The Inconvenience of Incontinence
by Kristine Dwyer, Staff Writer

Just mention the word “incontinence” or “bladder leakage” and watch people react. Most people are reluctant to speak about it and many are afraid to even discuss it with their doctor. Surprisingly, aging alone is not the only cause of bladder leakage or incontinence, as it is commonly known. Actually, it can occur in many age groups and affects men, women and, yes, even caregivers. Incontinence can be an inconvenient and unsettling condition for those who experience it on a regular basis. Many believe their only option is wearing absorbent undergarments when, in fact, there are now a wide variety of treatment options available today.

According to JAMA (Journal of the American Medical Association), incontinence is defined as the involuntary loss of urine severe enough to cause adverse social or hygienic consequences. Statistics show that more than 13 million Americans of all ages are currently affected by incontinence at an estimated cost of over 16 billion dollars per year. More of this money is spent on absorbent pads and undergarments than on treatments. Twice as many women than men are affected by this problem during their lifetime. Of all the issues and challenges that family caregivers face, few are as troubling as incontinence. Changing pads, clothing and bedding day and night can produce tremendous fatigue and frustration for both the caregiver and care receiver. In fact, caregivers report that one of the major factors leading to placing a loved one in the nursing home is unmanageable incontinence.

Urinary control problems are complex and involve three areas of the brain plus the spinal cord, bladder and many muscles in the body. It can range from occasional leakage to a complete loss of bladder control; a temporary condition for some, a long-term challenge for others. Incontinence can be divided into several categories: Stress, urge, mixed, overflow, neurologic and reflex/unconscious. Stress and urge incontinence are the most common types. Stress incontinence is the involuntary loss of urine with physical exertion such as sneezing, coughing or laughing. Urge incontinence occurs with a strong, sudden need to urinate. The bladder contracts prematurely and can be triggered by hearing running water or by an anxious moment such as standing at a locked door while trying to locate the key.

We now know that there are many other contributing factors that can lead to incontinence. Examples are: poor body mechanics during lifting, urinary tract infections, obesity, side effects from medication (such as diuretics, sedatives and alcohol, pain relievers, antihistamines, and cold medicines), nerve/muscle damage, physical and emotional stress, medical conditions such as diabetes, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, loss of muscle control from prostate surgery or a hysterectomy, repeated catheterizations and prolonged states of immobility (especially among patients who are bedridden or have extended hospitalizations).

One of the most important roles of a caregiver is to take the lead in addressing the problem and advocate not only for their loved one but also for themselves. Since incontinence is not an inevitable part of aging, the inability to control urination should always be brought to the attention of the physician.  Caregivers can help in ensuring their loved one is able to communicate with the doctor and partake in a joint treatment plan that benefits both parties.  Urinary-control problems must be assessed in the context of a complete medical history and physical exam from a physician. This thorough medical evaluation can identify the type of incontinence that one faces. A urologist or gynecologist may also be consulted for diagnoses and treatment options. A variety of treatment choices are now available to manage bladder health; however, choosing the right treatment plan is the key for both the caregiver and the care receiver.

The following effective approaches have been identified:

  • Medications (however, not all bladder leakage issues require medication to correct)

  • Exercises (such as Kegel’s) to strengthen the pelvic muscles around the bladder

  • Relaxation/breathing techniques

  • Lifestyle changes

  • Physical therapy including biofeedback and muscle stimulation

  • Behavior changes such as keeping a bladder diary and monitoring diet and fluid intake.

  • Medical interventions (surgery, implants and catheterization)

Robert has been caring for his wife for four years following a series of chronic health events. In the past year, his wife’s incontinence has become of increasing concern to both of them. Robert knows the problem is affecting more areas of their lives including their social life and sleep patterns. He is also concerned about skin infections and his ability to properly bathe his wife. Robert has become weary and is finding it progressively more difficult to manage his wife’s care. He consulted a physician and together they were referred to a physical therapist for an evaluation.

Across the country, physical therapists, as well as occupational therapists and registered nurses, are now becoming specifically trained in exercise therapy and continence re-training programs. Once a cause for incontinence is determined, an individual program is devised. Patients meet with therapists, learn how their bladder works and what steps to take to retrain and manage their bladder health. The program lasts from four to twelve weeks. By using exercises supported by biofeedback methods (a therapy that uses measuring devices or sensors to help you learn to identify and control the bladder muscles), physical therapists and the like are now able to help patients of all ages.

Re-training and strengthening pelvic floor muscles can help patients improve their bladder control. Lifestyle changes such as relaxation, decreased caffeine consumption, monitored diet and fluid intake, knowledge of proper lifting techniques and daily exercise can also positively impact bladder health. Therapists report that even the smallest changes or adjustments in one’s daily life can be very beneficial in treating incontinence. In addition, catching the problem early and seeking a physical therapy consultation are important steps toward treatment or management of incontinence issues.

Physical therapists report that the most difficult issues to conquer with patients are embarrassment, social isolation and the loss of independence that can result from bladder control problems. Patients often feel depressed and withdraw from social connections and opportunities. They fear losing bladder control and avoid spending time away from home. Hygienic considerations such as body odor and skin irritations, as well as having easy access to a bathroom, also impact one’s comfort level outside of the home environment. It is also worth noting that the person with incontinence may lose their ability to smell the odor of urine. This is a sensitive point for caregivers to realize as they are providing care and encouraging good personal hygiene.

Caregiving suggestions for oneself and the care receiver include:

  • Monitor fluid intake; focus on adequate water intake vs. juices, carbonated drinks, caffeine and alcohol. Cut back on fluids in the evening hours.

  • Exercise together and promote daily weight bearing (standing) to maintain pelvic control muscles.

  • Use personal care absorbent products, bed and furniture pads and plastic sheets.

  • Make sure an adequate supply of pads/sheets is available to avoid additional strain and reduce laundering.

  • Wear loose or pull-on clothing for easier wear and removal.

  • Pack a car bag with absorbent underwear/pads, hand wipes, extra clothing, and disposable bags.

  • Increase bathroom accessibility with a bedside commode and have a plan for bathroom visits while away from home.

  • Void urine every two hours and try to maintain this routine throughout the day.

  • Keep skin clean and dry to avoid skin breakdowns and irritations.

  • Maintain privacy and dignity during caregiving. Show patience and offer support when accidents do occur.

  • Consider hiring help at home to ease the stress of daily caregiving and to focus on your own needs for rest and renewal.

Physicians and other health care professionals are great resources for information about incontinent care. Disease-specific support groups are also excellent places to obtain useful information and receive mutual understanding. Thanks to the Internet, there are now opportunities for education and research as well as numerous resources available to caregivers at the touch of a button. Experts can answer questions and caregivers can find support in online chat rooms.

Web sites to consider are:

Caregiver Support at www.caregiver.com
National Kidney Foundation at www.kidney.org
National Association for Continence at www.nafc.org

Yes, incontinence is inconvenient, yet support and treatments are readily available.  Today, more than ever, society openly recognizes this personal challenge and even the media addresses the issue of “human plumbing” problems. It is a fact of life and does not have to lead to feelings of shame and embarrassment. Managing bladder health issues is possible and staying at home no longer has to be the solution.

 

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