This is a topic that no one affected by it really wants or likes to talk about. It really is an unpleasant condition, too often attributed to aging only and “resolved” by incontinence pads, only. It almost always triggers a strong feeling of embarrassment and even shame when it becomes obvious that someone can’t prevent involuntarily leakage of urine. Urinary incontinence in elderly-and not only in elderly. Millions, and maybe dozens of million not so old people have to fight some form of this condition. It can be a mild form, when only a few drops are leaked due to coughing or sneezing and all the way to wearing pads at all times, as there’s no way to get to a toilet in time.
Incontinence is so much more than just wet underwear. It’s missing a walk in the nature, because there’s no toilet out there. It’s not going to yoga or the gym because you’re afraid of an accident. It’s not going far away from home, because you might not be back in time to reach the bathroom. It’s not spending the night anywhere, because you think you might wet the bed. It’s never going anywhere without a spare pair of pants in your purse or pocket, as you might need it. It’s a feeling as if it were your fault. It’s isolating yourself more and more as you’d rather not risk in public or in company. It robs you of the joys of life and makes you feel ashamed for things you have no control over. Or, do you? The good news is, most cases of incontinence are treatable or, at least, manageable.
We’ll come to that just a bit later.
Let’s first understand what’s happening.
Bladder is an organ in the abdomen, that stores urine, produced by the kidneys in the process of filtering our blood. These two, ureters and urethra form the urinary system, the body’s drainage system for removing urine. Ureters carry urine from kidneys to bladder, which stores it until we find an appropriate time and place to urinate. It can store up to 0,5l (2 cups) of urine. The muscles of the bladder wall are relaxed while the bladder fills with urine. Pretty much like a water balloon being filled with water. A muscle called sphincter keeps the bladder closed. As the bladder fills close to its capacity, sends a signal to brain about it, which the brain reads as a need to find a toilet soon.
During urination, the muscles of the bladder wall tighten, squeezing urine out. At the same time, the brain instructs the sphincters to relax. As they relax, urine exits the bladder through the urethra, at the bottom of bladder and out of the body. There is another muscle around the urethra which supports it and makes sure urine escapes only when we want it to. It is called pelvic floor. If any of these muscles do not work properly, incontinence may occur. Typically, when muscles relax without us wanting it. It can be equally unpleasant and often embarrassing for women and men.
It occurs more often as people get older, but urinary incontinence is not an inevitable consequence of aging. There are some disadvantages, as weakening of muscles of the urinary tract as we age, especially in women who gave birth, or prostate gland enlargement in men, but the following signs are not a normal “goes with aging” problem, as very often mistaken. You need to see your doctor about it, if you experience any of these:
- Inability to hold urine or leaking urine
- Needing to urinate more than 6-7 times in one day
- Waking up multiple times at night to urinate
- Unconsciously wetting the bed at night
Other symptoms, like:
- Sudden and urgent need to urinate
- Pain or burning before, during, or after urinating
- Cloudy or bloody urine
- Passing only small amounts of urine after strong urges to urinate
- Trouble starting or having a weak stream while urinating
- Trouble emptying the bladder
indicate a possible UTI (urinary tract infection). You again need to see your doctor about it.
Do not hush it up, it won’t just go away
– seek help, it is available
Many people are reluctant to discuss bladder control issues with their doctors. Incontinence isn’t something that’s easy to talk about, but discussing it is often the first step in getting help.
You will first likely need to recognize what type of incontinence you have the displeasure to deal with:
-Stress incontinence: happens with any stronger activity, such as coughing, sneezing, running, jumping, bending, lifting, straining or even laughing. Any of these could put enough pressure on the bladder and the weakened muscles, causing the leak.
-Urge incontinence: There is a sudden and intense urge to urinate, right now, and urine leaks almost immediately. Also sometimes mentioned as overactive bladder, as it is caused by sudden contraction of bladder wall that we have no control of.
-Overflow incontinence: The bladder is unable to empty completely and it gets too full, so frequent small urination and continuing dripping happens.
–Neurological Bladder Disorder can have symptoms of either of the above types, or all together, if it’s primary cause can be linked to:damage to the brain, spinal cord, or nerves. It can affect patients who suffer from damages caused by trauma, stroke, multiple sclerosis and Parkinson’s disease.
-Mixed incontinence: Usually a combination of stress- and urge incontinence, so will have symptoms of both.
-Temporary incontinence: does not last long and is triggered by a temporary situation, such as using a certain medicine or having an illness that causes leaking, such as a bad cough from a cold.
–Bedwetting, well-known in children can also be a nightmare for adults. Certain foods, drinks and medications may act as diuretics — stimulating your bladder and increasing the volume of urine, which is it incapable of holding. Alcohol at night, caffeine, sodas and sparkling water, artificial sweeteners, chocolate, spicy food, citrus fruits, certain hormone deficiency, UTI (urinary tract infection) heart and blood pressure medications, sedatives, muscle relaxants, large doses of vitamin C – all can cause this highly unpleasant occurrence. It happens while a person sleeps, so can’t really be controlled.
Some classifications include also Total incontinence, when bladder cannot store urine at all, but this is mostly due to inborn anatomical defects, fistula creation or nerve rupture, and Functional incontinence, which is more a mobility issue, as a person cannot reach the bathroom in time, due to conditions affecting maneuverability, but otherwise would be in the control of the bladder.
What are the risk factors of incontinence? Who is more likely to develop one?
