Q: On occasion, I have noticed when I cough or sneeze that I leak urine. I also find that I have difficulty getting to the bathroom on time without leaking more. This can be embarrassing, and I wondered if there was anything I could do about this problem? Is there a doctor or specialist that could help?
A: Bladder control issues or urinary incontinence problems are not new and have recently received more public attention. This includes recent advertisements for incontinence pads or absorbent garments, medications available to treat the various bladder problems, physicians who specialize in the treatment of these problems (urologists), and surgeries to correct these problems.
Bladder control problems are NOT an inevitable part of life, the aging process, or the long-term effect following childbirth. Urinary Incontinence (U.I.) is a condition in which an "involuntary loss of urine is a social or hygienic problem and is usually under-reported." Statistically, U.I. affects 15% of all adults or about 15-25 million Americans. It affects 26% or the female population between the ages of 30-59. Women have an 11.1% lifetime risk of undergoing a single surgical procedure for pelvic organ prolapse and urinary incontinence. Of these women undergoing surgeries, 29.2% of them will face re-operations in the future. U.I. is also responsible for 50% of nursing home admissions and is the number one cause of admission to long-term care facilities.
U.I. can also affect males who have undergone prostatectomy (surgical treatment for prostate cancer) with 17-54% having U.I. at three months following surgery and 5-72% continue to have incontinence still six months post-surgically.
The total cost for U.I. in the United States is $27.9 billion. The non-medical costs (including absorbent pads, laundry, and care-taking) amount to $14.4 billion. Medical costs are $13.5 billion. Of this amount, 8% is spent on evaluation and 92% on subsequent complications including falls, urinary tract infections, skin breakdown, prolonged acute care stays, and increased admission to skilled nursing facilities.
Considering how common these occurrences of bladder problems are, it is important to first be evaluated by a doctor for diagnosis, treatment, and management. Medical causes of incontinence are classified as follows:
Short-term causes include bladder infections, urinary tract infections (UTI), constipation, and side effects of some medications. Relief is usually a change in diet or an adjustment of medications.
Long-term causes are the childbirth process and complications, accidents, and surgical procedures. Recovery from these can affect the recovery of bladder control issues.
Chronic causes are birth defects, progressive illnesses such as Parkinson's Disease, Multiple Sclerosis, or Alzheimer's Disease. These causes are more difficult to treat and may never be fully corrected.
U.I. affects individuals differently with the major types of incontinence listed below:
Stress incontinence includes urine leakage with activities such as coughing, sneezing, exercising, heavy/moderate lifting, and strenuous activities. Childbirth and some abdominal surgeries can weaken the pelvic floor muscles (which normally support the bladder) and due to this weakness, urine escapes under stress.
Urge incontinence occurs when individuals have a sudden urge to urinate but are unable to get to the toilet in time. Causes of this type of incontinence include infections which irritate the bladder or urethra, muscle spasms that force urine out of the bladder, constipation which results in impaction of the stool, or the loss of muscle control following a stroke, spinal cord injury, dementia, Parkinson's Disease, or Multiple Sclerosis.
Mixed Incontinence, both urge incontinence and stress incontinence occur in some people, particularly women, at different times or under different situations. The causes of the two forms of incontinence may or may not be related and should be addressed separately.
Occasionally, less common types of incontinence are:
Overflow incontinence occurs in instances where people either lack the urge to urinate or have a blockage of the urethra (tube passing urine from the bladder out of the body), and as a result, the bladder never fully empties. Then when the bladder overfills, excess urine spills out. Common causes include nervous system disorders and spinal cord injury.
Functional incontinence occurs when people who are unable or unwilling to use the toilet are functionally incontinent. Severe arthritis or confusion brought on by other illnesses which prevent an individual from using the toilet without assistance are examples of functional incontinence.
Total incontinence is rare. It could be caused by birth defects or injury which causes uncontrollable urine loss or leakage. One common cause is dementia (the result of a number of illnesses including Alzheimer's or Parkinson's Diseases) that cause or lead to mental deterioration.
Medication-related incontinence may occur with some medications which may relax the muscles or block the signal which the bladder sends to the brain to say it's full. This may lead to incontinence.
Treatments available for Urinary Incontinence include the following options:
Pelvic floor muscle exercises (called Kegel's) are a series of exercises to promote strengthening of a group of internal muscles which support the bladder and the opening around the bladder as well as some of the internal organs. By improving the strength of the pelvic floor muscles, symptoms may improve. The strengthening exercises should be instructed by a nurse, physical therapist, or occupational therapist to assure correct performance.
