Urinary Incontinence
There so many events to be aware of during the month of June, it’s no wonder that we missed spreading awareness about World Continence Week, which was from June 19th through the 23rd. It is an annual initiative headed by the World Federation of Incontinence and Pelvic Problems that offers resources and discussion to educate clinicians in best practices for care management and aid patients in gaining access to a support system of practitioners and others living with incontinence. Did you know that “bladder weakness affects 1 in 3 women and 1 in 10 men, which makes it more common than hayfever” (WFIPP statistic)!
Urinary incontinence refers to the involuntary loss of control over bladder function and is characterized by the inability to effectively hold or control elimination leading to the unintentional release of urine. Incontinence can range from occasional mild leakage to a complete inability to control bladder movements. There are multiple underlying causes that can contribute to the development of incontinence, including bladder inflammation, urinary tract infections, bladder muscle abnormalities, weakening of the pelvic floor muscles due to childbirth, hormonal changes, or pelvic surgery, and neurological disorders (including multiple sclerosis, Parkinson disease, Amyotrophic Lateral Sclerosis, diabetes, or spinal cord injury).
Urinary incontinence can be characterized in several different ways.
Urge incontinence occurs when there is a sudden and strong urge to urinate, followed by an involuntary loss of urine.
Stress incontinence occurs when there is increased pressure on the bladder, leading to urine leakage.
Overflow incontinence occurs when the bladder doesn't empty completely, leading to constant dribbling or frequent leakage.
Functional incontinence is primarily due to physical or cognitive impairments that prevent individuals from reaching the bathroom in time.
Mixed incontinence is diagnosed when a combination of different types of incontinence is present, such as a mix of stress and urge incontinence.
The etiology can be best understood by developing clarity around onset and duration or symptoms, the triggers and characteristics of symptoms, frequency and severity, medical and obstetric history, current medications, lifestyle factors, and the impact incontinence has on daily life activities. It can be very helpful for patients to journal their voiding habits, noting their frequency of urination during the day & night, any difficulties or discomfort during urination, and changes in urinary symptoms from day to day, which can aid in a more precise diagnosis and tailored treatment plan while also being used as a tool to track the efficacy of treatment.
Treatments and strategies that may be recommended for managing incontinence include the following:
Bladder retraining: This involves gradually increasing the time between bathroom visits to help train the bladder to hold urine for longer periods. Patients & practitioners work together to develop a schedule and strategies for implementing this technique.
Pelvic floor muscle exercises to strengthen the pelvic floor muscles can help improve bladder control. You may be referred to a physical therapist or pelvic floor therapist who can teach the proper technique for performing various exercises including Kegels.
Of note, a new tool for women with incontinence has become available called the Elitone (https://elitone.com/), which is designed to tone the pelvic floor muscles and treat both stress and urge incontinence. The device provides noninvasive surface electrical stimulation applied through a Gelpad placed on the pubic area that is connected to a tiny controller and worn discreetly below clothing. The recommended basic treatment is 20 minutes a day for 6 weeks, during which you can walk around and continue your daily routine.Medications are available that can help manage incontinence, which may include anticholinergic drugs, such as oxybutynin or tolterodine that work by reducing bladder muscle contractions. Other medications like mirabegron act as bladder relaxants. Careful oversight should be implemented with these medications since side effects can impact one’s overall quality of life in different ways.
Intermittent catheterization is mainly for individuals having difficulty emptying the bladder completely. This involves using a catheter to empty the bladder at regular intervals. Proper sterile technique is essential & can be taught by your practitioner.
Absorbent products such as pads or protective garments can help manage leakage and provide a sense of security. It's important to find the most suitable products for your needs.
Lifestyle modifications may include monitoring and managing fluid intake, avoiding bladder irritants (such as caffeine or alcohol), maintaining a healthy weight, and establishing regular toileting habits.
Nerve stimulation therapies can include methods such as sacral nerve stimulation or posterior tibial nerve stimulation. These approaches involve delivering electrical impulses to specific nerves involved in bladder control.
It is important to work with a physician who can assess your symptoms, provide a comprehensive evaluation, and tailor a treatment plan to address your needs and goals. Additional strategies may be recommended such as physical therapy, occupational therapy, or counseling to support your overall well-being.