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Incontinence

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Incontinence
Summary
  • Urinary Incontinence is caused by a weakening or spasming of the muscles in the bladder.
  • Although Incontinence is not normal, it is a common condition.
  • Treatment can be divided into 3 broad categories: behavioural techniques, medications and surgery.
Description

Incontinence is the inability to control urination, and/or the passing of faeces1. There is a loss of urine from the bladder at inconvenient times. Although Incontinence is not normal, it is a common condition. This topic refers to urinary Incontinence.

Urinary Incontinence is caused by a weakening or spasming of the muscles in the bladder. Types of Incontinence include2:

  • Stress Incontinence occurs when the bladder leaks due to coughing, sneezing, laughing or lifting heavy objects.
  • Urge Incontinence occurs when a sudden overwhelming urge causes spontaneous urination.
  • Overflow Incontinence occurs when the bladder is completely full but cannot empty properly due to an obstruction.
  • Mixed Incontinence is a combination of stress and urge incontinence.

Unless Incontinence is properly treated and managed, it can be very distressing, uncomfortable and embarrassing. The lifestyle may be restricted3. It is normal to pass urine from four to six times during the day and perhaps once at night. Urine should flow easily without discomfort in a good, steady stream until the bladder is empty. As we get older, our bladder capacity gets smaller and we need to pass urine more frequently.


Causes

Incontinence may be caused by: childbirth, lack of exercise, smoking, heavy lifting, menopause, a muscle weakness of the urinary sphincter or pelvic floor, nervous system disorders, constipation, obesity, certain medications, spinal injury, stroke, episiotomy (surgical procedure where the pelvic floor muscles are cut to prevent tearing during childbirth), nutritional deficiencies, prolapse of the organs in the pelvis, urinary infections, epilepsy and damage to the outside nerves of the bladder4.

Reversible causes of urinary incontinence may be investigated using the DIAPPERS model5.
D- Dementia and confusion must be treated.
I- Infection can be treated with antibiotics.
A- Atrophic vaginitis can be treated with oestrogen therapy.
P- Pharmaceutical agents may be altered if possible.
P- Psychological causes may be investigated.
E- Excess fluids such as caffeinated drinks can be reduced.
R- Restricted mobility can be addressed with regular toileting and bedside toileting aids.
S- Stool (constipation) may affect continence.


Signs & Symptoms

Signs and Symptoms include: wetting yourself when you sneeze, cough, jog, laugh, lift something heavy or on the way to the toilet; a heavy dragging feeling in the crotch area; inability to keep a tampon in place; drawing air into the vagina when sitting or kneeling low, then blowing it out with uncontrollable noises (vaginal flatus or wind), prolapses into the vagina and reduced sexual sensation and pleasure.

Warning signs of Incontinence include: leakage of urine regardless of the amount, when you cough, sneeze, laugh or stand, not making it to the toilet and leaking urine on the way, bedwetting - at any age over six years, an urgent need to pass urine, being unable to hold on, passing urine more frequently (more than 8 times per day), and only passing small amounts (less than 300 mls), difficulty getting your stream started or a stream that stops and starts instead of flowing smoothly.

  • Management

    It is very important to have the right management put in place by a Doctor or a trained Continence professional.
    Treatment can be divided into 3 broad categories: behavioural techniques, medications and surgery6.
    Behavioural techniques are the first method and are usually very successful.

    • Pelvic Floor Muscle Exercises aim to strengthen the muscles supporting the bladder in men and women. These exercises are particularly useful for mild stress or urge incontinence, with up to 80% of patients cured or improved using this technique. A physiotherapist or trained continence adviser can instruct you. See the Pelvic Floor Muscle Exercises topic on the HealthPoint.
    • Bladder training aims to increase bladder capacity and lengthen the time between voiding. It involves setting a strict voiding schedule and gradually increasing the time between voiding.
    • Fluid management aims to maintain adequate fluid intake while reducing diuretic fluids such as caffeine. It must be managed carefully to prevent dehydration. A fluid intake of 1.5 to 2 litres a day is recommended. Patients with congestive heart failure or other health problems requiring a restricted fluid intake should discuss the matter with their Doctor.
    • Incontinence devices such as pessaries are recommended in some cases of stress incontinence. A pessary is a small device that elevates the neck of the bladder, preventing unwanted leakage of urine without blocking the normal release of urine. A pessary should be fitted and checked regularly by a medical specialist.

