Continence Connection: What is incontinence?

Incontinence, or loss of bladder or bowel control, is a symptom of an underlying condition and is not a disease in itself. There are many conditions and disorders that can cause incontinence. Among them are birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. Incontinence can also occur as a result of pregnancy or childbirth.

Incontinence is a problem of the urinary system, which is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle called the sphincter controls the activity of the urethra. It is not a part of the urinary system but can play a role in incontinence.

Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence can result.

According to the Clinical Practice Guidelines on Urinary Incontinence in Adults published in 1996 by the Agency for Health Care Policy and Research, 13 million Americans are incontinent - 85% of them are women. More recent consumer research reveals that one in four women over the age of 18 experience episodes of leaking urine involuntarily. One in five adults over age 40 are affected by overactive bladder or recurrent symptoms of urgency and frequency, a portion of whom don't reach the toilet before losing urine. At least half of all nursing home residents are incontinent of urine and many of them experience loss of bowel control as well. In sum, the problem is widespread and affects people of all ages including children and young adults. NAFC estimates on the basis of multiple studies and expert opinion that 25 million adult Americans experience transient or chronic urinary incontinence.

Sufferers may experience emotional as well as physical discomfort. Many people affected by loss of bladder or bowel control isolate themselves for fear of ridicule and lose self-esteem. Adults may find employment impossible or compromised.

Bedwetting
Ten percent of children over the age of five in the United States have bedwetting problems. One percent of adolescents over the age of 16 continue to have the problem. Besides the embarrassment these children feel, their parents are often too uncomfortable with the situation to seek help. Many believe that their child will outgrow bedwetting tendencies. If your child's bedwetting continues, see your pediatrician. Ninety percent of the bedwetting in children who do not have physical abnormalities can be cured by a combination of counseling, bladder stretching exercises, and behavior modification including hypnosis or alarm systems.

Types of Incontinence

There are different types of incontinence:

Stress incontinence occurs when sphincter or pelvic muscles have been damaged, causing the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder. A problem that commonly affects women, stress incontinence may occur after multiple childbirth or menopause. Pelvic fracture, radical prostatectomy, or bladder neck surgery can also damage the sphincter muscle and cause stress incontinence.
Urge incontinence, the urgent need to pass urine and the inability to get to a toilet in time, occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited. Stroke, dementia, Alzheimer's Disease, and Multiple Sclerosis (MS) can all cause urge incontinence.
Mixed incontinence is very common and occurs when symptoms of both stress and urge types of incontinence are present. Symptoms of one type of incontinence may be more severe than the other. Treatment will depend on which symptom is more bothersome to the patient.
Overflow incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder's holding capacity. It can result from diabetes, pelvic trauma, extensive pelvic surgery, injuries to the spinal cord, shingles, MS, or polio.
Functional Incontinence is common in those who have mental or physical disabilities that keep them from urinating even though the urinary system itself is normal. Conditions that can lead to functional incontinence include Parkinson's disease, Alzheimer's disease and other forms of dementia. Mental confusion may prevent both recognition of the need to void and locating a bathroom. For individuals with severe depression a person may become incontinent because they are indifferent to self-control.

Help is Available

People who suffer from incontinence may feel that their doctors do not understand what they are going through. It is true that, in the past, the causes of incontinence have not been well understood and many people were reluctant to talk about their problems with their healthcare provider.

Physicians and providers have learned much more about the diagnosis and treatment of incontinence. In fact, a growing number of urologists, gynecologists, geriatricians, and nurse specialists have developed surgical and nonsurgical techniques for treating incontinence. Many pharmaceutical manufacturers also have created new drugs to help treat incontinence.

Treatment Options

Approximately 80% of those affected by urinary incontinence can be cured or improved. Diagnosis includes a medical history and a thorough physical examination. Tests such as X-rays, cystoscopic examinations, blood chemistries, urine analysis, and special tests to determine bladder capacity, sphincter condition, urethral pressure, and the amount of urine left in the bladder after voiding may be required.

Because incontinence is a symptom and not a disease, the method of treatment depends on diagnostic results. Sometimes simple changes in diet or the elimination of medications such as diuretics can cure incontinence. More frequently, treatment involves a combination of medicine, biofeedback, exercise, urethral inserts or collection devices, and absorbent products. Despite the high success rates in treating incontinence, only a fraction of people affected seeks help. Many types of treatment are available for incontinent people. After considering your specific case, a qualified specialist can recommend the treatment that is appropriate for you.

The three major categories of treatment are: behavioral, pharmacologic, and surgical.

Behavioral techniques sometimes include:
Scheduled Toileting. The caregiver prompts the incontinent patient to go to the bathroom every 2-4 hours. This puts the patient on a regular voiding schedule. The goal is simply to keep the patient dry and is a frequently recommended therapy for frail elderly, bedridden or Alzheimer's patients.
Bladder Retraining. This involves scheduled toileting, but the length of time between bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
Pelvic Muscle Rehabilitation. This technique involves pelvic muscle exercises (PME). PME may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation, and magnetic therapy.
Pharmacologic therapy (medications or drugs) is another common treatment for incontinence. Physicians can prescribe medications to help control incontinence, and sometimes they will take a person off a drug that is causing or contributing to incontinence. Of course, only your physician or nurse practitioner should tell you to stop using a drug he/she has prescribed.
Surgical treatment should be performed only after receiving a thorough diagnosis from a healthcare provider. All appropriate non-surgical treatments should be tried before deciding on surgery. There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of your incontinence. Some of the more common procedures performed to treat urinary incontinence include, bladder neck suspension or sling procedures, periurethral bulking injections (collagen injections around the urethra), or implantation of an artificial urinary sphincter or sacral nerve stimulator. Your healthcare professional will thoroughly discuss any procedure you might need.

For those people whose incontinence cannot be cured or for those who are awaiting treatment, there are devices or products to help manage incontinence. These include catheters, pelvic organ support devices, urethral inserts or patches, external collection systems, penile compression devices, and absorbent products.

Comments

Thank you for your question about Biofeedback and how it can help strengthen the pelvic floor. This is a treatment that truly works. I have performed it/taught it to numerous patients and it's quite effective. Please visit www.CoreNurse.com and www.RobinHowe.net to learn more about pelvic floor rehabilitation and electrical stimulation. I would also be happy to discuss this further with you over the phone.

Posted by: Robin Howe, BSN RN | December 03, 2008 at 11:16 PM