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Click a
topic below to find more information about incontinence
and how it effects you and your body.
 Dealing
with Incontinence
You Are Not Alone
Loss of bladder control, or urinary incontinence, is
a common condition, affecting from 5% to 10% of the
population. The tendency to leak urine or lose control
of the bladder can affect people of all ages and both
genders. Just remember - incontinence is not a disease;
it is a symptom of an underlying problem.
You Can Manage - There
is Help
Incontinence can be treated with special exercises,
medication and occasionally surgery. There are also
support organizations with the mission of helping both
the incontinent patient and the caregiver cope with
this challenging condition.
How Your Body Makes,
Stores and Releases Urine
When you eat and drink, your body absorbs fluids. The
kidneys filter out waste products from the body fluids
and make urine. Urine travels down tubes called ureters
into a muscular sac called the urinary bladder, which
stores the urine. When you are ready to go to the bathroom,
your brain tells your system to relax. Urine travels
out of your bladder through a tube called the urethra.
You release urine by relaxing the urethral sphincter
and contracting the bladder muscles. The urethral sphincter
is a group of muscles that tightens to hold urine in
and loosens to let it out. Many people lose urine when
they don't want to. When this happens enough to be a
problem, it is called urinary incontinence. Urinary
incontinence is common, but some people are to embarrassed
to get help. The good news is that millions of men and
women are successfully treated and cured.
Tell Your Doctor
It is important to tell your doctor about the problem.
You may want to print out this page and take it with
you to help you talk about your incontinence.
Causes
of Urinary Incontinence
Urinary incontinence is not a natural part of aging.
It can happen at any age and may be caused by many physical
conditions. Many causes of incontinence are temporary
and can be managed with simple treatment. Some common
causes are:
- Urinary tract infection
- Vaginal infection or irritation
- Constipation
- Effects of medications
Incontinence can also be caused by other conditions
that are not temporary. They are:
- Weakness of muscles which hold the bladder in place
- Weakness of the bladder itself
- Weakness of the urethral sphincter muscles
- Overactive bladder muscles
- Blocked urethra (can be from prostate enlargement)
- Hormone imbalance in women
- Immobility (not being able to move around)
- In almost every case, these conditions can be treated.
Your health care provider will help find the exact
cause of your incontinence.
Types
of Incontinence
There are also different types of incontinence. Some
people have more than one type. You should be able to
identify the type of incontinence you have by comparing
it to the list below.
Urge Incontinence
People with urge incontinence lose urine as soon as
they feel a strong need to go to the bathroom. If you
have urge incontinence, you may leak urine:
- When you can't get to the bathroom quickly enough.
- When you drink even a small amount of liquid or
when you hear or touch running water.
- You may also go to the bathroom as often as every
two hours during the day and night. You may even wet
the bed.
- Stress Incontinence
People with stress incontinence lose urine when they
exercise or move in a certain way. If you have stress
incontinence, you may leak urine:
- When you sneeze, cough or laugh
- When you get up from a chair or get out of bed
- When you walk or do other exercises
- You may also go to the bathroom often during the
day to avoid accidents.
- Overflow Incontinence
People with overflow incontinence may feel that they
never completely empty their bladder. If you have overflow
incontinence, you may:
- Often lose small amounts of urine during the day
and night
- Get up often during the night to go to the bathroom
- Often feel you have to empty your bladder but can't
- Pass only a small amount of urine but feel as though
your bladder is still part full
- Spend a long time at the toilet but produce only
a weak, dribbling stream of urine
- Some people with overflow incontinence do not have
the feeling of fullness, but they lose urine day and
night.
Treating Urinary Incontinence
Once you tell your doctor about the problem, finding
the cause of your incontinence is the next step. Your
doctor will talk with you about your medical history
and urinary habits. You may be asked to keep a record
of your usual habits in a bladder record. You probably
will have a physical examination and urine tests. You
may have other tests as well, which could include blood
tests, cystoscopy, PVR, stress tests, urinalysis or
urodynamic tests.
Behavioral Techniques
Behavioral techniques teach you ways to control your
own bladder and sphincter muscles. They are very simple
and work well for certain types of incontinence and
involve no risks. Two types of techniques are commonly
used: bladder training and pelvic muscle exercise. You
may also be asked to change the amount of liquid that
you drink by drinking more or less water, depending
on your problem. Bladder training is used for urge incontinence
and may also be used for stress incontinence. Both men
and women can benefit from bladder training. People
learn different ways to control the urge to urinate
such as:
- Distraction - thinking about something else
- Prompt voiding - urinating on a schedule
- Kegel exercises - pelvic muscle exercises which
are used to help strengthen weak muscles around the
bladder
Medication
Some people need to take medicine to treat conditions
which cause incontinence. The most common types of medicine
treat infection, replace hormones, stop abnormal bladder
muscle contractions or tighten sphincter muscles. Your
doctor may recommend medication for your condition;
you will be taught how and when to take it. As with
most drugs, there is a risk of having a side effect.
