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What are the types of incontinence?
How is incontinence treated? Timed Voiding or Bladder Training Other Procedures
Urinary incontinence is an inability to hold your urine until you get to a toilet. More than 4 million women in the UK, 20% of women in each country young and old experience some sort of incontinence. It is often temporary, and it sometimes could result from an underlying medical condition. Women experience incontinence twice as often as men. Pregnancy, childbirth, menopause, and the structure of the female urinary tract account for this difference. Both women and men can become incontinent from neurological injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging. Older women, more often than younger women, experience incontinence. But incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. Try to overcome your embarrassment and see a doctor to learn if you need treatment for an underlying medical condition. Incontinence is a medical condition just as much as any other condition, which needs to be addressed. Incontinence in women usually occurs because of problems with muscles that help to hold or release urine. The body stores urine—water and wastes removed by the kidneys—in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body (see Diagram 1). Incontinence will occur if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax. Diagram 1
The urethra is the tube, which passes urine from the bladder out. It normally maintains a tight seal to prevent involuntary loss of urine. For women with stress urinary incontinence, a weakened pelvic muscle floor or a defect in the urethra is unable to support the urethra in its correct position.If coughing, laughing, sneezing or other movements, which place pressure onto the bladder cause you to leak urine, you may have stress incontinence. The problem is especially noticeable when you let your bladder get too full. Physical changes resulting from pregnancy, childbirth, and menopause can often cause stress incontinence. It is the most common form of incontinence in women and is treatable. Pelvic floor muscles support your bladder (see diagram 2). If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken. Stress incontinence can worsen during the week before your menstrual period. At that time, lowered oestrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause. Diagram 2
This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your body may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night, urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water Some people with urge incontinence have a strong desire to urinate when they hear water running. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" . Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury—including injury that occurs during surgery—all can harm bladder nerves or muscles. People with functional incontinence may have untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet. A person with Alzheimer's disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women in nursing homes. If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, so it overflows uncontrollably and you leak urine. With overflow incontinence, you may feel as if you never completely empty your bladder — or that you need to empty your bladder, but can't. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase overflow incontinence. This means having more than one type of incontinence, typically stress incontinence and urge incontinence. Usually one type is more bothersome than the other is. The cause of the two forms may or may not be related. Usually the occurrence of stress and urge incontinence together. Leakage that occurs temporarily because of a condition that will pass (infection, medication).
How is incontinence treated? Kegel or pelvic floor muscle (PFM) exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by a health care professional. Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, you stand and hold a cone-shaped object within your vagina. You then substitute cones of increasing weight to strengthen the muscles that help keep the urethra closed. IncoStress allows you to carry out pelvic floor exercises whilst it is in situ. Over time the pelvic floor muscles could become stronger with regular use of IncoStress. A medical device, worn internally like a tampon. IncoStress is made from medical grade silicone. It works by supporting and placing gentle pressure against the urethra from the vagina. Incostress allows the bladder to be supported into its natural anatomical position. It may be worn night and day. The unique shape of Incostress enables the pelvic floor muscles to work naturally, which could improve the strength and tone when used regular. Pelvic floor muscle exercises may still be carried out with Incostress in situ. Incostress is easy to insert and remove. Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence. Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence. Timed Voiding or Bladder Training Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning—known as bladder training—can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence. Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as oestrogen, are believed to cause muscles involved in urination to function normally.Some of these medications can produce harmful side effects if used for long periods. In particular, oestrogen therapy has been associated with an increased risk for cancers of the breast and endometrial (lining of the uterus). Talk to your doctor about the risks and benefits of long-term use of medications. A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly. Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen (a fibrous natural tissue from cows) and fat from the patient's body have been used. A doctor can inject implants in about half an hour using local anaesthesia. Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material. Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a tape attached to muscle, ligament, or bone. For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage. In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass. If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections. Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol. Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers—especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments.
If you had a leaky tap, you wouldn't put a cloth under it to catch the drips, you would probably fix the washer or certainly deal with the problem, so why treat your own body any different? Be positive make this a year where you take a step to control your incontinence problem and not just hide it, there is help available, but it’s you that must take the initiative. If you feel that surgery may be your only option, why not fill in our pre-surgery form to help you decide?
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Copyright C&G Medicare Ltd © 2007 | Reg UK 5949325 | VAT 885 5503 90 | The Incostress is patented. |
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