Biofeedback training is the use of an assistive device or unit which provides feedback to the individual about the contraction or strength of the pelvic floor muscles. The unit acts like a "microphone" to tell the person about the strength and duration of the pelvic floor muscle contractions.
Electrical stimulation is also an assistive unit or device which provides stimulation to the pelvic floor muscles to enhance the contraction and strength. It is administered under the supervision of a physical therapist in a private clinical setting.
Bladder retraining is a systematic approach to successfully to successfully increase the time between trips to the bathroom (voiding interval). This retraining may include keeping a bladder diary of current habits as well as activities and methods to delay the episodes of urge in urination. The bladder retraining develops a specific toileting schedule for the specific needs of the individual.
Medications may assist in controlling episodes of incontinence along with the previously mentioned methods of treatment. It is important that the doctor or nurse is informed of any and all prescription and over-the-counter medication or drugs that the person is taking to best assess the effectiveness of medications as it relates to the incontinence.
Surgery options may be suggested by the physician to correct any physical problem associated with the incontinence. The physician will advise the individual of specific surgical techniques and the best surgical options for their consideration. The individual should then discuss the advantages, recovery, and risks associated with these surgical options with their physician.
Catheterization is a procedure which involves draining the bladder manually by inserting a tube, or catheter, through the urethra to the bladder. The physician would recommend the procedure if necessary, and the procedure will be performed by a nurse or doctor.
Other factors in managing incontinence are:
Diet and health can affect incontinence. Eat high fiber and high carbohydrate food and drink plenty of water (recommend 50-72 ounces per day). It is a misconception with incontinence that limiting fluid intake will help. Limited water intake leads to constipation and increased concentration of the urine which can contribute to incontinence problems. Certain foods and beverages are irritants to the bladder and these include orange juice, grapefruit juice/acidic juices, caffeinated beverages (coffee, tea, and sodas), tomatoes, milk products, artificial sweeteners, spicy foods, and alcohol. Extra body weight (being overweight) can also contribute to incontinence with the extra lead on the pelvic floor muscles and internal organs.
Odor and leakage control products will allow the incontinent individual to participate in activities until symptoms of incontinence are reduced or controlled. These products include pantiliners, pads, undergarments, briefs, underpads, and protective underwear.
Resources such as brochures, books, self-help groups, and support organizations include:
1. Your team of health care professionals including doctor, nurse practitioner, specialist, surgeon, nurse, physical therapist, and occupational therapist.
2. Select Physical Therapy - Select Physical Therapy offers expanded services for Urinary Incontinence treatments. We have seven Indiana locations.
3. Suggested Reading related to Incontinence:
The Urinary Incontinence SourceBook by Diane Newman, R.N.C., M.S.N., C.R.N.P., F.A.A.N. - order directly by calling 1-800-552-7551
Overcoming Bladder Disorders by Rebecca Chalker and Kristene Whitmore, M.D. - order directly by calling 1-800-331-3761
Staying Dry by Kathryn L. Burgio, PhD, K. Lynette Pearce, R.N. and Angelo J. Lucco, M.D. - order directly by calling 1-800-537-5487
Answers to Your Questions About Urinary Incontinence from the Bladder Health Council of the American Foundation for Urologic Disease - order directly by calling 1-800-242-2383
Urinary
Incontinence in Adults: A Patient's Guide (Publication # AHCPR96-0684)
- write to request:
AHCPR Clearinghouse
Urinary Incontinence Guidelines, Publication # 96-0684
P.O. Box 8547, Dept. KM-194
Silver Spring, MD 20907-8547
4. Self-Help Groups:
National
Association for Continence
NAFC
P.O. Box 8310
Spartanburg, SC 29305-8310
1-800-BLADDER
http://www.nafc.org
The
Simon Foundation for Continence
P.O. Box 835
Wilmette, IL 60091
1-800-23-SIMON
URINARY INCONTINENCE
Affects:
15% of all adults
15-25 million Americans
26% of all females between ages 30-59
Responsible
for:
11.1% lifetime risk for women to undergo a single surgical procedure for
pelvic organ prolapse and urinary incontinence
29.2% of these women will face re-operation
50% of all nursing home admissions
Number one cause for admission to long-term care facilities
Costs:
$27.9 billion total cost for urinary incontinence
$14.4 billion of this is non-medical costs (pads, laundry, caretaking)
$13.5 billion of this is medical costs (8% for evaluation, 92% for further
complications)
