Norton Hurley

What is Urinary Incontinence?

More than 25 million Americans have some degree of incontinence and most suffer alone. It takes an average of 5 years for people to even discuss the situation with their healthcare provider. With statistics like these, it is likely that there are people close to you who are suffering as well but don't want to talk about it.
Most cases of incontinence are treatable and easily managed with today's cutting edge products bringing you both the comfort and flexibility to get back to doing what you love to do.

What is Urinary Incontinence?

Urinary Incontinence is a condition where a person loses partial or complete control of their bladder. This can be permanent but often is temporary and manageable.

The level of severity can vary from a few drops to full emptying of your bladder.  Many of us experience mild to moderate incontinence symptoms especially as we age, after an injury or surgery (including childbirth) and with certain medications.

Types of Urinary Incontinence

Stress Incontinence

Don't be confused by the name. This has nothing to do with actual "stress"...as in emotional stress. With Stress Incontinence, the loss of control of your urine happens because of 'stress' (meaning pressure) on the bladder, like when we cough or sneeze.

This can also include strenuous physical activities like running, jumping, or bending. Extra pressure on the bladder paired with weakened muscles that hold back the urine allows some of it to leak out.

Smokers with stress incontinence may experience minor instances of leakage due to the chronic coughing associated with smoking. Most times only a little bit of urine leaks out because the bladder is not full. In more severe cases, however, a full bladder can cause a much heavier leakage of urine after a cough or sneeze.

What Causes Stress Incontinence?

  • Pregnancy - vaginal delivery of a baby at some point in their life will cause a woman to experience stress incontinence. The added stress/pressure on the bladder from the child in combination with changing hormones can cause minor leakage.  Sometimes, if you’ve had more than one baby, the symptoms can be worse.
  • Age - Stress Incontinence is very common in women over 50, and even more common with women who have experienced Menopause.
  • Prostate Surgery in Men - the prostate glands may disrupt the urethra causing bladder retention issues. The surgery and treatment itself may weaken the muscles and reduce the holding capacity of the bladder.
  • Lung Conditions - excessive coughing or sneezing as a result of a lung condition.

Urge Incontinence

This type of incontinence can be described as a sudden strong "urge" that forces you to leak urine immediately because you can’t make it to a bathroom in time. You may also hear this referred to as "Overactive Bladder".

Urge incontinence occurs when the muscles of the bladder contract (tighten) too much which in turn fools your brain into thinking that your bladder is full when in reality it is not.

Unfortunately, this can happen at night too, causing frequent trips to the toilet when you’re just trying to get some beauty rest.

What Causes Urge Incontinence?

  • Urinary Tract Blockage - something blocking the flow of urine such as a stone, tumor, or enlarged prostate.
  • Damage to Nervous System - conditions affecting the nervous system, such as a stroke or spinal cord injury, keep the brain from signaling when the bladder is full.
  • Urinary Tract Infection - an infection can inflame or irritate the bladder, causing you to feel the urge to urinate frequently despite not having a full bladder.
  • Foods or medications that irritate the bladder (more on this later!)

Mixed Incontinence

This incontinence is a combination of stress and urge incontinence. This is most common in women, especially as we age, and also common in men who have had prostate surgeries.

Its severity is affected by a combination of factors that cause both stress and urge incontinence.

Functional Incontinence

When a person knows they have to use the toilet but cannot physically get there quick enough, they often deal with functional incontinence. Patients with chronic pain or arthritis that slows their response time down make daily activities, like removing clothing to use the toilet, very painful.

Functional Incontinence can also occur when a brain disorder or disease, like dementia or alzheimers, makes it hard for a person to find the toilet in time.

What Causes Functional Incontinence?

  • Inability to get to the restroom fast enough
  • Restrictive clothing that is hard to remove quickly
  • Mental impairment from either dementia or medications
  • Deep sleeping or bedwetting

Natural remedies for incontinence

While there are causes of incontinence that we cannot control, like our genes or previous injuries and surgeries, there is a range of factors we can. Lifestyle decisions and general good health play a huge role in managing incontinence.

Here are some natural remedies, mindsets, and lifestyle recommendations that may help you manage your incontinence:

