Evaluation Of Urinary Incontinence
Urinary incontinence usually does not indicate a disorder that is life threatening nevertheless, incontinence may cause embarrassment or lead people to restrict their activities unnecessarily, contributing to a decline in quality of life. Also, rarely, sudden incontinence can be a symptom of a spinal cord disorder. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation.
What Causes Urinary Incontinence
Urinary incontinence is not an inevitable result of aging, but it is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after the hormonal changes of menopause.
What Are The Symptoms Of Fecal Incontinence
The symptoms of fecal incontinence depend on the type.
- If you have urge fecal incontinence, you will know when you need to pass stool but not be able to control passing stool before reaching a toilet.
- If you have passive fecal incontinence, you will pass stool or mucus from your anus without knowing it.
Some medical experts include streaks or stains of stool or mucus on your underwearcalled soilingas a symptom of fecal incontinence.
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What Are The Variations Of Male Incontinence
There are six different types of urinary incontinence that can affect men.
Urgency incontinence: you feel a sudden urge to urinate that is followed by accidental leakage
Stress incontinence: leakage occurs as a result of quick movements or pressure like coughing or sneezing.
Overflow incontinence: leakage occurs because of a full bladder
Transient incontinence: this is usually the result of a temporary infection in the urinary tract or a side effect of medication
Functional incontinence: obstacles or physical disabilities keep you from getting to the bathroom in time, and accidental leakage occurs
Mixed incontinence: when the cause of your incontinence falls under two or more of the above types
Can Pelvic Floor Exercises Treat Urge Incontinence
Yes, pelvic floor exercises can strengthen your muscles that support your urinary system. These exercises can improve symptoms.
Its important to target and use the correct muscles . A physical therapist who specializes in pelvic floor disorders can teach you the proper technique. This healthcare provider may use biofeedback to ensure you get the most benefit from the exercises. It can take four to six weeks to see improvements.
While some people need to strengthen the pelvic floor muscles, others have spasm or excess tension in the pelvic floor muscles that can make their overactive bladder worse. In this case, you can work with a pelvic floor physical therapist on relaxing and coordinating these muscles.
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How Can Incontinence Products Help Me
The right incontinence products will also help you manage the problem and carry on with normal life. Products include:
- washable products such as re-usable pads, which often come as part of a pair of pants
- disposable pads which are held in place by close-fitting pants
- disposable pants, or all-in-one pads with a plastic backing and adhesive patches to seal the sides
- bed or chair protectors in the form of disposable or washable pads
- for men, there are a range of products that fit over the penis and collect urine into a bag strapped to the leg.
You can buy most of these in pharmacies and supermarkets, but seek professional advice before using them permanently.
To qualify for free incontinence products provided by the NHS, youll need to meet criteria set out by your local NHS.
Contact your local NHS continence service or clinic for a location in your area and check if you need to be referred by your doctor.
A specialist nurse may need to assess if you are eligible and will then arrange your supply of products.
Conditions That Cause Urinary Incontinence
There are several health and lifestyle issues that can make you start to leak urine. They can include:
Problems with your prostate. Itâs common for prostate issues to cause urinary incontinence. Your prostate may be larger due to a non-cancerous condition called benign prostatic hyperplasia . Your prostate may also be bigger than usual because of cancer. An enlarged prostate can block your urethra. When your urethra is blocked, your bladder has to work harder to squeeze pee out. This makes its walls thicker and weaker. That makes it hard for your bladder to empty all the urine in it.
You can also struggle with urinary incontinence with prostate cancer or after having certain treatments for it — such as radiation treatment or surgery to remove your prostate. The surgery may cause problems with the nerves that control your bladder.
Certain diseases. Multiple sclerosis is a disease that can damage the nerves that tell the bladder when to empty and can also lead to bladder spasms. Some other conditions that can damage your nerves and keep your bladder from sending or receiving the signals it needs to work correctly are:
- Diabetes
- Stroke
- Parkinsonâs disease
Surgery. Major bowel surgery, lower back surgery, and prostate surgery can all cause problems with your bladder. This is usually because some of the nerves in your urinary tract have been damaged during surgery.
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Enuresis Or Bedwetting Urinary Incontinence In Adults Young And Old
Enuresis, or bed-wetting, is commonly associated with children but night time incontinence also affects adults, both young and old.
