WHAT IS INCONTINENCE?
Incontinence (in-CONT-ti-nunce), or loss of bladder or bowel control, is a symptom, NOT a disease in itself.
The kidneys remove waste products from the blood and continuously produce urine, which then travels to the bladder through the ureters. The bladder is a complex organ consisting of muscle tissues that enable it to hold urine in place as necessary and to push urine through the urethra and out of the body during urination.
Simply stated, Incontinence is a problem of the urinary system.
Normally, as the bladder fills with urine, nerves inside the bladder send messages to the brain alerting you to the need to urinate. Once the bladder nerves send a message of "full" to the brain, the brain in turn sends a message to the sphincter muscle that it is time to release the urine from the bladder into the urethra and out of the body.
Incontinence, the loss of bladder control, is the result of a dysfunction somewhere in the urinary process. The dysfunction may be related to the nervous system message relay between the brain, muscles and nerves involved in urination, or it may be the result of other factors. Some may include birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth.
It is important to consult your physician for proper diagnosis of the cause of any dysfunctions of the urinary process. Remember: cutting down on the amount of fluids you drink or drastically changing your diet can be dangerous. The proper medication prescribed by your doctor combined with the quality products we offer are the best fight against incontinence--so you can get back to living the life you deserve.
HOW WIDESPREAD IS INCONTINENCE?
You are not alone and it is far more common than most people realize as it affects people of all ages ranging from children and young adults to senior citizens. 1
- Over 25 million Americans experience some form of inability to completely control their bladders or bowel movements.
- 1 in 5 adults over age 40 are affected by overactive bladder or recurrent symptoms of urgency and frequency, a portion of who don't reach the toilet before losing urine.
- 67% of adults between 30-70 years in age have never discussed bladder health with their doctor and only 12.5% who have experienced bladder control issues have been diagnosed.
- 1 in 4 women over the age of 18 experience episodes of leaking urine involuntarily.
- 1 in 5 women with urinary incontinence also have bowel control problems because of underlying pelvic floor dysfunction.
- More than 33% of the resident population in an assisted living facility is likely to have urinary incontinence.
- More than 50% of all nursing home residents are incontinent of urine and many of them experience loss of bowel control as well.
- 2/3rds of those with urinary incontinence symptoms ignore treatment or product usage to manage the condition!
SOME OF THE CAUSES OF INCONTINENCE 2
- Weakened muscle control due to age or natural occurrences like childbirth.
- Side effects from surgery.
- Nervous system disorders like spina bifida or strokes.
- Infections or inflammation of the bladder, prostate gland, or surrounding muscles.
- Neuromuscular diseases such as multiple sclerosis and cerebral palsy.
- Damage caused by spinal cord injuries.
Diet and Fluid:
Diet and fluid intake can have a significant effect on bladder and bowel control. There is no "diet" to cure incontinence. However, there are certain dietary matters you should know about. Many people who have bladder control problems reduce the amount of liquids they drink in the hope that they will need to urinate less often. The smaller amount of urine may be more highly concentrated thus, irritating to the bladder surface. Highly concentrated (dark yellow, strong smelling) urine may cause you to go to the bathroom more frequently. It also encourages growth of bacteria. And when bacteria begin to grow, infection sets in, and incontinence may be the result. In general, it is recommended that you drink a total of six to eight glasses (8 ox. each) of fluid throughout the day. However, some studies have found that patients with over active bladders who reduce their daily fluid and water-containing food intake by 25% have improved episodes of urgency, frequency, and nocturia. Do not restrict fluids to control incontinence without following the advice of your physician and establishing a baseline intake.
Some foods cause urine to smell bad or peculiar. The most notable of these foods is asparagus. Some other foods may affect the way your urine smells. Another cause of foul-smelling urine, and the most dangerous cause, is urinary tract infection. If you notice that your urine has a strong odor and you have not eaten any foods that would cause this, you should see a physician and have a specimen of your urine tested for infection.
Some medicines may cause your urine to be discolored or have an unusual odor. Some are medicines that you take for bladder inflammation or for urine tests. Others you take for separate health conditions. If your urine has a peculiar color or odor, consult your physician or the pharmacist who filled your prescription.
Some foods and beverages are thought to contribute to bladder leakage. Their effect on the bladder is not always understood, but you may want to see if eliminating one or all of the items listed improves your urine control.
