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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