URINARY INCONTINENCE

Urinary incontinence is a common disorder caused by many factors. It’s also a really embarrassing problem. Fortunately, there are ways to prevent the discomfort of urine leakage. Find out more about incontinence and how to treat it.

WHAT IS URINARY INCONTINENCE?

Urinary incontinence is the involuntary loss of urine in a sufficient amount that causes a hygiene problem and disrupts a person’s social life. Although more frequent in seniors, incontinence can also occur in younger people. No matter how old you are, incontinence can be embarrassing and must be treated.

In some cases, incontinence can be resolved by correcting the cause (e.g., constipation). In other cases, treatment involves re-educating the bladder muscles and nerves or helping them work better through medication and pelvic floor muscle exercises.

Talking to your pharmacist is a key first step in managing incontinence.

URINARY INCONTINENCE CAUSES

The primary factors contributing to incontinence include:

  • Constipation.
  • Urinary tract infections, interstitial cystitis, bladder stones.
  • Childbirth, menopause.
  • Medications like diuretics, sedatives, and hypertension medications.
  • Poorly controlled diabetes.
  • Bladder or prostate cancer, or secondary cancers resulting from radiation therapy.
  • Genitourinary surgery (such as a prostatectomy).
  • Medical conditions such as Parkinson’s disease, multiple sclerosis, stroke, Alzheimer’s disease, and dementia.
  • Spinal cord injuries.

TYPES OF INCONTINENCE

There are different types of incontinence that can manifest independently or coexist.

    • Urge Incontinence:

      • Also known as “overactive bladder” or “spastic bladder.”
      • Characterized by a nervous bladder, causing a sudden and urgent need to release small amounts of urine frequently throughout the day and night.
      • Conditions such as Parkinson’s and multiple sclerosis, as well as factors like changes in posture, rapid bladder filling (e.g., from alcohol intake), and urinary tract infections, can contribute to this type of incontinence.

    • Stress or Effort Incontinence:

      • Involves the relaxation of the sphincter muscle (which keeps urine in the bladder) and pelvic floor muscles (supporting the bladder) when pressure is applied to the bladder.
      • Triggers include laughing, sneezing, exercise, and pregnancy.
      • Physiological changes during menopause can also lead to the loosening of pelvic floor muscles.

    • Overflow Incontinence:

      • Often observed in men with an enlarged prostate, exerting pressure on the urethra (the tube that empties the bladder).
      • The compressed urethra hinders complete bladder emptying, causing urine to leak frequently or continuously with a low flow.
      • Hypotonic or neurogenic bladder, where nerve connections to the bladder malfunction, can also result in this type of incontinence.

    • Functional Incontinence:

      • Occurs when an individual cannot reach the bathroom in time to urinate.
      • Not related to bladder issues but rather an inability to urinate due to physical or mental disabilities, or difficulties accessing the toilet in the home.

INCONTINENCE TREATMENTS AND MEDICATIONS

Bladder re-education can be a valuable approach for individuals dealing with urge incontinence. This involves establishing a regular urination schedule to re-educate the bladder, muscles, and nerves:

  1. Determine the shortest interval between urges to urinate (e.g., 1 hour).
  2. Urinate at this interval for 1 week, regardless of the urge.
  3. If no leaks occur during the first week, increase the interval by 30 minutes weekly until experiencing the urge 5 to 8 times a day (normal frequency) without leaks.

Pelvic floor muscle exercises, known as Kegel exercises, are beneficial for various types of incontinence. These exercises strengthen the muscles supporting the bladder, enhancing control and reducing or eliminating incontinence episodes:

  1. Tighten muscles for at least 10 seconds, then release for another 10 seconds. Repeat 10 times in a row, 3 times daily.
  2. Gradually increase the number of exercises based on your ability, as advised by a physiotherapist or doctor.
  3. Significant results are typically noticeable after 6 weeks, with maximum effect after 6 months. Consistent exercise is essential for long-term benefits.

Devices like pessaries, which support the bladder and reinforce weak pelvic floor muscles, or urethral plugs can mimic normal bladder control. However, these devices may carry risks of urinary tract infections and vaginal inflammation, requiring recommendation by a urologist.

Medication may be considered after ruling out other causes or medications contributing to incontinence. Specific drugs address different types of incontinence, such as benign prostate hypertrophy in men or reinforcing bladder muscles. Maximum effects are usually felt 4 to 8 weeks after initiating treatment, but potential side effects and interactions should be discussed with a pharmacist.

Complementary treatments, including physiotherapy, offer additional options:

  1. Vaginal weights, such as LadySystem™ exercise cones, can strengthen pelvic floor muscles.
  2. Electrical stimulation directly applied to pelvic floor muscles enhances contractions.
  3. Biofeedback, measuring pelvic floor muscle activity, provides insight into strength and duration of contractions.

Surgery should be considered only when alternative options prove ineffective.

TIPS AND ADVICE

Incontinence pants or underwear offer a discreet solution to manage incidents while you explore suitable treatments. Various products available at pharmacies cater to different needs, and your pharmacist can assist you in selecting the most comfortable and effective option based on your type of incontinence.

To maintain bladder health and prevent urinary incontinence, consider the following practices:

  1. Maintain a healthy weight.
  2. Avoid products that increase the urge to urinate, such as coffee, tea, herbal tea, and alcohol.
  3. Stay hydrated by drinking 6 to 8 glasses of water and ensure an adequate fiber intake to prevent constipation.
  4. Limit fluid intake after 5:00 p.m. and refrain from drinking after 7:00 p.m.
  5. Incorporate regular exercise, aiming for at least 30 minutes, at least 5 times a week.
  6. Urinate promptly when the urge arises, avoiding unnecessary delays.

If you are experiencing incontinence, don’t hesitate to discuss it with a healthcare professional. Incontinence is a treatable condition, and with proper care, you can manage it while preserving your dignity and quality of life.