COMMON BLADDER IRRITANTS:
||Soft drinks with caffeine
||Coffee (even decaffeinated)
||Medicines with caffeine
||Citrus juice & fruits
||Highly spiced foods
Grape juice, cranberry juice, cherry juice, and apple juice are thirst-quenchers that usually are not irritating to a normal bladder. Cranberry juice (or cranberry tablets) and cherry juice may help control urine odor. The best beverage is water. A very thin slice of lemon (not enough citrus juice to irritate the bladder) may improve the taste of water enough that you will find it enjoyable.
Smoking is irritating to the bladder surface and is associated with bladder cancer. Coughing associated with smoking may lead to stress urinary incontinence (SUI) during coughing spasms.
BASIC TYPES OF INCONTINENCE 3
There are a number of different types of incontinence and they are important as they affect the type of treatment that can be offered to manage the condition. It is possible that you may experience symptoms of more than one type of incontinence mentioned below. A complete urodynamic exam by a doctor can determine the type of incontinence and the appropriate method of treatment.
There are two main types of incontinence:
This is leakage of urine as a result of sudden stress on the bladder. Often this is caused by coughing, laughing, exercising, or lifting a heavy object. The bladder pressure as it fills with urine becomes greater than the strength of the urethra to stay closed. It is most common in young women (25–49 years of age). No one knows exactly why these muscles may become weak; some women notice the problem after childbirth or during or after menopause.
Typical Reasons for Stress Incontinence
- Genes are now thought to be a very important cause of stress incontinence, which explains why this type of incontinence tends to run in families. Because of their genes, some women are born with a weak pelvic floor. It is probably a weakness of collagen, the tiny strengthening fibers of muscles.
- Obesity. Being overweight is a major cause of incontinence. It puts stress on the pelvic floor muscles, so if you are obese you double the chance of pelvic floor weakness.
- Childbirth is probably an important cause of stress incontinence. The actual birth is mostly responsible, not just the pregnancy. Women who have had Caesarean sections may not develop incontinence. The nerves can be stretched and bruised during a natural delivery, and they are then unable to make the pelvic floor work after the birth. As a result, the muscles become lazy and weak.
- Hysterectomy. A woman who has had a hysterectomy is more likely to develop incontinence in middle age than a woman who has not had the operation.
- Menopause may be another reason, perhaps because the lowering levels of estrogen make the pelvic floor muscles less efficient. However, recent research shows that although the likelihood of incontinence increases in middle-age, the hormone changes of the menopause may not be the main cause. It could be that middle-aged women are more likely to be overweight and to have had a gynecologic operation, such as a hysterectomy.
- High-impact sports, such as jogging on hard pavements, are probably not good for the pelvic floor. Sports such as swimming and cycling are fine. Interestingly, women parachutists in the US Air Force have developed incontinence because the impact of landing has damaged their pelvic floor.
- Lifting heavy objects strains the pelvic floor. If you have to lift anything heavy (such as a baby or small child!), get into the habit of doing it in the right way. Place your feet firmly apart in the walking position, and bend at the knees and hip but keep your back straight. Tighten your pelvic floor muscles, hold the heavy object close to you and then lift by straightening your legs.
- Smoking 20 cigarettes/day (now or in the past) doubles your likelihood of urinary incontinence: another reason for never smoking.
- Drugs can relax the pelvic floor around the ring of muscles at the neck of the bladder, making leakage more likely. The most common culprits are some blood pressure medications, particularly alpha-blockers such as prazosin and doxazosin, which are also prescribed to men who have a large prostate. If your incontinence problem seems to be related to starting treatment for blood pressure and you are a man, ask your doctor if you are taking an alpha-blocker. Other medications such as fluoxetine (Prozac) and muscle-relaxant drugs, can also promote urine leakage.
Urge Incontinence / Overactive Bladder
The sudden need to pass urine desperately, and maybe not being able to reach the toilet in time, is a slightly different sort of incontinence called urge incontinence and overactive bladder. The cause is the bladder muscle; it starts to contract when it should be stretching to hold more urine. This is called an overactive or irritable bladder (the medical term is detrusor over activity, because the bladder muscle is called the detrusor muscle). People with urge incontinence have to pass urine often (probably more than eight (8) times a day and also during the night), but may not pass much each time.
The following causes of urge incontinence have been identified:
- Cystitis - inflammation of the lining of the bladder. It usually occurs when the normally sterile urethra and bladder are infected by bacteria and become irritated and inflamed. Cystitis is fairly common and can affect both men and women of all ages - it is more common in women.
- CNS (central nervous system) problems - examples are multiple sclerosis, stroke and Parkinson's disease.
- Enlarged prostate (men) - the bladder may drop and the urethra could become irritated.