Night time incontinence or bedwetting requires medical attention starting with primary care providers. When asking about urinary history, providers may consider inquiring about any recent incontinent episodes along with any history during childhood. This would help uncover a problem and save the patient the embarrassment of bringing it up. Simply asking if there is any problem with bowel or bladder may not uncover an issue a patient is uncomfortable talking about. In young adults, bedwetting is uncommon and can be indicative of something more serious. In the elderly it is not as unusual, but is not considered a normal part of aging. Incontinence can be managed in a variety of ways.
Causes of bedwetting in younger adults might be:
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Diabetes new or undiagnosed
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Sleep apnea, or not awakening to the sensation of a full bladder
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Manufacturing large amount of urine at night
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Underdeveloped bladder
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Urinary tract infection or kidney/bladder stones
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Chronic constipation
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Weak pelvic floor muscles
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Neurological disorder or injury
In older adults, causes might also include:
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Bladder cancer or tumor
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Weak pelvic floor muscles
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Dementia
Here are some other ideas, but patients should speak to their doctor before trying:
Alternative And Complementary Therapies
The treatment of urinary incontinence varies depending on the cause of the bladder control problem. In most cases, a physician will try the simplest treatment approach before resorting to medication or surgery.
Bladder habit training This is the first approach for treating most incontinence issues. The goal is to establish a regular urination schedule with set intervals between urination. A doctor will usually recommend urinating at one-hour intervals and gradually increasing the intervals between urination over time.
Pelvic muscle exercises Also called Kegel exercises , this exercise routine helps strengthen weak pelvic muscles and improve bladder control.
The person contracts the muscles used to keep in urine, holds the contraction for 4 to 10 seconds, then relaxes the muscles for the same amount of time.
It may take weeks or months of regular pelvic exercise to show improvement.
Another way to perform Kegel exercises is to interrupt the flow of urine for several seconds while urinating.
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How Soon After Starting Kegel Exercises Will Urinary Incontinence Get Better
It may take 4 to 6 weeks before you notice any improvement in your symptoms.10
Kegel exercises work differently for each person. Your symptoms may go away totally, you may notice an improvement in your symptoms but still have some leakage, or you may not see any improvement at all. But even if your symptoms dont get better, Kegel exercises can help prevent your incontinence from getting worse.
You may need to continue doing Kegel exercises for the rest of your life. Even if your symptoms improve, urinary incontinence can come back if you stop doing the exercises.
Effects Of Incontinence On Young People
University of Bristol research on continence problems in young people aged 11-20 years showed that embarrassment, fear of bullying and stigmatisation, and lack of understanding meant that some went to great lengths to conceal bladder and bowel issues, thereby risking:
- Serious distress
- Social isolation
- Underlying conditions going untreated .
The social assumption that continence problems only affected very young children, women or older adults caused participants to feel abnormal and misunderstood. A small number told friends, but all hid it at some level, and many did not want anyone to know. This led to worry about being discovered, at a time of development when fitting in with peers and society felt particularly important . However, many found effective ways of coping and those who told friends reported positive experiences and a sense of relief .
In terms of the healthcare experience, participants wanted to be supported to self-manage, reporting positive treatment experiences when there was good rapport with clinicians and they felt fully involved in decision-making . However, many felt frustrated about a lack of continuity of care and poor understanding of the wider impacts of continence problems on their lives.
Box 1. Case study: a young mans story
*The patients real name has been used, with his permission.
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What Is The Long
If you are experiencing any symptoms of urinary incontinence, it is important to speak with your doctor right away. It is easy to treat bladder control problems, especially when they are diagnosed early.
When you work closely with your doctor and follow the advised treatment plan carefully, you can regain control of your bladder, and urinary incontinence doesnt have to interfere with your livelihood or quality of life.
In This Article
Should I Drink Less Water Or Other Fluids If I Have Urinary Incontinence
No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health.
Women need 91 ounces of fluids a day from food and drinks.11 Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.
After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.12
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Related Conditions And Causes Of Urinary Incontinence
Fecal incontinence is light to moderate bowel leakage due to diarrhea, constipation, or muscle or nerve damage.
As described in the section above on causes of urinary incontinence, common conditions may contribute to chronic urinary incontinence, including: urinary tract infection , constipation, interstitial cystitis or other bladder conditions, nerve damage that affects bladder control, side effects from a prior surgery, and neurological disorders.