  • Kegel Exercises - These maneuvers, named after Arnold Henry Kegel (the gynecologist who invented them), help to strengthen the muscles in your bladder that hold the urine back. Aside from specific exercises you can do in the gym, simply "bearing down" and squeezing your pelvic muscles for 4-10 seconds at a time for just 5 minutes a day can begin to have an impact. Improving the strength of your urinary muscles helps you to have more control over the flow of urine.
  • Restrict Bathroom Frequency - Train your bladder by developing a urination schedule. Start by urinating every hour and then gradually increase from there, trying to hold off a bit longer between bathroom trips. Your body may slowly become accustomed to anticipating when you’ll have the opportunity to urinate again.
  • Be Hygienic - Practicing good hygiene will decrease the risk of urinary tract infections. Women should always wipe front to back to avoid feces contaminating the vaginal area.
  • Monitor Your Weight - Obesity can cause increased pressure on the bladder. It also makes it more difficult to get to the bathroom and remove clothing in time to reach the toilet.
  • Avoid constipation - Constant straining can weaken the muscles of the bladder as well as the bowel. Eat a diet rich in fiber and let your doctor know if you are not passing your bowels frequently enough or if your stools are hard to pass.
  • Don’t keep your symptoms a secret - 1 in 3 people experience incontinence symptoms at some point in their life yet most of them keep it a secret. Yes, it’s embarrassing. But it can be equally frustrating to deal with symptoms alone. Discuss your incontinence with your doctor so they can equip you with the information you need to live with your condition. Do not suffer in silence.
  • Avoid foods that irritate the bladder -These include spicy foods, alcohol, caffeine and foods with high acid content like tomato sauce and citrus fruits...even cranberry juice! Sodas are especially bad because the carbonation irritates the bladder, on top of the caffeine and acidic components.
  • Monitor Fluid Intake - Your body needs a healthy level of hydration to protect your kidneys, produce urine and flush out infections. But, it’s important to know when you’re drinking water more frequently than you need to. Check with your doctor to see how much fluid you should be drinking per day to ensure you’re properly hydrated but not overdoing it.
  • Avoid Diuretics Before Bed - Medications that are diuretics cause you to expel water. Avoiding these right before bedtime may keep you out of the bathroom in the middle of the night. Work with your doctor to develop a medication schedule that won’t have you running to the bathroom all night.

How is Urinary Incontinence Diagnosed?

Most times, urinary incontinence is diagnosed by the symptoms alone. Your doctor will ask you some questions and run some tests to find out what type of incontinence you have and what may be causing it. This will help you and your medical team to develop a treatment plan.

Some of the tools and tests the doctor may use include the following:

Bladder/Incontinence Diary

The doctor will ask you to record when and what you drink, and when and how much you urinate for a few days to a week. They will also want to know if you had any episodes of incontinence during that time.

Log the symptoms you have and what may have brought them on (like a coughing or laughing episode).

Urinalysis

This is a test of the urine itself to tell the doctor if you have any infection that may be causing the incontinence. It will also give the doctor a general idea of the wellbeing of your kidneys and if you are experiencing high sugar levels.

Blood Test

The blood can provide much insight into how your organs are functioning and the state of your overall health. Your doctor will be looking for signs of underlying conditions that may signal to them why you are experiencing incontinence symptoms.

Post-Void Measurement

This is an ultrasound exam that shows the doctor how much urine is left in your bladder after you are done urinating. It allows the doctor to see if maybe there is something blocking the urine from releasing or if the muscles/nerves of the bladder are not working properly.

Bladder Function Testing

Certain x-rays and scans can allow the doctor to see if the sphincters and other structures of the bladder and urethra are working properly. A sphincter is a ring-like muscle that squeezes to stop the flow of urine and can become weakened over time or after surgery/injury.

Physical Exam

Your doctor will perform a general overall physical exam and likely include a rectal and vaginal exam to see if they can find any physical evidence of what is causing your symptoms. They may also ask you to cough while your bladder is full to see if they can detect any leakage.

Past History

Knowing what your lifestyle and family history entails is a great way for physicians to gain more insight into what may be the cause of your urinary incontinence. This usually involves a lot of questions and possibly a quiz or two.

How to Manage Your Incontinence

There are a wide variety of products that help you to manage your incontinence symptoms and maintain an active lifestyle. 

Choosing which product is right for you depends on:

  • The volume of leakage you experience
  • The size/shape of your body
  • Your lifestyle
  • The type of incontinence you experience (urinary or fecal)

When you purchase incontinence aids at the grocery store or online, they will have sizing charts on the packaging as well as something indicating how much fluid they can absorb (usually a series of 5 or 6 water drops). More filled in drops means more absorbency.

The sizing of the brief usually coincides with the size of your waist (in inches) and your body weight. Some websites will allow you to order a sample of their products to help you find which works best for you.

The most common types of incontinence aids are:

Pull-Up Underwear

Pull-ups are styled like normal underwear with a unified waistband and two leg openings. They pull up and down just like regular underwear and come in a variety of sizes and absorbency levels.

There are extra thin versions that are easier to conceal under your clothing and allow for ease of movement. Most pull-ups feature tear-away sides for easy removal if needed. This type of incontinence product allows the user to experience an active lifestyle and the familiarity of traditional undergarments. 

Ideal User: Active persons experiencing light to heavy incontinence.