If you are taking medications for other conditions,
the drugs could react with each other. Be sure to review
all of your other medicines with your doctor and report
any side effects as soon as they happen.
Surgery
Surgery is sometimes needed to help treat the cause
of incontinence. Surgery can be used to:
- Return the bladder neck to its proper position in
women with stress incontinence
- Remove tissue which is causing a blockage
- Correct severely weakened pelvic muscles
- Enlarge a small bladder to hold more urine
There are many different surgical procedures that may
be used to help treat incontinence. The type of operation
you may need depends on the type and cause of your incontinence.
Your doctor will discuss the specific procedure you
may need. With any surgery there is a possibility of
a risk or complication. It is important to discuss these
risks with your doctor. Be sure to ask questions so
you understand the procedure.
Other Measures and
Supportive Devices
Some other products can be used to help manage incontinence.
These include pads and catheters. A catheter is a tube
placed in the bladder to drain urine into a bag outside
the body; it is used when a person cannot urinate. The
catheter is usually left in the bladder, but some are
put in and taken out as needed to drain the bladder
every few hours. Condom catheters (used mostly in men)
attach to the outside of the body and are not placed
directly in the bladder. Specially designed pads are
available to help men and women with incontinence. Catheters
and pads are not the first and only treatment for incontinence.
They should only be used to make other treatments more
effective or when other treatments have failed.
Conditions
What is Alzheimer's?
Alzheimer’s disease is a disorder that destroys
cells in the brain. The disease is the leading cause
of dementia, a condition that involves gradual memory
loss, decline in the ability to perform routine tasks,
disorientation, difficulty in learning, loss of language
skills, impairment of judgment, and personality changes.
As the disease progresses, people with Alzheimer’s
become unable to care for themselves. The loss of brain
cells eventually leads to the failure of other systems
in the body. The rate of progression of Alzheimer’s
varies from person to person. The time from the onset
of symptoms until death ranges from 3 to 20 years. The
average duration is about 8 years.
- Source: The Alzheimer’s Association
It is estimated that Alzheimer’s Disease affects
4 million Americans and that 90% of them having caregivers.
Incontinence, the loss of bladder or bowel control,
can accompany Alzheimer’s Disease especially as
it progresses.
It is very important to have the person experiencing
incontinence evaluated by their physician or medical
profession to determine the cause. Factors impacting
bladder or bowel control can be urinary tract infections,
prostate trouble, side effects of medication or bowel
impaction. Once the cause has been determined an effective
management method can be implemented.
Alzheimer's and Incontinence
Alzheimer's and Incontinence
It is common for persons with Alzheimer’s disease
to experience loss of bladder and/or bowel control.
This can be caused by:
- Medical conditions. The person
may have a urinary tract infection, constipation,
or a prostate problem. Other illnesses, such as diabetes
and stroke, and medication side effects may also trigger
incontinence.
- Fear. The person may fear that
an embarrassing accident may occur. This fear may
cause him or her to visit the bathroom more times
than necessary.
- Abrupt movement. Urine release
may be caused by a sneeze, laugh, or cough. Weak pelvic
muscles in women can also cause uncontrollable loss
of urine.
- Dehydration. Withholding fluids
when a person starts to lose bladder control may compound
the problem. Dehydration can create urinary tract
infections that lead to incontinence.
- Diuretics. Certain beverages, such as coffee, cola,
and tea, may contribute to incontinence.
- Environment. The person may be
having trouble finding the bathroom or getting to
it in time because it is too far away.
- Clothing. Zippers and buttons on
clothing could be making it difficult for the person
to undress.
If incontinence is a new problem, consult your doctor
to rule out potential causes such as a urinary tract
infection, weak pelvic muscles, or medications. If the
problem continues, try to:
- Provide visual cues. Signs may
assist an individual in finding the bathroom. Placing
colored rugs on the bathroom floor and lid covers
on the toilet may help the bathroom stand out. Avoid
having items nearby that can be mistaken for a toilet,
such as a trash can.
- Monitor incontinence. Identify
when accidents occur and plan accordingly. For example,
if they happen every two hours, get the person to
the bathroom before that time. To help control incontinence
at night, limit the intake of liquids after dinner
and in the evening.
- Remove obstacles. Make sure clothing
is easy for the individual to remove. Clothing with
Velcro™ may be easier for the person to remove
than clothing with buttons.
- Provide reminders. Because the
person with Alzheimer’s may forget to use the
bathroom, you may need to remind him or her periodically.
Also watch for visible cues such as restlessness or
facial expressions that may indicate the person needs
to use the bathroom.
