Wednesday May 24, 2017
So, we're admittedly diverging slightly on our Kidney Health theme of the week, to focus on a condition affecting the final stage of the waterworks (and digestive) system: incontinence. Why? Because it's an important, yet often unreported issue, with many people not telling their doctor about any accidents they may be having.
This is often because many people don't realise that there is anything their doctor can do to help - but this is not true! Your GP or private GP is able to advise on this issue, to help you better manage your symptoms.
What Is Incontinence?
Incontinence refers to a lack of control over urination (passing urine) or defecation (passing a bowel movement), and happens when the normal process of storing and eliminating urine from the bladder or faeces from the bowel is affected. It is a common, but often embarrassing and stressful, complaint.
Urinary incontinence is the leakage of urine from the bladder, and faecal incontinence is a leakage of faeces from the back passage. Both tend to occur unexpectedly, and are impossible to foresee or control, meaning that incontinence of any type is distressing, and highly impactful on your quality of life.
Incontinence is often underreported to medical professionals, due in part to a sense of shame or hopelessness on the part of the sufferer. However, the good news is that this problem is very common, and there is lots that can be done to help you. In this article we will talk in more detail about urinary incontinence, which is the more common type.
More On Urinary Incontinence
Urinary incontinence is the leakage of urine from the bladder when you haven’t decided to urinate, and are not expecting it. It is twice as common in women as in men. This is because women’s muscles can often be stretched or torn during childbirth which may weaken them, and also because women have a shorter urethra (tube that the urine passes through) than men.
Types Of Urinary Incontinence
There are four main types of incontinence:
- Urge incontinence due to an overactive bladder
- Stress incontinence due to poor closure of the bladder
- Overflow incontinence due to either poor bladder contraction or blockage of the urethra
- Functional incontinence due to medications or health problems making it difficult to reach the bathroom
Urinary Incontinence Causes
We have already mentioned two main causes of urinary incontinence in women above. Other causes include:
- Weakened pelvic muscles
- Often due to normal ageing
- Drinking too much liquid
- Especially caffeinated drinks!
- Waiting too long to go to the toilet, or lacking the ability to reach the bathroom in time
- Sometimes seen in people with disabilities
- An overactive bladder muscle
- Feelings of anxiety or stress
- An obstructed bladder
- This may happen in men who have prostate problems or bladder stones
- Increased pressure on the tummy
- e.g if you are pregnant or overweight
- Damage to the bladder or the surrounding area
- for example, during surgery
- Certain medications
- Neurological conditions
- Conditions affecting the brain
- These include such as Parkinson’s Disease or Multiple sclerosis, or traumatic spinal cord injuries
Drinking too much liquid, especially caffeinated drinks, can lead to urinary incontinence
Urinary Incontinence Symptoms
The symptoms you might experience depend on the type of incontinence that you are suffering from. The two main types of incontinence are stress and urge incontinence, and the symptoms of these are outlined below.
Symptoms of stress incontinence:
- Involuntary release of urine, especially when you do things that pressurise the bladder, such as cough, sneeze, or laugh
- Leaking a small to moderate amount of urine
Symptoms of urge incontinence:
- Frequent and urgent uncontrollable need to urinate
- May leak a moderate to large amount of urine
Urinary Incontinence Diagnosis
We know that suffering from urinary incontinence can be distressing, but there is no need to suffer in silence. Your GP will be experienced in dealing with sensitive issues like this, and will not make you feel uncomfortable or embarrassed.
If you think you may have a problem, the best place to start is to visit your GP, who can assess you for incontinence by asking you questions about what you have been experiencing, and evaluating your risk factors for urinary incontinence.
You may also have a physical exam, and be asked to supply a sample of your urine or blood for testing. Some possible investigations may include:
- Examination of the urine
- This is carried out to eliminate the possibility of infection, inflammation, diabetes mellitus or protein loss as a potential cause of the incontinence
- Ultrasound and X-ray
- These are used to investigate the possibility of an obstruction
- A measure of the pressure in the bladder
- This checks whether the bladder is operating normally or whether there are any abnormalities of the nerves supplying the bladder
- Examination of the urethra and bladder through a viewing instrument
- Checks for the presence of bladder stones, or cysts
What Can I Do To Help Myself?
First of all, there are a lot of small lifestyle changes you can make to better manage your urinary incontinence. This conservative approach to managing the condition will usually be recommended before pursuing medical treatment, such as medications.
These self-help tips for urinary incontinence management include:
- Don't hold urine — go when you feel the need
- Practice good genital hygiene
- Get a portable urinal or bedside commode – this may make you feel uncomfortable, but it is a good short term solution to night time incontinence while you search for a long term resolution
- Do your daily Kegel exercises, which involve clenching and releasing the pelvic floor muscles in order to strengthen them. Females can try using a vaginal cone, which is a small weight inserted into the vagina, which is held in place using pelvic floor muscles, strengthening them over time
- Use incontinence pads (available from your local supermarket). These are absorbent pads placed inside the underwear, which catch escaping urine. Although they do not treat the problem, they are a good solution for keeping you comfortable and confident
- Plan a schedule for emptying the bladder
- Keep a daily diary of fluid intake and urination
- Try to lose weight if you are overweight
- Don’t drink a lot of fluids in situations where access to bathroom facilities is limited
If you are suffering from urinary incontinence, try to keep a daily diary of fluid intake and urination. You should also try to plan a schedule for emptying your bladder
Urinary Incontinence Treatment
The treatment that is best for you will depend somewhat on the type of incontinence you are diagnosed with, and the severity of your symptoms. You can try some of the lifestyle changes above, and these alone may improve your symptoms and make the condition more manageable.
If lifestyle changes alone don’t seem to be controlling your symptoms, you may want to try other treatments.
This treatment uses a device to send a mild electric current to nerves in the lower back, or the pelvic muscles that control urination, in the hope that the pelvic floor muscles will be strengthened.
Medications used for incontinence include duloxetine (which increases the tone of the muscular lining of the tube the urine passes through, helping to keep it closed). This medication is often used in the treatment of stress incontinence.
Medications used for urge incontinence are called anti-muscarinics, which can be taken by mouth or applied to the skin in a patch. These medications block activity in the bladder muscle, helping to relax it. If these anti-muscarinic medications don’t work for you, you might be offered an alternative called Mirabegron, which also helps the bladder muscle to relax.
Urinary Incontinence Outlook?
The majority of people with incontinence can be helped and even chronic cases can often be cured.
So if you, or someone you know is suffering from urinary incontinence, please do not suffer in silence! The most important first step is to book an appointment at your GP surgery to discuss your management options. Our discrete and sensitive private GP's at London Doctors Clinic are a perfect source of advice and information, and with appointments available across 9 central London clinics 7 days a week, there's no time like the present to nip this issue in the bud! We even have same day doctor appointments. As always, if you need to find a GP, LDC is here for you.
By Melissa Dillon