The Well Woman Centre Adult Urinary Incontinence 1
Adult Urinary Incontinence... 3 Stress Incontinence Symptoms... 3 Urge Incontinence Symptoms... 4 Mixed Incontinence Symptoms... 5 Where to Start?... 6 Make an Appointment with your Doctor... 6 Pelvic Floor Exercises... 7 How to Identify the Pelvic Floor Muscles... 7 How to Do Pelvic Floor Muscle Exercises... 8 Other Tips... 8 Bladder Training... 9 Bladder Retraining Instructions... 9 2
Adult Urinary Incontinence Urinary incontinence means that you pass urine when you do not mean to. It can range from a small amount now and then to large floods of urine. It is common. It can occur at any age but is more likely to develop as you get older. The estimate is that as many as 1 in 5 women over the age of 40 have some degree of incontinence. Some people wrongly think that it is a natural part of getting older or that it cannot be treated. This is not the case many people can be successfully treated or their symptoms significantly improved. There are three main types of urinary incontinence, Stress, Urge and Mixed. Stress Incontinence Symptoms Examples of Stress Incontinence would include leaking urine when coughing, sneezing, lifting, dancing, walking down the stairs, playing sport. Causes of Stress Incontinence The support muscles around your urethra, which is the outlet passage from the bladder, keeps the urine in your bladder from escaping. When these muscles become weak, even the small amount of stress created by everyday activities may cause a small amount of urine to pass. In women, stress incontinence often occurs after pregnancy or menopause. In women who have recently given birth this is due to a combination of pregnancy hormones causing the pelvic floor muscles to become softer in preparation for the delivery and then the muscle stretch that happens during the birth. Women who have a caesarean section can also have incontinence due to the effect of the pregnancy hormones. In postmenopausal women pelvic floor muscles are affected by the lack of oestrogen. Prolapse of the vaginal walls and / or prolapse of the uterus can also cause bladder problems particularly in older women. 3
Urge Incontinence Symptoms Urgency is a symptom where you get a sudden urgent desire to pass urine. You are not able to put off going to the toilet. Urge incontinence is when urine leaks before you get to the toilet when you have urgency. Causes of Urge Incontinence The possible causes of urge incontinence are not fully understood, but it is thought that a variety of things can worsen symptoms. Some of these could be: A recent urinary tract infection: it can take several weeks for the bladder to go back to normal after an infection has been successfully treated. Alcohol: For some people, alcohol may make bladder problems worse. If you do drink alcohol, try to cut down the amount you drink or, if possible, avoid it altogether. Anxiety: Being anxious or nervous can make the feeling of urgency worse. Use slow deep breaths, gentle exercises or doing activities that help you to relax. Constipation: Constipation can put pressure on the bladder. To avoid this, try to eat a balanced diet with lots of fruit, vegetables and drink enough fluid. When sitting on the toilet raise your feet up on a stool so that your knees are higher than your hips. Drinks: Try to avoid drinks containing caffeine (tea, coffee, cola) as this is known to increase the production of urine and may also irritate the bladder and make urgency symptoms worse. Also avoid diet fizzy drinks containing artificial sugars (diet cola, diet lemonade). Medication: Some medicines such as diuretics (water tablets) may cause urgency. Medical conditions (diabetes, stroke, heart problems): It is important that these conditions are under control as they may cause bladder problems. For example, diabetes that is not controlled can increase the risk of urine infections. Overweight: Losing weight may help your bladder problem. 4
Surgery: Previous pelvic surgery Smoking: Stopping smoking may help you reduce your symptoms It is not uncommon for someone to have both the symptoms of an overactive bladder and stress incontinence. Mixed Incontinence Symptoms Frequency: Having to go to the toilet more than 8 times over 24 hours. Urgency: Strong, sudden need to urinate which often necessitates rushing to the toilet. Urge Incontinence: This is an overwhelming urgency to urinate but not having enough time to get to the toilet. This often results in wetting accidents. Leaking Urine: When coughing, sneezing, lifting, walking, playing sport. 5
Where to Start? Make an Appointment with your Doctor If urinary symptoms are causing problems you are making very frequent visits to the bathroom or you are concerned about leaking then you should arrange a visit to see your doctor. A simple dipstick urine test will check whether or not you have an infection. Your doctor may also send the sample to a laboratory for confirmation. Bladder infections are common and a short course of antibiotics may be all that is needed to treat your symptoms. S/he will also talk about your fluid intake. The bladder only comfortably holds about 400 mls of fluid less than a pint so if you are drinking several litres of water every day it may simply be that you need to drink less. Some foods act as a bladder irritant spicy foods, citrus fruits and anything with caffeine, such as coffee, tea and chocolate. The doctor may examine you to see if there is any physical problem such as weak pelvic floor muscles or a prolapse of the vaginal walls or uterus. Depending on your symptoms the doctor will discuss pelvic floor exercises if stress incontinence is the problem or bladder retraining if urge is the main issue or both if you have a mix of both types of symptoms. Both pelvic floor exercises and bladder retaining are very effective in reducing urinary incontinence. Both take several weeks to have an effect but they are well worth doing and have the advantage of being medication-free. What Happens If They Don t Work? If the pelvic floor muscles do not respond to exercises the next step is to see an expert. Some physiotherapists have specific training in pelvic floor therapy so they can assess your exercise technique and if necessary use electrical stimulation of the muscles to improve response. 6
