that the scientific literature analyzed itself has significant gaps. It is observed that the literature on male UI in the workplace, even when intersected by social markers such as race, social class, disability, and sexual orientation, tends to predominantly prioritize the experiences of cisgender men. In this sense, the experiences of transmasculine individuals remain underrepresented or rendered invisible, creating a significant theoretical gap and reinforcing the need for research that addresses other bodily experiences and gender identities.
This gap highlights the need for further research in this field to account for different gender experiences, thereby contributing to a more comprehensive and equitable understanding of the relationships between UI, work, and masculinities.
Despite these limitations, the study offers relevant insights for advancing scientific knowledge in the field of occupational health, particularly regarding the integration of gender perspectives in the analysis of UI, thereby encouraging future research that considers the diversity of human experiences at work.
Conclusion
The analysis presented suggests that male UI in the workplace, when examined through Raewyn Connell’s theory of masculinities, can contribute to the denaturalization of this experience, situating it within the complex interplay between the body, gender norms, and professional demands, which, in certain contexts, tend to appear inflexible and insensitive to workers’ bodily and health needs.
Hegemonic masculinity, anchored in ideals of control, autonomy, and invulnerability, may represent a source of tension for men with UI, potentially being associated with feelings of shame, concealment of the condition, and resistance to seeking support or negotiating accommodations in the workplace.
Understanding male UI as a phenomenon that transcends the biomedical dimension and is embedded in a structuring gender system contributes to the development of more comprehensive strategies for care and inclusion. An analysis of the hierarchy and plurality of masculinities allows us to recognize that vulnerability should not be interpreted as a masculine failing, but as a legitimate dimension of the human experience, capable of being incorporated into more diverse and potentially healthier ways of being a man.
Raewyn Connell’s theoretical framework, by highlighting power relations and the multiple expressions of masculinity, was used as a critical lens to deepening the understanding of the barriers and opportunities experienced by men with UI in the workplace. This approach can be considered relevant for guiding the formulation of organizational policies and practices aimed at building more equitable, protective, and health-sensitive work environments, potentially fostering a balance between productivity and workers’ well-being.
To address these challenges, it is suggested that organizations and managers consider adopting measures aimed at balancing productivity and well-being. Among the possibilities, the following stand out: the implementation of formal confidentiality and support policies; the adaptation of workstations and routines that facilitate access to restrooms and breaks; the inclusion of male UI in occupational health programs; the development of awareness-raising initiatives on gender and health, aimed at reducing stigmas; and the creation of safer channels for negotiating adjustments.
When combined with initiatives that challenge stereotypes of masculinity and promote self-care, such strategies can contribute to the creation of more inclusive and protective work environments for men experiencing UI.
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