By Nurse Practitioner Ila Shebar
You may not know it but this is World Continence Week dedicated to raising awareness of continence and treatments.
Did you also know that urinary incontinence (UI) costs $16 billion a year?
Did you know that more than 40 percent of American women are affected by it? That there is a strong association between UI and depression?
That greater than 50 percent of residents in long-term care facilities have UI?
That women more likely than men to be affected?
That the risk of UI increases 14 percent with each decade of life? That there are many options for treatment?
Urinary incontinence is the complaint of any involuntary leakage of urine. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra.
At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine.
Factors that contribute to urinary incontinence include:
- Fluid intake: Large amounts of fluid may place unnecessary overload on the bladder resulting in frequency or leakage. But limiting fluids can cause bladder irritation with increased urge to urinate accompanied by incontinence.
Some types of fluids- caffeine, alcohol, carbonated beverages, citrus, and artificial sweeteners may worsen UI.
Spicy foods and tomato based products can also irritate the bladder and make symptoms worse.
- Constipation: The accumulation of stool in the rectum alters the position of the pelvic organs and presses on the bladder, reducing its capacity to hold urine.
- Habitual preventative emptying: This may result in training the bladder to hold only small amounts of urine. It can lead to ‘urge to void’ sensations occurring at lower bladder volumes.
- Familial incidence: Women reporting UI have a greater likelihood of an immediate family member also with UI.
- Age: Age-related anatomic changes such as striated muscle taking longer to develop force and/or a decline in the number and density of urethral striated muscles can be a factor in the development of UI.
- Pregnancy and childbirth: The strength of the pelvic muscle contraction is decreased after a vaginal birth. UI associated with pregnancy rises as fetal size rises. There may be a loss of support to pelvic structures or damage to the structures during the birthing process.
- Other factors: As BMI increases, UI increases. Smoking cigarettes increases the risk. Medications such as diuretics, benzodiazepines, tranquilizers, antidepressants, high blood pressure drugs, and sleeping pills can increase the risk.
Specific diseases associated with UI include diabetes, stroke, hypertension, cognitive impairment, Parkinson’s disease, arthritis, back problems, and hearing and visual impairments.
Many people find that specific diet and behavioral changes can help to reduce problems with incontinence. Behavioral changes have few side effects, can improve control of bladder and pelvic muscle function and can be used alone, or in combination with other therapies for the treatment of stress, urge, or mixed UI.
Maintain a healthy weight as being overweight can put pressure on the bladder, causing leakage of urine.
Nicotine in cigarettes can be irritating to the bladder muscles and cause contractions and urgency with leakage, so stop smoking.
Pelvic floor muscle exercises (kegels) are performed to strengthen the pelvic floor muscles, and are often recommended for stress UI associated with urethral hypermobility.
Biofeedback can be useful in assisting women who have difficulty identifying the correct muscle for pelvic floor muscle exercises, or as a means of improving extremely weak muscles.
Bladder retraining is used primarily to manage urge UI. Retraining involves scheduling trips to the bathroom, with the schedule slowly increasing the time between bathroom visits.
Non-surgical options for the treatment of UI also include the use of pharmacological measures. Several medications have been proven to be beneficial, however as with all pharmacologic interventions, individual risk-benefit ratios must be considered prior to recommendation.
If the symptoms of urinary incontinence don’t respond to these conservative methods, urinary incontinence surgery may be considered.
Urinary incontinence surgery includes a variety of procedures, from minimally invasive injection of bulking agents to major surgical intervention.
Urinary incontinence can lead to shame and embarrassment, depression, decreased sexual activity, decreased job opportunities, increased risk of falling (from rushing to the bathroom), and social isolation. If you or your loved one is struggling with incontinence, don’t wait.
Make an appointment to discuss the problem with your health care provider.
More information can be found at www.worldcontinenceweek-usa.org
Ila Shebar is a women’s health nurse practitioner specializing in women’s pelvic health and continence at Pioneer Valley Urology in Springfield. She has also taught fitness classes at the Jewish Community Center in Springfield for more than 20 years, and is the mother of three sons.