Some people have both types together and this is called Mixed Incontinence
Put simply, overflow incontinence is an inability to empty the bladder. The patient frequently dribbles urine, some patients constantly dribble urine (as opposed to frequently), and some experience interrupted urinary flow (start/stop urinating). This type of urinary incontinence is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. The enlarged prostate gland obstructs the bladder; the person often only manages to urinate in small trickles and has to go frequently. He may feel that his bladder is never really completely emptied, even after trying hard.
Types of Urinary Incontinence
|Questions to ask yourself
||Urge Incontinence and Overactive Bladder
|Do you go to the toilet to pass urine more than 8 times a day?
|Do you go to the toilet to pass urine more than once during the night?
|Do you ever have to hurry to reach the toilet in time (for urine)?
|Do you ever not reach the toilet in time (for urine)?
|Do you ever leak urine when you laugh, sneeze, cough, run or jump?
|If you leak urine, is it just a drop or is it sometimes quite a bit more?
|Are you able to hold your urine alright, but you need to pass it more than 8 times a day, in small or large amounts each time?
||See your doctor because you might have a urine infection (small amounts) or diabetes (large amounts and you are thirsty).
This occurs when the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem. If a person has a disability they may not be able to get their pants down in time; this would be an example of functional incontinence. The amount of urine lost may be large. Common causes of functional incontinence include:
- Poor eyesight
- Poor mobility
- Poor dexterity (cannot unbutton pants in time)
- Depression, anxiety or anger (unwilling to go to the toilet)
People with functional incontinence may have difficulties in thinking, moving or communicating - these difficulties may prevent them from reaching a toilet.
Functional incontinence is more prevalent among elderly people, and is common in nursing homes.
Of note, Functional incontinence may occur when there is nothing physically wrong with the person.
Gross Total Incontinence
This either means the person leaks urine continuously all day and night, or has periodic uncontrollable leaking of large amounts of urine. The bladder is unable to store urine. The patient may have a congenital problem (was born with a defect), there may be an injury to the spinal cord, and injury to the urinary system, or there may be a fistula between the bladder and, for example the vagina.
DEALING WITH INCONTINENCE
People often find the psychological symptoms of incontinence are worse than the physical ones. The fear of having an "accident," the helpless feeling of not being in control, or the embarrassment of spotting clothing or creating an unpleasant odor tend to keep people who suffer from incontinence from getting out and freely enjoying life.
For almost 35 years we've found a wide range of reactions to incontinence. Some of the most common are:
- AFRAID to leave home for fear of having an "accident",
- HELPLESSNESS of not being in control,
- EMBARRASSED by spotted clothing or unpleasant odor,
- ANGRY at being the one afflicted by the problem,
- DEPRESSED by the fact this (usually) is a long-lasting condition.
However, the RIGHT product makes ALL THE DIFFERENCE in improving daily quality of life. It can restore:
- ✓ Confidence
- ✓ Independence
- ✓ Assurance
- ✓ Dignity
- ✓ Self-esteem
There are various levels of incontinence and a wide array of products that can be utilized to help you.
Following is a BASIC guideline to help you begin to narrow your search by garment type for what best suits your needs:
Very Light Incontinence
✓ Shields or Pads: the best choice for light incontinence. They easily and discreetly attach to undergarments with an adhesive strip.
✓ Liners or Guards: provide the higher absorbency you need for light to moderate incontinence, and attach to existing undergarments with an adhesive strip.
✓ Disposable Underwear: Soft, cloth-like outer cover can be worn instead of underwear and provides discreet, comfortable and odor-free protection for moderate to heavy incontinence.
✓ Underpads: Excellent and reliable extra protection for beds, chairs, and wheelchairs. Available in a variety of sizes and absorbency levels.
✓ Briefs/Diapers: Ultra comfortable, discreet and disposable briefs offer superior protection and confidence. Easily fasten with tape tabs.
OTHER SOURCES OF INFORMATION ON INCONTINENCE
(Citations Courtesy of Attends)
The Simon Foundation for Incontinence is known worldwide for its innovative educational projects and tireless efforts on behalf of people with loss of bladder and bowel control. Learn more at www.simonfoundation.org
The National Association for Continence works to de-stigmatize incontinence, promote preventive measures, motivate individuals to seek treatment, and provide collaborative advocacy and service for those who are affected by this problem. Learn more at www.nafc.org
The Canadian Continence Foundation strives to enhance the quality of life of people who suffer from incontinence by helping them to understand their symptoms and empowering them to seek help. Learn more at www.canadiancontinence.ca
3 http://www.embarrassingproblems.com/biography/13. Citation from Diane Newman, Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center, in Philadelphia.