- Be supportive. Help the person
with Alzheimer’s retain a sense of dignity despite
incontinence problems. A reassuring attitude will
help lessen feelings of embarrassment.
Reproduced with the
permission of the Alzheimer's Association.
Copyright 2004 Alzheimer’s
Association, www.alz.org,
800.272.3900
Alzheimer's and Incontinence by Chris Woolston
Most caregivers will do practically anything
for a loved one with Alzheimer's disease. They'll give
baths, help to dress the person, cut up food into manageable
bites, and patiently answer the same question 20 times
in a row.
But when a patient starts wetting or soiling himself,
even the most dedicated caregivers can feel defeated.
It's hard to face the prospect of constantly cleaning
urine stains from the couch cushions or changing the
sheets three times a night. Such accidents, in fact,
drive some dedicated caregivers to look for nursing
homes.
It doesn't necessarily have to be that way. Sometimes,
with a few simple steps, you may be able to help your
loved one regain control, or at least more comfort,
while saving yourself some work and distress.
How to keep it under
control
The first thing you should do is discuss the problem
with the patient's doctor. Incontinence -- especially
urinary incontinence -- is a very common condition among
older people, and it may have nothing to do with Alzheimer's.
For instance, many older people have overactive bladders,
which leads to a sudden and urgent need to urinate and
causes frequent leaking. Others have trouble squeezing
urine from the bladder, so the bladder overfills and
produces a more or less constant dribble of urine. Due
to weak pelvic muscles, many older women lose urine
when they sneeze, laugh, or exert themselves. A person
with bowel incontinence may be suffering from an infection,
diarrhea, constipation, or a fecal impaction (an accumulation
of waste lodged in the bowel).
Many of these problems are reversible. A doctor can
prescribe medications to improve bladder and bowel control
in some cases. For instance, several drugs are available
to calm an overactive bladder, and a number of medications
can help people empty a bladder that is overfull.
As the brain damage done by Alzheimer's progresses,
you may need to take extra steps to prevent accidents.
A confused person can forget to go to the bathroom,
or he may not remember what to do once he gets there.
You can help by taking your loved one to the bathroom
every few hours and, if necessary, showing him the toilet.
You should also watch for restlessness, such as tugging
at clothes, or other subtle clues that he may need to
relieve himself.
If the person you are caring for continues to have
accidents, do your best to keep him comfortable. To
prevent sores, wash the skin thoroughly and apply powder
to keep it dry. "Adult briefs" or absorbent
pads can be extremely useful in preventing accidents,
as long as the patient doesn't find them too uncomfortable
or demeaning. He may be more accepting of pads if he
can pull underwear over them, or if they are built into
the briefs themselves. (If your loved one suffers from
fecal incontinence, he probably needs to wear adult
briefs.)
Most of all, try not to scold a person for accidents.
Your loved one isn't trying to make your life difficult.
Rest assured, he dearly wishes he could take care of
himself.
Here are some other tips that will help keep
accidents and frustration at a minimum:
- If your loved one has trouble finding the bathroom
in the early stages, put up clear signs with words
and pictures.
- If walking is a struggle, buy a portable commode
to shorten the trip. A commode next to the bed can
be especially useful for preventing nighttime accidents.
- If a person often wets the bed, limit her fluids
before bedtime. In later stages, use adult briefs
and put a plastic cover under the sheets.
- Make sure a person has plenty to drink during the
day. Without enough liquids, a person can become constipated
and dehydrated.
- Provide clothes such as sweatpants, which are easy
to take off quickly.
- If patterns of urination change dramatically, have
the person evaluated for a possible urinary tract
infection.
- If the person with Alzheimer's has diarrhea, consult
with your doctor; the condition often needs to be
treated aggressively.
- If an overstressed caregiver mistakes a urinary
accident for a deliberate act, he or she may in rare
instances lose control. If you ever find yourself
becoming abusive or yelling after your loved one has
an accident, seek counseling help immediately. You
don't want to take out your anger on a bewildered,
demented person, and your reaction is a sign that
you need more help caring for him.
Chris Woolston, M.S., is a
health and medical writer with a master's degree in
biology. He is a contributing editor at Consumer Health
Interactive, and was the staff writer at Hippocrates,
a magazine for physicians. He has also covered science
issues for Time Inc. Health, WebMD, and the Chronicle
of Higher Education. His reporting on occupational health
earned him an award from the northern California Society
of Professional Journalists.
Diabeties
and Incontinence
The Effects if Diabetes
on the Elimination System
When a diabetic has an increase of serum glucose, the
glucose tends to "bond" to the red blood cells,
the platelets in the blood and the walls of the blood
vessels. This causes the blood to begin to flow less
effectively and will eventually "clog" the
blood vessels. Many blood vessels are so tiny that even
an extra glucose molecule attached to the cells will
cause damage to the surrounding organs or tissue.
