BASIC INFORMATION ON INCONTINENCE

Take Control!

Urinary Incontinence is the involuntary loss of urine at an inappropriate time or in an inappropriate place. The amount can vary from slight to copious – but is always very embarrassing to the person involved. Because Incontinence is not a disease, but a symptom of an underlying disorder, something can be done to treat it! 
 

Symptoms
The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent and heavy, or it can be small and rather rare. Some other common symptoms of include:

  • A strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
  • Urinating more than once in a two-hour period or more than seven times a day
  • The need to get up and urinate at least twice during sleep
  • Painful urination
  • Bed-wetting or urinating while sleeping
  • Leaking when coughing, sneezing or laughing
Types of Incontinence

1.Stress incontinence
This is when a person leaks urine with coughing, sneezing, lifting and exercise. This is due to weakness of the support structures of the bladder and weakness of the pelvic floor muscles. This is often caused by pregnancy, childbirth and surgery.

2. Urge incontinence (now referred to as Over active bladder)
With urge incontinence, involuntary bladder contractions cause leakage before the toilet can be reached. People complain of an urgent desire to void frequently, often at night as well. Medication, caffeine intake, constipation, bladder infections, spinal cord injuries, diseases like multiple sclerosis and Parkinson’s disease can cause this condition and often no specific cause is found.

3. Mixed Incontinence
The presenting complaint is a mixture of stress and urge symptoms, both symptoms should be treated individually.

4.Overflow incontinence
In this condition the bladder overfills and does not empty properly, causing symptoms of continuous leaking, frequent infections, burning sensation when emptying the bladder, dribbling, urgency and the need to empty the bladder at night. An enlarged prostate, narrowing of the urethra, spinal cord injuries and other nervous system disorders, cause this condition.

5. Neurogenic bladder
This is often caused by birth defects, spinal cord injuries, and other neurological diseases. There is often continuous leakage of urine.

6.Post- micturition dribble
Men suffer from a slight loss of urine on walking away from the toilet. This is caused by accumulation of urine in the bulb of the urethra and is easily treated.

7. Enuresis
The presenting complaint is urine loss when asleep. The person needs to be evaluated and treated according to the underlying cause.

General facts about incontinence

  • One in four people suffer from some from of incontinence.
  • 10-35% of all adults have a problem with incontinence.
    50% of the elderly in nursing homes suffer from incontinence.
  • One in 6 men and one in seven woman suffer from urge incontinence.
  • More people suffer from incontinence than from chronic diseases like asthma and diabetes.
  • Prostate problems and related treatments are frequent causes of urinary leakage in men.
 

Temporary causes of incontinence  (DIAPPERS)

  • Delirium, in this case incontinence is caused by a confusional state
  • Infection, of the bladder, which is easily treated.
  • Atrophic urethritis or vaganitis due to a shortage of a hormone called oestrogen
  • Pharmacological, many medications can cause or aggravate incontinence
  • Psychological, especially depression can contribute to incontinence
  • Endocrine, a high calcium or blood sugar can cause incontinence
  • Restricted mobility can cause a patient not to reach the toilet in time
  • Stool impaction can cause an over active bladder or overflow incontinence

These conditions are all treatable. Speak to your doctor about your condition and possibly prescribing of other medication to treat other conditions.
 
 

Help Your Doctor Assess Your Situation

There are steps you can take to control incontinence and minimise its effect on your lifestyle. Your first step should be into your doctor's office.

Find out what form of incontinence you have. You can help your doctor or nurse to make an accurate assessment and diagnosis by completing a urine-voiding diary for seven days before your visit to his or her office.

Treatment options                                                                                                                      

Treatment for urinary incontinence depends on the type, how bad your problem is and the underlying cause. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms. Treatment options fall into four broad categories:

  • Behavioural techniques and lifestyle changes work well for certain types of urinary incontinence and may be the only treatment you need. These include bladder retraining, scheduled toilet trips, pelvic floor exercises, electrical stimulation, and fluid and diet management.
  • Medications commonly used to treat incontinence include Anti-cholinergic (antispasmodic) drugs, Imipramine,(delete) Pseudoephedrine, Hormone replacement therapy, antibiotics and others. The type of drug used depends on the underlying cause of the incontinence, so speak to your doctor about the your options and the potential side effects of various medications. 
  • Several Medical devices are available and designed specifically for women. This includes a urethral insert (a small, tampon-like disposable device or plug that a woman inserts into her urethra)(not available in SA) or Pessary (PES-uh-ree) (a stiff ring inserted into the vagina and worn all day).
  • Surgery is usually recommended if other treatments aren't working. There are nearly 100 variations of surgical procedures used to fix problems that cause urinary incontinence. (Please delete and change to: Surgery is recommended for certain types of incontinence. The success of treatment depends on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.
  • Absorbent pads and catheters help ease the discomfort and inconvenience of leaking urine. Most products are no more bulky than normal underwear and can be worn easily under everyday clothing. They can be purchased at pharmacies, supermarkets and medical supply stores.
 

