Too often caregivers feel that their
loved oneís incontinence is a natural result of aging, dementia,
medication or disability. They may not seek help because they assume
that nothing can be done. But that might not be entirely true. Letís
learn about this too-little-talked-about condition.
First of all, we need a basic anatomy
lesson. The urinary system contains a urethra, a bladder, two ureters,
and two kidneys. A circular muscle called the sphincter can play a role
in incontinence, but it is not an official part of the urinary system.
The kidneys remove waste from the blood and turn it into urine. The
muscular ureter tubes move the urine from the kidneys to the bladder.
The balloon-like bladder stores the urine until itís released through
the urethra. If any part of this system malfunctions, incontinence could
More often than not, incontinence in
women occurs because of problems with muscles that aid in holding or
releasing urine. While urinating, bladder wall muscles contract, forcing
urine from the bladder into the urethra. While this is happening,
sphincter muscles surrounding the urethra relax, letting urine pass from
the body. If bladder muscles suddenly contract or muscles surrounding
the urethra suddenly relax, incontinence will occur.
Many things can cause
incontinenceósome temporary, some not. The temporary causes may include
constipation, medication side effects, urinary tract infections, and
vaginal irritation or infection. Causes that arenít temporary could
include a weak bladder, weak urethral sphincter muscles, weak pelvic
floor muscles due to pregnancy and childbirth, overactive bladder
muscles, nerve disorders, immobility, a blocked urethra(sometimes
because of an enlarged prostate), or a hormonal imbalance(especially in
menopausal women). As you might be able to deduce from that list, twice
as many women experience incontinence as men.
There are several types of
incontinence: stress incontinence, functional incontinence, overflow
incontinence, and urge incontinence. If your loved one has a combination
of two or more types, they are said to have mixed incontinence. Another
type, transient incontinence, is the temporary type, triggered by the
temporary causes in the previous paragraph. Letís explore the different
types in more detail.
The stress here is physical not emotional. Stress incontinence is the most
common form of incontinence in women. It is normally the result of the
pelvic floor muscles stretching after childbirth, certain surgeries or
weight gain. The neck of the bladder drops due to this stretching and
the neck may open when any pressure in the abdomen on the bladder causes
leakage. The leakage is worse during a womanís menstrual period and
during menopause. Thatís because the decrease of estrogen leads to lower
muscular pressure around the urethra. Pressure on the bladder while
laughing, sneezing, coughing, lifting, running, or getting out of a bed
or chair may cause leaking.
With this type of incontinence the person has normal bladder control but,
due to a physically limiting disorder, they are unable to reach a toilet
in time. For instance, someone in a wheelchair might be blocked from
getting to a toilet on time or someone with Alzheimerís may not think
well enough to plan a trip to the bathroom. This is a big problem in
many nursing homes.
Here the bladder is always full, so small amounts of urine leak out. It
feels as though your bladder is never completely empty or you may feel
the need to empty it and you canít. Small amounts of urine are often
lost during the day and night, frequent trips to the bathroom may
produce only a small amount of urine leaving the feeling that the
bladder is still partly full, and a long time spent on the toilet may
produce a weak, dribbling stream of urine.
The causes of overflow incontinence
can be loss of normal bladder control in a person with diabetes,
obstruction of the urethra due to an enlarged prostate gland, or tumors
and urinary stones that may also block the urethra. This is a serious
condition that requires immediate medical attention. If left untreated,
it can cause urine to flow backwards from the bladder to the kidney that
raises the risk of kidney infection and even permanent damage. This type
of incontinence is rare in women.
Urge incontinence is an overpowering urge to urinate followed by leakage
of a large amount of urine. The muscles that help control the bladder
spasm which can be scary, because it happens too quickly to get to a
bathroom. Some medical professionals might describe such a bladder as
ďunstable,Ē ďspastic,Ē or ďoveractive.Ē Also, this condition is
sometimes called reflex incontinence.
If you have urge incontinence, you may
leak urine when you drink even a small amount of liquid or even when you
hear or touch running water. Usually you go to the bathroom very often
and you may even wet the bed. Itís best to drink very little after 6pm.
Urge incontinence is often caused by
nerve damage, alcohol consumption, bladder infection, or some
medications. It is common in menopausal women, people with diabetes,
multiple sclerosis, dementia, Parkinsonís disease, and those who have
suffered strokes. Others have chronic pelvic tension in the muscles
surrounding the urethra due to sexual abuse, or vaginal or urinary
infections, and they donít pick up on weak signals that their bladder is
full. Some people have bladders that contract spontaneously, without
warning causing loss of urine.
If you or your loved one are
experiencing any of these symptoms or conditions, we urge you to see
your primary care physician. Incontinence can be cured or at least
alleviated. Letís explore how in the next article.
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