Urinary Incontinence

Urinary incontinence is the unintentional passing of urine.

Urinary incontinence causes a person to pass urine unintentionally. This can range from a small dribble now and then, to large floods of urine. Urinary incontinence is common. It is more common in women and older people. There are different causes, most of which are treatable.

The bladder is a muscular bag that collects and stores urine and is located in the pelvis. Filtered urine from the kidneys is held in the bladder by the pelvic floor muscles, which keep the urinary opening (urethra) closed. A signal is sent to the brain that triggers the need to pass urine once the bladder is full. When we are ready to pass urine, the brain tells the pelvic floor muscles to relax and the bladder contracts to push the urine out. However, this process can be interrupted in several different ways, resulting in urinary incontinence.

There are various types of Urinary incontinence. The two main types are:
Stress incontinence - which occurs when the pelvic floor muscles are too weak to prevent urination. Stress incontinence is not related to feelings of stress, but occurs when your bladder is put under an extra amount of sudden pressure. This type of incontinence is common in women who have given birth or been through the menopause. Having had a hysterectomy or being obese are also risk factors.

Urge incontinence - which is thought to occur as a result of incorrect signals being sent between the brain and the bladder. It can be described as an unstable, or overactive bladder. Conditions that affect the nervous system are also risk factors for urge incontinence. These include Parkinsons disease, multiple sclerosis and stroke.

These two types of urinary incontinence are thought to be responsible for up to 90 percent of all cases of the condition. It is also possible to have a mixture of both stress and urge urinary incontinence.

SIGNS AND SYMPTOMS
Stress incontinence - can cause leaks of small amounts of urine during physical activities such as: coughing, sneezing, laughing, heavy lifting and exercise. If the bladder is very full, stress incontinence can trigger a larger amount of urine loss.

Urge incontinence - can cause a sudden and very intense need to pass a large volume of urine. There is often only a few seconds between the need to urinate and the release of urine. Triggers can include a sudden change of position, the sound of running water etc. Urine may be passed during sex. A person with Urge incontinence may need to pass urine very frequently including several times during the night.

Overflow incontinence - can occur when there is an obstruction to the outflow of urine preventing the normal emptying of the bladder. An enlarged prostate gland in men is the common cause of this. Overflow incontinence can cause small trickles of urine to be passed very often. It may also feel as though the bladder is never fully empty. The normal bladder emptying mechanism becomes faulty and urine may leak past the blockage from time to time.

TREATMENT OPTIONS
As with all medical conditions it is advisable to consult your Doctor for a correct diagnosis and treatment. The type of treatment you receive will depend on the type of incontinence you have and the severity of the symptoms. If an underlying medical problem is causing your incontinence e.g. an enlarged prostate gland, you will receive treatment for this first.

Stress incontinence is initially treated with simple lifestyle changes, such as reducing your caffeine intake, insuring you are drinking the correct amount of fluids and losing weight if you are overweight or obese. Doing Pelvic floor exercises may also be recommended. If lifestyle changes and pelvic floor exercises prove to be unsuccessful in treating your stress incontinence, surgery may be recommended. Your Doctor can discuss the benefits and risks of this surgery.

Urge incontinence is also treated initially with the lifestyle changes described above. Your GP may refer you to a specialist for 'bladder training'. This involves learning techniques that will help you to increase the length of time between feeling the need to urinate and actually passing urine. The course should usually last for a minimum of six weeks. If bladder training is not effective your Doctor may prescribe medication to help you pass urine less frequently. Your Doctor can discuss the risks and benefits with you.

In some situations mild symptoms may resolve without treatment. If your incontinence persists and is not helped by treatment, your local continence advisor can give practical advice on how to manage. Incontinence pants, pads, etc are available and there are a range of aids and appliances that can greatly help when living with Incontinence.



DIET HINTS
• Foods high in magnesium may help Incontinence. These include almonds, cashews, green vegetables, figs, whole grains and fish.
• Foods high in silica are thought to support the bladder. Sources include almonds, peanuts, sunflower seeds, linseeds, lean red meat, strawberries and alfalfa.
• Herbal teas such as horsetail, valerian, lemon balm and uva ursi may be of assistance. Drink a cup morning and afternoon.
• Try to reduce caffeine beverages such as coffee, tea and cola.
• Try to include foods high in B Group vitamins to help the nervous system. These include brewers' yeast, nuts, seeds and fresh vegetables.
• Increase fibre intake to avoid constipation. Psyllium, guar gum, apple pectin, fresh fruit and vegetables and slippery elm are good sources.

VITAMINS/MINERALS/HERBS
Vitamins may only be of assistance if dietary intake is inadequate.
• Silica is a mineral, which is believed to strengthen and maintain elasticity of tissues.
• Horsetail herb is very high in silica and may help strengthen connective tissues and reduce urinary tract irritation.
• Calcium Fluoride is thought to increase integrity and strength of tissues. It is also thought to help prolapsed tissue.
• Magnesium and calcium may support weak muscles and nerves.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the correct Pelvic Floor Muscle Exercises.
2. Your Pharmacist stocks a range of Incontinence pads. These have to be fitted correctly.