Urinary Incontinence

Urinary incontinence is a physical inability to retain urine (it has nothing to do with a lack of willpower). People with incontinence may involuntarily urinate at any time, in any circumstances...

Incontinence can be temporary or permanent. When it is due to a urinary infection, constipation, or medication (such as antidepressants, antihypertensives, or diuretics), incontinence can be treated by eliminating its cause. On the other hand, when it is caused by a physical problem or is age-related, treatment may be more complicated.

Incontinence can often be prevented.

To prevent incontinence:

• lose excess weight
• avoid grapefruit juice
• avoid diuretic products, such as alcohol and coffee
• do not decrease water and fibre intake too much, since constipation can also cause incontinence

There are various types of incontinence

1. Urge incontinence
   Caused by nervous bladder that needs to void all the time, as soon as it contains a small amount of urine.
2. Stress (or exercise-induced) incontinence
   Caused by a weakened or more relaxed "urinary" sphincter (the muscle that keeps urine inside the bladder). This often occurs in menopausal women and may be due to decreased estrogen levels. Because of this weakness, the bladder leaks a small amount of urine every time there is increased pressure on the abdomen as happens when laughing, sneezing, or even when being picked up in someone's arms.
3. Overflow incontinence
   Often occurs in men who have an enlarged prostate, making it impossible for the bladder to empty. When the bladder becomes over-distended, there is so much pressure that the urine is forced outside.
4. Functional incontinence
   This is not really a type of incontinence. It occurs mostly in people with physical disabilities that keep them from reaching the bathroom in time...

Medication

Before taking any drug to control incontinence, tell your physician or pharmacist which drugs you are already taking since they may be responsible for the problem. Several very effective drugs for the control of incontinence are available. Your physician can determine which medication is best for you, based on the type of incontinence you are experiencing.

Incontinence products

Protective pads or undergarments are used to avoid accidents while the incontinence problem is being addressed. They allow people to maintain autonomy and lead normal lives, without having to worry about leaks. There are many products on the market. Your pharmacist can help you choose the right product based on comfort, capacity, and type of incontinence

Nonpharmacologic Treatment:

Bladder re-education and Kegel exercises can help people with incontinence.

1. Bladder re-education
   The goal is to prolong by half an hour each week, the interval between visits to the toilet, until this interval is at least 4 hours. For example, someone who cannot wait for more than 1 hour will start by going every hour in the daytime during the first week, even if there is no urge to urinate. The second week, the person's visits to the toilet are spaced an hour and a half apart, the third week 2 hours apart, and so on, until the person can wait at least 4 hours before going to the toilet. Being able to wait 4 hours is considered "success".
2. Kegel exercises
   The goal of these exercises is to strengthen the muscles that support the bladder, so they can again accomplish their function.

   Step 1: Locate the pelvic floor muscles
   Contract the muscles that you use to interrupt the flow of urine or prevent a bowel movement or the passing of gas. To make sure you are contracting the right muscles :

   • women: should feel pressure around a finger when inserted in the vagina;
   • men: the penis should retract inwards slightly when contracting the muscles.

   A biofeedback device can be used to help locate the right muscles. This device may be recommended by a qualified health care professional in the treatment of incontinence.



Step 2: Tighten the muscles for 5 to 10 seconds

• without holding your breath
• without contracting your glute or abdominal muscles

Step 3: Relax muscles for 10 seconds

Step 4: Repeat steps 2 and 3, 12 to 20 times in one exercise session
Gradually increase until you can do these exercises 3 times a day. Try to integrate into your daily exercise routine. You should notice results after a few weeks. As with any other muscle, they need to be kept in shape if you want them to stay strong. Once you have achieved your goal, regular maintenance workouts are required.

To further strengthen the pelvic floor muscles, women can use vaginal cones (ex.: LadySystem®). These cones, of varying weights, are inserted into the vagina and held in place by tightening the pelvic floor muscles.

In closing, if you or someone you know has urinary incontinence, don't hesitate to talk about it. Urinary incontinence is nothing to be ashamed of. With the right kind of help, you can lead a normal life and maintain your dignity.

For more information or support:

The Canadian Continence Foundation

www.canadiancontinence.ca