Management of Urinary Incontinence

Adequate Fluid Intake:

Individuals with urinary symptoms often limit fluids so that they will not have to urinate as often. Individuals with urge incontinence and who have a high fluid intake (> 2400 ccs/day) may show a reduction in incontinent episodes and voiding frequency by lowering their fluid intake. Incontinent persons with low fluid intakes (< 1500 ccs/day) may benefit from increasing their fluid intake. Reducing fluid intake after 6 pm, and concentrating fluid intake during morning and afternoon hours, may decrease nighttime incontinence episodes.

Smoking Cessation

Nicotine is irritating to the detrusor muscle causing bladder contractions and urgency.
A smoker's repeated and chronic coughing may cause urinary leakage. Smoking cessation may help to decrease urine leakage.

Dietary Modification

Individuals with urge UI may benefit from caffeine reduction. Significant rise in detrusor pressure has been demonstrated with caffeine administration.

The effect of other foods and beverages on the bladder is not understood, but elimination of 1 or all of the items listed below may improve bladder control.

  • Alcoholic beverages, including beer and wine
  • Citrus juices and fruits
  • Highly spiced foods
  • Carbonated beverages
  • Sugar, honey
  • Milk/milk products
  • Corn syrup
  • Soft drinks with caffeine, tea, coffee (even decaffeinated)
  • Artificial sweetener

Maintaining Optimal Weight

Weight reduction is associated with improvements in urinary symptoms because of less pressure on the bladder.

Maintaining Bowel Regularity

Constipation and difficulty with defecation (straining during bowel movements) causes increased pressure on the bladder leading to UI. Individuals should keep regularity through increased fibre, exercise, and fluid. A successful way to adequately increase fibre is by using a "special bran recipe." Mix together: 1 cup applesauce, 1cup coarse unprocessed wheat bran, and 1 cup prune juice. Refrigerate mixture and take 2 tablespoons of the mixture every day. Take the mixture in the evening for a morning bowel movement. Increase the bran mixture by 2 tablespoons each week until bowel movements are regular. Always drink 1 large glass of water with the mixture.
   

Tips for self-care

  • Select the absorbent underwear of choice for your specific condition and personal preference, from stores, pharmacies or medical distributors
  • Problems with urine leakage may require you to take extra care to keep your skin clean and dry
  • Products such as powders, moisturisers and deodorising tablets are available that can help you feel clean and eliminate urine odour. You also might consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine
  • If you have functional incontinence, a home or bathroom renovation project also may help.
  • Changes to your house can allow you to make it to the toilet more easily. These include adding a bathroom in a more convenient location, widening the bathroom doorway, installing an elevated toilet seat or simply adding a few well-placed lights
  • You might even benefit from a bedpan
 

FAECAL INCONTINENCE

Faecal  incontinence is the impaired ability to control gas or stool,  thus loss of bowel motion at an inappropriate time or in an inappropriate place. Severe faecal incontinence occurs when the patient is incontinent to solid or liquid stool at least weekly.

Causes of faecal incontinence

There are 4 major categories 

  1. Altered stool consistency- diarrheal states eg  Irritable bowel syndrome, Inflammatory bowel  disease, Infectious diarrhea
  2. Inadequate reservoir capacity or compliance eg  Absent rectal reservoir,  Rectal ischemia,   Collagen vascular disease
  3. Inadequate  rectal sensation eg Neurological conditions, Cerebral vascular accidents (stroke),  Multiple sclerosis, Spinal cord injuries
  4. Abnormal sphincter mechanism  eg Trauma from obstetric injury, Complications of anorectal  surgery, Pelvic floor denervation, Chronic straining at stool.
   

Important Facts

The most important fact in the management of incontinence is to make the correct diagnosis. With the correct diagnosis the proper treatment can be implemented and the patient can be completely cured or his/her problem can be managed effectively. Incontinence is not part of ageing. It is a symptom of an underlying disease and should be treated accordingly.
 

OUR PARTNERS

CASA would like to thank their partners who assist in the running of this non-profit organisation and continuing to allow much needed support to incontinence sufferers.

       
Don’t suffer in silence if you have a continence problem. Talk to your doctor or health practitioner today. It could be your first step towards an altogether more comfortable future.
 
 
   
         
  © CASA :: Continence Association of South Africa 2006  
Created By: KEYLINE DESIGN