Bladder control is something we take for granted. Once it becomes a problem, it can affect every aspect of your life. Fortunately, you can take action to improve it.
Urinary incontinence means that you cannot control when you lose or leak urine. The problem is more common than you might think. Nearly 10 per cent of Canadians have this issue – 20 per cent are men and 80 per cent are women. More people may experience these problems than statistics report.
Those who have problems with bladder control already know that it affects both confidence and daily activities. Extra clothing must be packed before an outing. Visiting an unfamiliar place may be out of the question because of concerns about bathroom access. Apart from the associated anxiety, the cost of laundry and pads can become a financial concern.
Incontinence is not a condition in itself. It signals an underlying issue. Something else is going on, and the body is signalling that it needs help.
Symptoms of urine loss develop for different reasons. They include:
Make an appointment to discuss your problems. Your doctor will ask questions (take a history), do a physical examination, and have your urine tested (urinalysis). You may require other tests or procedures. Keeping a diary for a few days can provide a record of how much urine you pass, whether you have leakage, and how much fluid you have taken in. Adjustments to your lifestyle and diet may be recommended, along with exercises for your pelvic floor muscles.
If lifestyle and behaviour changes do not help, the next step is to involve a health care team consisting of many disciplines. This group of specialists can look deeper into the causes and correction of involuntary bladder spasms or at organs that are in unusual positions. Health care providers who explore, understand and treat the pelvic floor include gynecologists, nurse continence advisors, pelvic floor physiotherapists, urologists and urogynecologists, gastrointestinal and colorectal specialists.
Myths about incontinence have been around for a long time. Unraveling the truth behind your assumptions allows you to take charge and best support your own pelvic floor health.
Nothing can be done about incontinence. It is just part of aging.
No, age does not cause incontinence.
It can be a factor, and can make symptoms worse. An older adult experiences some normal changes, including:
It is a tall order to react to your body’s signals, use the bathroom on time, and drink enough water, while staying mindful of chronic conditions.
Incontinence is not limited to older adults.
Since I already have issues with bladder control, drinking more water will make it worse.
Contrary to popular belief, limiting the amount of water you drink will not solve incontinence problems. Instead, you risk dehydration. Dehydration creates bladder spasms, which are interpreted as urgency (needing to pee right away). You will make as many bathroom trips but pee smaller amounts.
Dehydration can also cause constipation. Large amount of stool in the bowel can push on the bladder, giving a signal of urgency. Certain fluids and foods that irritate the bladder also dehydrate the body. Caffeine and alcohol are good examples. Even decaffeinated tea has a small amount of caffeine. While alcohol may help you to fall asleep, it will not help with staying asleep. Drink healthy fluids, especially water.
I put off visiting the bathroom until I get home, so I can avoid using a public toilet.
When waiting for over four hours to use the bathroom becomes a habit, the delay can stretch the bladder and damage the nerves to the tissues. This causes two problems. The urge to pee will not be felt as readily. As well, the bladder will not contract as effectively as it empties. Some urine will remain in the bladder, putting you at risk for urgency and recurrent urinary system infections. The bladder will also reach capacity much faster, leading to overflow incontinence.
I never touch the toilet seat.
Many people feel this way, especially girls in their twenties. However, hovering above the toilet to pee makes your pelvic muscles contract. This habit tenses, shortens, and weakens the very muscles you need to relax to pee effectively.
I cannot exercise those muscles.
Most people learn to use the toilet by age three or four, and believe that training should last the rest of their lives. No one even thought of exercising the pelvic floor muscles until the 1940s. Dr. Arnold Kegel, an obstetrician and gynecologist, recognized the advantages. He showed that when women who were pregnant or just had a baby contracted their pelvic floor muscles on a schedule, they toned these muscles. They had better bladder control and delivered their babies more easily.
Men who learn how to engage their pelvic floor muscles and do regular Kegel exercises have an easier time regaining continence after prostate-related surgery.
The best way to do pelvic floor muscle contractions is to stop peeing midstream.
Always stopping your urine stream to find the pelvic floor muscles or to do contractions can interfere with normal bladder nerve signals. If these signals are ineffective, urine may not be fully emptied from the bladder, resulting in urinary retention. Stopping the flow midstream should not become a regular habit.
I have to do 300 to 800 Kegel exercises each day.
Pelvic floor exercises are not a competition! When you first start doing the exercises, it is normal to tire easily.
The pelvic floor is a band of muscles between the pubic bone (at the front of your pelvis) and the coccyx (tailbone) in the back. For women, this band of muscles has three openings – the urethra, vaginal canal, and anal opening). Men have two, the urethra and anal opening. Continence depends largely on whether this band of muscles is toned. During a pelvic floor exercise, you contract these muscles.
To find these muscles, first empty your bladder. Lie down with your knees up. Practice contracting the back opening (anus) just as you would when you stop passing gas. Both men and women contract using the same muscles. When contractions are done correctly, men notice and feel a slight lift in the groin area. Women mostly need awareness to feel this action without a visual aid.
While doing these exercises, remember to breathe. Do not use any other muscles for the contraction. It is possible that you may feel tension or pain when contracting. This is a sign that your pelvic floor muscles need to be fully relaxed before doing any Kegel exercises.
We all are different, with unique tissue make-up and abilities. It takes about three to four months for a muscle fibre to grow, so be patient with yourself!
Embrace Continence Solutions: embrace-cs.ca
The Canadian Continence Foundation: canadiancontinence.ca
Canadian Nurse Continence Advisors Association: cnca.ca
Continence is like a finished puzzle. Each puzzle piece can help prevent or reduce symptoms. Place the pieces in the right spot, review the puzzle daily, clear the space around it, and focus on what other connections are possible. You will make steady progress, and enjoy the process and the finished picture in no time.
As you strive for continence, you focus on your own resources. Pay attention to your body and become aware of your daily habits. Social confidence, dignity, and an improved quality of life will be your reward.
by Naomi Wolfman, BScN, NCA, GNC(C), PRPC, BCB-PMD
Source: Family Health Magazine, Fall/Winter 2015