Having spent 3 years in various wards, community areas, clinics etc., there has always been one problem which many of my patients have been affected by; incontinence!
Incontinence can be urinary, faecal or both. Incontinence is not a disease, rather a sign of a lifestyle problem, or a symptom of a medical condition. It affects between 3 and 6 million people (!!!!), and many do not seek help until much later. This needs to change!
Types of incontinence
Stress incontinence -not actually related to stress! It means that there is pressure on the bladder due to pregnancy, being overweight, sneezing, lifting heavy objects and some medical conditions (such as prostate cancer). It happens because the pelvic floor and urinary sphincter are weakened.
Overactive bladder- this is when you feel a strong urge to urinate, as your bladder is not relaxed. This means your bladder doesn’t like any amount of urine, so is constantly telling you to get rid of it! This can be caused by the type of fluids you drink, like caffeine or alcohol. It may be due to dehydration, as small concentrated amounts of urine in the bladder will irritate it. A urinary tract infection (UTI) can also cause an overactive bladder, but this is easily ruled out through a urine dip.
Functional incontinence- This means that the incontinence is occurring as they are unable to reach the toilet on time, often due to immobility but also caused by Dementia or other physical/mental illnesses.
Mixed incontinence- As the name suggests, this is when there are two causes of incontinence. For example, a mix of stress and overactive bladder. Very common in women!
Total incontinence- This is the most severe, as there is no control over the bladder so there is constant leakage. This can be due to bladder abnormalities, spinal cord damage or bladder fistulas.
Faecal incontinence can be harmless or serious, so it’s important to know all the details! Diarrhoea and constipation are the most common causes. Chronic constipation can lead to a weakening of rectal and intestinal muscles, causing faecal leakage. This is common in people with Parkinson’s.
How can you prevent incontinence?
- Avoid/cut down on “bladder unfriendly” things such as caffeine, alcohol and spicy/acidic foods
- Regular exercise (the answer to everything!)
- Regular pelvic floor exercises
- Treat any constipation and diahorrea quickly
- Don’t strain during bowel movements, as this can weaken the muscles which control your bowel movements and only allow small amounts of faeces to pass
There are so many options, and it depends upon the persons health and mental capacity, as well as the type of incontinence they have.
Pelvic floor exercises– These strengthen the pelvic floor muscles, which is the most effective treatment for stress or childbirth related incontinence. They are undertaken for 12 weeks, and must be completed 3 times a day (8 contractions each time).
Bladder training- This is a method I’ve been doing accidentally in all my years as a waitress/student nurse (2 professions where emptying you bladder needs to be precisely scheduled with your many other tasks). It involves delaying the passing of urine for 5-10 minutes, in order to force the bladder to wait. Techniques to achieve this include crossing you legs, standing on your toes, distracting yourself or applying pressure to your perineum.
Medicinal- I won’t go too far into detail, as I’m not an expert just a keen observer. Medicinal treatment of incontinence only works for overactive or mixed incontinence, and it is not the first-line of treatment (in nurse-led services). Drugs such as Oxybutynin, Tolterodine, Darifenacin and Festoterodine. These drugs are either immediate or extended release, with extended release causing less side effects but interacting with more drugs. They work by inhibiting the parasympathetic nerve impulses, relaxing your bladder. However, it is highly important to educate your patients about the possibility of urinary retention with these drugs, and a bladder scan is required 4 weeks after starting these treatments.
So that’s your one stop blog about continence! I can highly recommend spoking with your local continence service, whether in hospital or community, as you learn so much!
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