When you can’t hold on

Urinary incontinence can be embarrassing but it can be treated, says Dr. Achala Balasuriya

Urinary incontinence is the loss of bladder control. This means that you can’t always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control. This can be embarrassing, but it can be treated.

Millions of adults around the world have urinary incontinence. It’s most common in people over 50 years old, especially women. But it can also affect younger people, especially women who have just given birth.

Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.

Normal urination

The ability to hold urine is dependent on having normal anatomy and a normally functioning urinary tract and nervous system. You must also possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The first sensation of the urge to urinate occurs when approximately 200 ml (just under 1 cup) of urine is stored. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.

The average person can hold approximately 350 to 550 ml (over 2 cups) of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. At the same time, your body must be able to relax the sphincter to allow the urine to pass out of the body.

What causes incontinence?

Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes.

  • For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
  • For men, enlarged prostate gland or prostate surgery
  • Weakened and stretched pelvic muscles after childbirth
  • Certain medicines- heart medications, blood pressure drugs, sedatives etc
  • Build-up of stool in the bowels
  • Overweight and obesity, which increases pressure on the bladder and muscles that control the bladder
  • Urinary tract infections
  • Vascular disease
  • Diseases such as diabetes, Alzheimer’s disease and multiple sclerosis
  • Alcohol- acts as a bladder stimulant and diuretic
  • Over hydration- Taking lot of fluid in a short period of time
  • Bladder cancer, bladder stones

Are there different types of incontinence?

Yes. There are five types of urinary incontinence.

They are:

Stress incontinence

Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women.

Urge incontinence

This occurs when the need to urinate comes on very suddenly, often before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of a urinary tract infection or an overactive bladder.

Overflow incontinence

This type of incontinence is the uncontrollable leakage of small amounts of urine. It’s caused by an overfilled bladder. You may feel like you can’t empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumour. Diabetes or certain medicines may also cause the problem.

Functional incontinence

This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.

Mixed incontinence

This type involves more than one of the types of incontinence listed above.

Is urinary incontinence just part of growing older?

No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesn’t mean you’ll have urinary incontinence just because you’re aging. With treatment, it can be controlled or cured.

Tests and diagnosis

Bladder diary. Your doctor may ask you to keep a bladder diary for several days. You record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.

Urinalysis. A sample of your urine is sent to a laboratory, where it’s checked for signs of infection, traces of blood or other abnormalities.

Blood test. Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.

How can it be treated?

Treatment depends on what’s causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence through strengthening the pelvic muscles. Medicine and surgery are other options.

What are Kegel exercises?

Stress incontinence can be treated with special exercises, called Kegel exercises. These exercises help strengthen the muscles that control the bladder. They can be done anywhere, any time. Although designed for women, the Kegel exercises can also help men. It may take 3 to 6 months to see an improvement.

Kegel exercises

4To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you’re able to slow or stop the stream of urine, you’ve located the right muscles.
4Squeeze your muscles. Hold for a count of 10. Relax for a count of 10.

4 Repeat this 10 to 20 times, 3 times a day.

4You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day.

What is bladder training?

Some people who have urge incontinence can learn to lengthen the time between urges to go to the bathroom. You start by urinating at set intervals, such as every 30 minutes to 2 hours (whether you feel the need to go or not). Then gradually lengthen the time between when you urinate (for example, by 30 minutes) until you’re urinating every 3 to 4 hours. Bladder training may take 3 to 12 weeks.

Fluid and diet management: In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity are other lifestyle changes that can eliminate the problem.

Medicines for incontinence

If you have an overactive bladder, your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency.

Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing. Other side effects include drowsiness, confusion, or memory loss. If you have glaucoma, ask your ophthalmologist if these drugs are safe for you.

Medicine helps some types of urinary incontinence. For example, estrogen cream to put in the vagina can be helpful for some women who have mild stress incontinence. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine through the prostate. Talk to your doctor about possible medicine options for your type of incontinence.

Surgery can sometimes be helpful, especially in stress incontinence in women and in overflow incontinence in men due to an enlarged prostate. It is usually only performed if other treatments haven’t worked or if the incontinence is severe.

Medical devices

Sometimes, for females medical devices can be prescribed to help treat the incontinence. Pessary: Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

If medical treatments can’t completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.

Pads and protective garments: Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that’s worn over the penis and held in place by closefitting underwear. Men and women can wear adult diapers, pads or panty liners, which can be purchased at drugstores, supermarkets .

Catheter: If you’re incontinent because your bladder doesn’t empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization).

This should give you more control of your leakage, especially if you have overflow incontinence. You’ll be instructed on how to manage the catheter and when to remove and re –insert which could be done by your family doctor.

Healthy tips to prevent incontinence

  • Maintain a healthy weight - If you’re overweight, reaching a healthy weight may help.
  • Don’t smoke - Get help with quitting if you do smoke.
  • Practise Kegel exercises - Doctors may advise pregnant women to do Kegel exercises during pregnancy as a preventive measure.
  • Avoid bladder irritants - Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or foregoing caffeine may be all that you need to do.
  • Eat more fibre - Including more fibre in your diet or taking fibre supplements can help prevent constipation, a risk factor for urinary incontinence.
  • Exercise: Physical activity reduces your risk of developing incontinence.

(The writer is a Consultant Physician)

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