How To Look After A Teenager With Incontinence
- On October 12, 2017
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The International Continence Society defines as the complaint of any involuntary leakage of urine. Teenagers with incontinence can often be reluctant to seek advice or try even address the incontinence.
A study of healthy adolescents indicated that 3 percent of 15 to 16-year-olds experienced regular daytime wetting. A longitudinal study of children with constipation showed that one-third of children, followed up beyond puberty, continued to have the condition. It is therefore apparent that there are more teenagers than you may think who will have or management issues. However, many teenagers will be reluctant to address the issue or look for a solution. Most teenagers believe that the condition is limited to the frail elderly and can be ashamed of telling others about their problem.
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Male Urinary Incontinence Home Remedies
There are a number of home remedies and lifestyle adaptations that are known to assist with UI, as well as help to prevent it. They can either be tried on their own, such as for mild cases of UI, or combined with other medical treatments. However, a consultation with a urologist is recommended to evaluate each individual case. With expert medical assistance, these home remedies can be adopted in addition to receiving any other necessary treatments.
Clues From Young Women
Davis’ study has made her consider doing her own research in younger women who’ve never been pregnant, Buchsbaum says.
“We are in some ways so focused on childbirth being the main risk factor for urinary incontinence that we neglect women who have not given birth,” says Buchsbaum, who has shown that older nuns who’ve never been pregnant deal with incontinence. “We know so little about the pathophysiology . Looking at really young women might help us to understand things a little bit further.”
Emerging evidence shows that incontinence before conception predisposes women to pregnancy-related urinary incontinence, Davis and the other researchers write.
Buchsbaum says she has seen patients as young as 14 and 15 who are dealing with stress incontinence, which older women know is what sometimes happens when they cough or sneeze. Her youngest patients are usually involved in sports or cheerleading, Buchsbaum says. “They leak quite a bit.”
An ideal study of urinary incontinence would begin with teenagers and follow them to age 50 or 60, she says. That’s not possible with the young women Davis studied, because although they provided demographic information, they were not asked to put their names on the questionnaires.
Davis’ study is published in the Annals of Internal Medicine.
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What Causes Urinary Incontinence In Men
Different types of incontinence have different causes.
- Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone. The sphincter may be too weak to hold back the urine. And any extra pressure from sneezing, coughing, or straining can cause urine to leak.
- Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can’t hold back the urine. This causes a very strong urge to urinate. Doctors don’t know why this happens. But sometimes it can be caused by other urinary problems.
- Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. Over time, the bladder gets so full that pressure builds up and forces the extra urine to move past the blockage and out of the bladder. Overflow incontinence may also happen because of weak bladder muscles.
In men, incontinence is often related to prostate problems or treatments.
Drinking alcohol can make urinary incontinence worse. Taking prescription or over-the-counter drugs such as diuretics, antidepressants, sedatives, opioids, or non-prescription cold and diet medicines can also affect your symptoms.
What Causes Urge Incontinence
Most people with urge incontinence have overactive bladders. Your bladder is the organ in your urinary system that holds urine.
An overactive bladder causes your muscles in your bladder to squeeze more often than they should. This makes you feel like you have to pee before your bladder is actually full.
The squeezed bladder also causes your sphincter muscle inside your urethra to relax. When this muscle opens, it lets urine leak out.
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Nurses View On The Case Study
Davina Richardson is childrens nurse specialist, Bladder and Bowel UK.
Childrens continence services are not universally available in the UK and adult continence services will not always see young people under 18 years. Transition from child to adult services is improving, but experiences for some young people remain poor.
Most nurses and other healthcare staff have little training and experience in continence issues, particularly relating to young people. Mr Ganes* experience highlights the need to treat intimate issues sensitively, ensure privacy for asking questions about personal care particularly on hospital wards, and ensure young people understand that staff need to document information, and how and with whom this will be shared.
Sufficient time should be allowed in consultations to build rapport with young people, and listen to and understand their perspective. They should be encouraged to have at least part of a consultation without a parent/carer so that intimate, personal or risk-taking behaviours can be discussed openly in a safe and non-judgemental way.
Continuity of care, explaining all the options and understanding young peoples preferences is important. Meeting these as far as possible or, when it is not possible, explaining the reasons why is helpful and contributes to positive outcomes.
Common misconceptions and trigger questions to ask young people are outlined in Box 2.
Box 2. Common misconceptions and useful trigger questions