There is also a medication available but as with all medicines side effects may occur in this instance tummy upset and headaches are relatively common particularly when starting the medication. If bladder training does not have the desired effect then there are several medications that your doctor can prescribe to slow the activity of the bladder. These can cause a dry mouth and constipation. Vaginal oestrogen pessaries are also of benefit and are suitable for most women. Surgery is an option particularly for stress incontinence where exercises and medication have not been effective or where there is a significant vaginal or uterine prolapse. Urge incontinence may respond to botox injection into the bladder or implanting a device into the bladder to control nerve stimulation. Pelvic Floor Exercises Pelvic muscle exercises are an essential part of improving incontinence and preventing it from worsening. They also can be used to help you suppress the urge to urinate. The exercises strengthen and tone the muscles that support the pelvic organs. These muscles contract and relax under your command to control the opening and closing of the bladder. When these muscles are weak, urine leakage or loss may result. To achieve the best results when performing these exercises, imagine yourself as an athlete in training. You need to build strength and endurance of your muscles. This requires commitment and regular exercise. Correct technique is also very important. How to Identify the Pelvic Floor Muscles Squeeze the area of the rectum to tighten the anus as if trying not to pass wind. Feel the sensation of the muscles pulling inward and upward. OR Insert a finger in your vagina and contract the vaginal muscles. The squeeze you feel will confirm that you are exercising the correct muscles. 7
Remember not to tense your stomach, buttock or thigh muscles. Using other muscles will defeat the purpose of the exercise and slow your progress. How to Do Pelvic Floor Muscle Exercises When you have located the correct muscle, set aside a short time each day for three exercise sessions. At breakfast, lunch, dinner or before bed are convenient and easy to remember times for many women. Make it a habit to exercise at regularly scheduled times each day. Squeeze your muscle for a slow count of three. Then relax the muscle completely to a slow count of three. Do not "push out" during the relaxation of the muscle. Repeat the exercise 15 times. Fifteen exercises is one set. Be sure to do three complete sets each day. As you feel your muscle strength growing, increase the count to five for each squeeze and each relaxation. Other Tips Remember that this is a muscle conditioning exercise and like any other exercise, it is important to do it correctly in order to gain the most benefit. Focus on isolating the pelvic muscle and continue to breathe normally throughout each repetition. Muscles need oxygen to grow and strengthen. In the beginning, check yourself frequently by placing your hand on your abdomen and buttocks to ensure that you are not contracting these muscle groups. If you feel movement, continue to experiment until you have isolated just the muscles of the pelvic floor. Don't get discouraged. This is a learning process. It can take four to seven weeks to notice improvement. If you keep a record of leakage each day, you will begin to notice fewer accidents as you regain control. If you have difficulty performing these exercises or fail to see any improvement in the expected time, discuss this with your health care provider. Advice, support and learning aids are available. 8
Bladder Training Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence. The goals are to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. It also can decrease leakage and the sense of urgency associated with the problem. Bladder training requires following a fixed voiding schedule, whether or not you feel the urge to urinate. If you feel an urge to urinate before the assigned interval, you should use urge suppression techniques such as relaxation and pelvic floor exercises. As success is achieved, the interval is lengthened in 15 to 30 minute increments until it is possible to remain comfortable for three or four hours. Keeping a diary of your bladder activity is very important. This helps you to monitor your progress throughout your program. Bladder Retraining Instructions Empty your bladder as soon as you get up in the morning. This act starts your retraining schedule. Go to the bathroom at the specific times you and your health care provider have discussed. Wait until your next scheduled time before you urinate again. Be sure to empty your bladder even if you feel no urge to urinate. Follow the schedule during waking hours only. At night, go to the bathroom only if you awaken and find it necessary. When you feel the urge to urinate before the next designated time, use "urge suppression" techniques or try relaxation techniques like deep breathing. Focus on relaxing all other muscles. If possible, sit down until the sensation passes. If the urge is suppressed, adhere to the schedule. If you cannot suppress the urge, wait five minutes then slowly make your way to the bathroom. After urinating, re-establish the schedule. Repeat this process every time an urge is felt. When you have accomplished your initial goal, gradually increase the time between emptying your bladder by 15-minute intervals. Try to increase your interval each 9
week however, you will be the best judge of how quickly you can advance to the next step. Increase the time between each urination until you reach a three to four hour voiding interval. It should take between six to twelve weeks to accomplish your ultimate goal. Don't be discouraged by setbacks. You may find you have good days and bad days. As you continue bladder retraining, you will start to notice more and more good days, so keep practicing. You will hasten your success by doing your pelvic floor muscle exercises faithfully every day. Your diaries will help you see your progress and identify your problem times. 10