Tabbed Briefs

These briefs are similar to pull-ups but include two tabs on either side of the waistline. The tabs make it easier to place the brief on a person who is immobile or bedridden, therefore removing the need to sit upright.

Tabbed briefs are a great choice for caregivers as they allow for easier diaper changes when the patient cannot change it themselves. They usually offer a higher level of protection and absorbency than most pull-ups as they are designed for a patient who is mostly incontinent and is either sitting or lying most of the time.

Ideal User: Less active persons with physical limitations and heavy to severe absorbency needs.

Pads

Incontinence pads (or boosters) are typically used in regular underwear when a full diaper is not needed or as an extra layer of absorbency in a diaper. They are similar to a maxi pad and made for both men and women, designed with the respective anatomy of the person in mind (more to the front of the brief for men and closer to the vaginal area in women).

Incontinence pads attach to the underwear or briefs with an adhesive strip. Pads offer the most discreet option for light to moderate urinary incontinence as well as the most flexibility for physical activities.

Ideal Users: Persons with light to moderate incontinence that do not need a full diaper or persons looking for an extra layer of protection in their diaper.

Bed-Liners

Bed liners are a great option for patients who have incontinence during the night time or while in bed. Getting the right level of protection during this time can be tricky since we often move around a lot while we sleep.

Bed liners can be either washable or disposable and they lay on top of a bedsheet to protect the linens if leakage does occur. They are also a great option for patients who have skin breakdown from their briefs as a bed liner can hold a significant amount of fluid, eliminating the need for a brief at all. 

Liners can also be used to help caregivers "boost" or pull the patient up in the bed to a more comfortable position and\or turn the patient from side to side to help prevent bedsores.

Ideal Users: Persons needing extra leakage protection in their bed.

Caring for Your Skin While Managing Incontinence

When urine comes in contact with the skin it can cause irritation and skin breakdown. This, paired with the constant rubbing of the pads/briefs during movement can cause you to be quite uncomfortable at times and may eventually lead to infections.

Keeping your skin clean and dry is super important when it comes to incontinence and skincare. Certain creams can provide moisture and a barrier to keep the urine from irritating the skin while other creams have healing properties. Incontinence wipes can clean the skin without the need for water and help balance the Ph (acidity level) of the skin.

They can also include deodorizers for a more pleasant smell. If the skin becomes infected or you begin to see areas where the skin is breaking down, you will need to contact your physician as this is an early indication of sores.

Be especially mindful in areas where the skin is creased (like the skin in the groin area) because these areas are extra prone to yeast and bacteria build-up. They’re also much softer than the rest of your body which allows the skin to breakdown more easily.

Medical remedies for incontinence

Sometimes lifestyle changes and natural remedies are not enough and you need more help. There are many treatments these days for incontinence ranging from natural to medications, to surgery. Talk to your doctor to see which options would be best for you.

Some of the most common medical treatments for incontinence include:

Medications

There are medications, such as anticholinergics, that relax the muscles in the bladder to ease the symptoms of urge incontinence. Medications may be added to treat the underlying cause of incontinence, such as cough medicine or medicine to reduce the inflammation and pain caused by arthritis.

Also, changing the medications that you are currently taking (for other health conditions) may be a great help as well. Always speak to your doctor first before making these changes.

Devices

Medical devices are available that help you to drain your bladder (such as a catheter) or to release the pressure off of the bladder (such as pessary.) A pessary is a smooth, plastic ring-shaped device that is inserted into the vagina to hold up a bladder that has dropped or shifted.

There is also a tampon-like device that helps to put pressure on the urethra (the tube that your urine comes out of) that helps to close it off and minimize leaks.

Bulking Agents

Your doctor can inject a gel (or even Botox) into your urethra to "bulk up" the area and help to close the opening of the bladder.

Surgery

A surgeon can go in and remove something that may be obstructing the urinary tract or put the bladder back where it belongs if it has dropped or shifted. This is often performed by inserting a mesh or a "sling" to hold things in place. It is also possible to put in an artificial sphincter, mostly in men with prostate surgeries in the past.

How to Cope with Incontinence

It is incredibly important that you take care of your physical health as well as your mental health. As mentioned before, most of us suffer alone with incontinence and don't seek help.

Talk to a trusted friend or family member, they may have experienced incontinence at some point in their lives as well. They can often offer some great suggestions and support without judgment. You can also join a local or online support group, even anonymously if that makes you feel more comfortable.

Support groups are great for introducing you to resources and educational material about incontinence that eases your symptoms and lets you know you’re not alone.

Most importantly, speak to your physician about the symptoms you are experiencing so they can find out what is causing them and come up with a treatment plan. If necessary, seek counseling with a professional therapist. Reach out, educate yourself, and get back to being you!

 

Disclaimer: The information presented here is purely for educational purposes and should not be used in place of the advice of your doctor or physician.

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