- Women, more often than men, especially if they have had children.
- Overweight people, as the weight is extra pressure on the bladder and surrounding muscles. Over a longer period, it weakens the muscles, making a person more prone to stress incontinence.
- Older people: The muscles in the bladder and urethra weaken with age in women, allowing leakage, while in men the prostate enlarges and prevents normal urinating.
- Men undergone prostate surgery: or undergoing radiation therapy.
- Smokers: A chronic frequent coughing, characteristic for smokers may promote stress incontinence.
- Patients with other diseases and conditions: Diabetes, kidney disease, spinal cord injury, a stroke, multiple sclerosis, Parkinson’s disease-they all increase the risk.
Top urinary incontinence treatment?
For many people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence. A wide range of medical treatments is available and the choice of the top one for you will rely on your doctor, who will prescribe it depending on the type, severity and the underlying cause of incontinence.
Besides medical treatment (Drugs, hormone treatment, surgical solutions, nerve stimulation, bladder Botox …) there is a lot you can do yourself to minimize this rather irritating condition:
-Water is the best fluid for bladder health. Not less than half of the necessary 8 glasses of fluid per day should be water.
-Cut down on alcohol, coffee, tea, sodas and chocolate
-Eat healthy diet, especially food rich in fiber food in order to avoid constipation, which can put extra pressure on bladder
-Maintain a normal weight, as obesity is one of the main risk factors.
-Quit smoking, if you haven’t buy now. Among other serious problems, it causes a chronic cough, which can trigger stress incontinence.
-Exercise regularly. It will contribute to your overall health and better metabolism.
-Give yourself enough time and stay relaxed when emptying your bladder, so it can empty completely. Do it at least every 3 to 4 hours.
-try training yourself :
-Start slightly delaying urination after getting the urge, gradually increasing the time, until you feel you are able to control how long it will take before you go to the toilet.
-get into a habit of urinating twice to empty the bladder more completely
-schedule urination, i.e. go to the toilet in preset periods of time, more rare than before, trying to extend the time between gradually.
-Do pelvic floor muscle exercises (Kegel) daily, as they can strengthen the muscles so that they will be strong enough to prevent urine passing without your control. There are also many devices available, which by physical or electrical stimulation can strengthen these muscles.
Are male pelvic floor exercises the same as female? How to do it correctly?
Both men and women can successfully use Kegel as means of improving pelvic floor muscles. First, you need to know the exact location of your pelvic floor muscles. When using these muscles, women will feel a slight pulling in the rectum and vagina. Men will feel a pulling-in of the anus and their penis will move a bit. If you’ve ever tried to prevent gasses passing by squeezing muscles, you know where they are. You can double-check by trying to stop the flow of urine midway through emptying your bladder. If you were able to stop it, you are squeezing the correct muscles. This is not an exercise, but a way to identify the correct muscles, so do not do it repetitively as it can promote retaining urine in your bladder.
It is important to relax your body as much as possible and concentrate on your pelvic floor muscles in order to avoid using other muscles around. You want to strengthen the weakened muscles and the only way is to stimulate or put exactly them in use. No stomach, chest, buttocks, thigh muscles should be involved at all. You can always check it by placing your hand on one of them at a time and feeling if they are being in use. If they are, relax and start again.
As all the other muscles, pelvic floor muscles are best trained if squeezed and relaxed interchangeable, in sets. First, it will be a short squeeze and hold of a single second followed by two seconds of relaxation. Repeat this 5 -10 times in a day. When you get adjusted to this level, gradually increase the squeeze and hold time to 2 and then 3, 4 and 5 seconds with equal relaxation time. When you are at ease with this level, you can start doing the exercise additionally in sitting, then in lying down positions. After a while, when you are comfortable completing 10 sets in each body position, you can increase again the squeeze and hold time up to 10 seconds, with equal relaxation time. These are guiding numbers, of course, it is not a carved in stone rule. Do the exercises often enough to turn them into a habit. Do not give up too early, as it will take at least 3-4 month to encounter significant improvement.
You should always breathe normally and nothing from outside should indicate you are performing the exercise. No one should be able to tell, except you. In time, with practice, you’ll be able to do it whenever and wherever -while brushing your teeth, washing dishes, sitting in the car at a stoplight, reading a book in bed or in a chair, watching TV, going for a walk, talking on the phone and even while having sex.
You may be able to find a physical therapist who can coach you or your loved one through these exercises if uncertain about doing them at home.
Performing pelvic floor exercises aim to strengthen your pelvic muscles to improve bladder control, prevent urine leakage, and support your organs. Along with lifestyle changes and discipline, these are the keys to managing urinary incontinence. You should never hesitate talking to a urologist to address any possible medical issue to resolve the basic cause of the problem.
Incontinence is not life threatening. People live with much worse conditions than this. But that doesn’t mean you have to be happy about how influenced or affected your life has become. If incontinence affects your daily life get up the nerve to talk to your doctor about doing something about it.
Suffering from any form of incontinence at old (or equally at a younger) age should have nothing to do with shame or embarrassment. Still, it is exactly what withholds millions of people actively seeking help. Reading about it, I hope, may help some, at least understand what it is all about and perhaps, even want the improvement bad enough to start working on it.
I am aware it is not pleasant to publicly share an experience connected to this topic, but I’m sure it would be of a great help to others, and I’d really appreciate seeing some in the comments.
As always, feel free to reach out should you have any questions and I’ll be happy to give you an answer to the best of my knowledge.
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