Courtesy of Total Patient Care
Have you ever been embarrassed by accidentally wetting your pants? Relax, you are not alone. You may have a surprising common condition referred to as Urinary Incontinence. During urination, the muscles of the wall of the bladder contract forcing urine out of the bladder and into the urethra. The sphincter muscles surrounding the urethra relax allowing urine to be passed out of the body. Urinary Incontinence occurs when there is an inability of the internal urinary sphincter to control the flow from the bladder. Urinary incontinence can be categorized into five types and as temporary or permanent.
The good news is that most incontinence can be cured or helped considerably by a bladder training program which establishes a schedule (timed voiding) for emptying the bladder and performing Kegel exercises. Timed voiding develops the habit of emptying your bladder at regular scheduled intervals. Kegel exercises strengthen the pelvic floor and sphincter muscles.
Types of urinary incontinence include stress incontinence which can occur with any activity that increases intra-abdominal pressure, or sudden pressure on the bladder such as laughing, coughing, and exercising. It is usually caused by weakening of the pelvic muscles or the wall between the bladder and vagina, or a change in the position of the bladder.
Urge incontinence occurs when the urge to void is so immediate that there is not sufficient time to get to the toilet. It may be a result of injury, illness or surgery for such as enlarged prostrate, spinal cord injury, radiation, or it may be a symptom of kidney or bladder infection. Some medications can interfere with sphincter control.
Overflow incontinence occurs when the bladder is always full due to an inability to completely empty it accompanied by a constant need to urinate or a leaking bladder. Weakened bladder muscles may be the underlying cause, or disease, structural changes or obstructions like kidney stones.
Functional incontinence occurs when there is an inability to control the bladder complicated by a loss of mobility, cognitive deficits, or the inability to communicate needs effectively, a common problem among the elderly especially those with Alzheimer’s, arthritis or Parkinson’s.
Mixed incontinence is having more than one type of incontinence simultaneously. And temporary or transient incontinence may result from restricted mobility, severe constipation, urinary tract infection, medications such as diuretics, muscle relaxants, antidepressants, antipsychotic drugs, narcotics and antihistamines.
The procedure for the stress and urge incontinence Bladder Training Program starts with:
1. Increase fluid intake. Adequate fluid intake is basic to establishing a schedule for emptying the bladder.
2. Avoid carbonated drinks and citrus juices which are alkalizing and bladder irritants.
3. Drink fluids 30 minutes before emptying bladder. Avoid liquids at bed times.
4. Establish a schedule. Empty the bladder immediately upon awakening, then every 1-2 hours while awake.
5. Maintain this schedule for a week, then increase the intervals between empting the bladder by 30 minutes. Maintain this schedule for a week then increase the interval again until interval for empting the bladder is every 3-4 hours.
Training for overflow incontinence includes steps 3 and 4 above. Immediately after emptying bladder as best possible, stand up, wash hands, walk around for a few minutes, then sit down and empty bladder again. Repeat this exercise until no additional urine is produced. Continue timed voiding.
Kegel exercises consist of contracting the correct muscles. Key is identifying the pelvic muscles. When you can stop the flow of urine while emptying the bladder, you have the basic move. However, do not make a habit of stopping the flow as this may weaken the muscles you are trying to strengthen.
Perform Kegel exercises by squeezing the pelvic muscles as hard as possible, hold for a count of 5 seconds, release and relax for 5 seconds. Do not give up if you are unable to hold for 5 seconds. Work at your own pace
Continue squeeze-hold-release pattern five times and repeat this exercise 3-4 times a day. Every few days increase the hold time and the number of repetitions. Set a goal of 10 repetitions and sets. Once you have mastered the technique vary it by increasing the intensity of the squeeze. Continue to increase your schedule every week until you have established a schedule of emptying your bladder every 3 to 4 hours a day while awake.
Bladder training and Kegel exercises are the conservative approach to managing incontinence. If they fail, more aggressive treatment options are available such as medications and surgery. It is important to seek medical advice to determine your best treatment option. If urinary incontinence is affecting your day-to-day activities and quality of life, remember this is a common and treatable problem.