    Medications or drugs are only recommended in conjunction with behavioural techniques. A wide range of medications such as anti-cholinergics, antidepressants, muscle relaxants and oestrogens may be prescribed depending on the individual.

    Surgery is only considered when all other methods have failed. There are a variety of techniques which involve lifting and supporting the structures surrounding and supporting the bladder.


    Lifestyle

    Diet Hints
    • Foods high in magnesium may help Incontinence. These include almonds, cashews, green vegetables, figs, whole grains and fish.
    • Foods high in silica are thought to support the bladder. Sources include almonds, peanuts, sunflower seeds, linseeds, lean red meat, strawberries and alfalfa.
    • Herbal teas such as horsetail, valerian, lemon balm and uva ursi may be of assistance. Drink a cup morning and afternoon.
    • Try to reduce caffeine beverages such as coffee, tea and cola.
    • Try to include foods high in B Group vitamins to help the nervous system. These include brewers' yeast, nuts, seeds and fresh vegetables.
    • Increase fibre intake to avoid constipation. Psyllium, guar gum, apple pectin, fresh fruit and vegetables and slippery elm are good sources.


    Vitimins/Minerals/Herbs

    Vitamins may only be of assistance if dietary intake is inadequate.

    • Silica is a mineral which is believed to strengthen and maintain elasticity of tissues 7.
    • Horsetail herb is very high in silica and may help strengthen tissues and have an astringent action8.
    • Calcium Fluoride is thought to increase integrity and strength of tissues. It is also thought to help prolapsed tissue9.
    • Magnesium and calcium may support weak muscles and nerves10.

  • Phamarcist's Advice

    Ask your Pharmacist for advice.

    1. Follow the correct Pelvic Floor Muscle Exercises listed on the Healthpoint.
    2. Your Pharmacist stocks a range of Incontinence pads. These have to be fitted correctly.
  • Notes

    Organisations & Support Groups

    Continence Foundation of Australia - http://www.contfound.org.au/


    References

    1. Woodtli A. Mixed incontinence: a new nursing diagnosis? Nurs-Diagn. 1995 Oct-Dec; 6(4): 135-42.
    2. Jayasuriya P. Urinary Incontinence: How to treat. Australian Doctor 2001 May 11; I-VIII.
    3. McCandless S, et al. Physical therapy as an effective change agent in the treatment of patients with urinary incontinence. J-Miss-State-Med-Assoc. 1995 Sep; 36(9): 271-4.
    4. Kamouchi M, et al. Urinary incontinence in elderly patients in the chronic stage of stroke. Nippon-Ronen-Igakkai-Zasshi. 1995 Nov; 32(11): 741-6.
    5. Jayasuriya P. Urinary Incontinence: How to treat. Australian Doctor 2001 May 11; I-VIII.
    6. Jayasuriya P. Urinary Incontinence: How to treat. Australian Doctor 2001 May 11; I-VIII.
    7. The Clinical Science of Mineral Therapy,. Leslie Fisher. Maurice Blackmore Research Foundation. 1993. pp81.
    8. Mabey R, et al. 1988. The Complete New Herbal. Penguin. London.
    9. The Clinical Science of Mineral Therapy,. Leslie Fisher. Maurice Blackmore Research Foundation. 1993. pp81.
    10. Gursche S, et al. Encyclopedia of Natural Healing. Alive Pub. 1997. Canada.
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