Chronic renal failure is usually a secondary condition
of diabetes. It occurs usually later in the state of
the disease and effects approximately 20 – 30%
of all diabetics. With the kidneys unable to filter
toxins from the blood stream, this often produces undesired
lab values, especially increased in Createnine, BUN,
and protein.
Nerves are susceptible to glucose bonding much the
same as small blood vessels. The minute neurons can
become "gunked up" with excess glucose molecules,
thus sending misinformation through the nervous system
to the brain. The brain can mis-reads this information
from the confused neurons as pain signals, hot signals
or cold signals just to name a few. This condition is
referred to as "diabetic neuropathy" and can
cause diabetics considerable discomfort. The most common
areas effected by neuropathy are feet and legs but can
occur on hands and arms as well.
The urinary and bowel elimination system are effected
by diabetes usually as a result of faulty innervation
caused by the excess glucose build up on the nerves
effecting the bladder and the large intestines. What
can happen is the bladder nerves cease to feel the need
to void. The entire physical act of voiding involves
the nerve signals sent to and from the brain, which
causes different sphincters and muscles in the bladder
to tighten and relax. When this process is disrupted
secondary to the glucose build up on nerves, incontinence
or retention may occur.
The bowel is effected in much the same way. Nerves
become damaged and therefore the need to defecate goes
either unnoticed or unrecognized resulting in constipation
or an incontinent stool episode.
Multiple
Sclerosis and Incontinence by Jane Hankenhof-Curry
Multiple Sclerosis, a disease of the central nervous
system that impairs the coordination and strength of
muscles, can also impact bladder and bowel control.
Bladder dysfunction is estimated to affect approximately
80% of those diagnosed with Multiple Sclerosis. Just
as Multiple Sclerosis symptoms vary and differ in severity
from person to person so too can the symptoms, types,
and levels of incontinence. An evaluation can determine
the cause of bladder dysfunction and early treatment
can lead to prevention of further complications such
as urinary tract infections or kidney damage.
According to the National Multiple Sclerosis Society
“bladder dysfunction develops because MS blocks
or delays transmission of nerve signals in areas of
the central nervous system that control the bladder
and urinary sphincter”. Those with Multiple Sclerosis
may experience the need to urinate frequently or urgently,
urination hesitancy, frequent need to urinate at night,
or be incontinent. Medication side effects, a “spastic”
bladder that doesn’t hold a normal amount of urine,
or a bladder that improperly empties can all lead to
bladder control issues. Those living with MS may experience
dysfunction in urine collection, storage or the combination
of both often leading to urinary tract infections or
incontinence.
If you have MS or care for someone with the disease
it is important to know that there are successful incontinence
treatments and management methods available. Medications,
diet modifications, and intermittent catheterization
are treatment methods that may preserve normal functioning,
relieve symptoms, or prevent complications. The advancements
in treatment and management provide many benefits to
both those living with incontinence and their caregivers.
Disposable products offer effective, affordable, and
convenient solutions for light, moderate, and heavy
levels of incontinence. Today’s superabsorbent
technology eliminates the worry of odor, leakage, and
skin breakdown. High performance products comprised
of superabsorbent polymers ensure that urine is quickly
absorbed into the product’s core thus keeping
the skin dry. Polymers also neutralize urine’s
harmful bacteria that cause odor and can lead to urinary
tract infections or skin breakdown. High performance
products provide the security of knowing that they will
hold large amounts of urine without leakage and prevent
embarrassing accidents.
High performance products are available in a variety
of styles to best meet each individual’s bladder
control needs. The unique needs of individuals with
chronic diseases, such as MS, are taken into consideration
when developing product lines. Manufacturers of high
performance products want to ensure that individuals
can continue to lead an active life. Today’s advanced
technology provides thinner and more comfortable styles
while still ensuring that a large amount of urine is
absorbed and neutralized. Pads, pull-ons, liners, and
briefs are available in a variety of absorbency capacities.
Manufacturers and distributors of high performance products
may also provide you with confidential consultations
and educational tools to help you determine which products
would best meet your individualized needs.
There are many valuable resources available to those
with incontinence and Multiple Sclerosis. A support
group, incontinence specialist, web site, or book may
provide the additional information. The National Multiple
Sclerosis Society at 1-800-344-4867, your local MS Society
chapter, or www.nationalmssociety.org offers valuable
brochures on MS and incontinence. Especially helpful
is the brochure titled “Urinary Dysfunction and
MS: A Guide for People with Multiple Sclerosis”
which is based on “A Clinical Practice Guideline
for Professionals, developed by the Multiple Sclerosis
Council for Clinical Practice Guidelines”. |
