The misery of incontinence

Incontinence is the accidental or involuntary loss of urine from bladder (urinary incontinence) or bowel motion, faeces, or wind (flatus) from the bowel (faecal or bowel incontinence).
People of all ages, cultures and backgrounds may experience incontinence. Women are prone to bladder and bowel problems earlier in life than men as a result of pregnancy and childbirth. Amongst older men and women, however, the number of people with incontinence is fairly even for both sexes. Incontinence can be investigated and managed. Treatment may help you to improve or possibly cure the incontinence.
Normal urinary function is defined as emptying the bladder 4-8 times each day. The bladder can hold up to 400-600 ml of urine, but usually feels quite full at about half this amount (200-300 ml). You may wake you up once at night to pass urine, twice if you are older
Bladder problems and urinary incontinence can happen for many reasons, so there are different types of incontinence. The following are the most common.

Stress incontinence
Stress incontinence is urine leakage with physical exertion or effort – coughing, sneezing, laughing, exercising, walking or when lifting things.
Both men and women may develop stress incontinence, although it is mainly women who suffer from it as the bladder outlet (urethra) is very close to the birth canal (vagina). Both the urethra and vagina pass through the pelvic floor muscles. Pregnancy and childbirth can stretch and weaken the pelvic floor muscles which support the urethra.
Oestrogen, a female hormone, is important to the pelvic floor muscles and the pelvic organs and assists in keeping the lining of the vagina and urethra thick. The thickness of the lining keeps the urethra sealed after passing urine, much like a washer seals water from leaking in a tap. Less oestrogen is produced after the menopause and the lining of the urethra thins. As a result, in some women the urethra does not close fully. A chronic cough, constipation and being overweight all strain the pelvic floor and can eventually lead to stress incontinence.

Urge incontinence
Urge incontinence occurs with a sudden, strong urge to pass urine. It is very often associated with frequency, the need to pass urine more often than usual. It is also associated with nocturia (waking several times at night to pass urine). Some people have such a strong urge and so little warning that they wet the bed or their clothing.
Urge incontinence is often caused by an over-active or unstable bladder. This can happen at any age, but becomes more common as people get older. Often the cause of an unstable bladder is unknown.
It can happen following a stroke, in Parkinson’s disease, Multiple Sclerosis (MS) and other health problems which interfere with the brain’s ability to send messages to the bladder via the spinal cord. T|his affects a person’s ability to continue to hold and store urine.

Overflow incontinence
Overflow incontinence happens when urine leaks out from an already over-full bladder. The bladder does not empty completely. Urine continues to fill the bladder and then overflows with little |sensation or warning.
Symptoms include:
l Little or no warning when you need to pass urine
l Passing urine while asleep
l Frequent urinary tract infections or cystitis
l Dribbling” more urine after visiting the toilet.
Causes include
A blockage to the urethra by a rectum full of very hard faeces |(this puts pressure on the urethra, making it difficult to pass urine)
A prolapse of pelvic organs in women (which also can block the urethra)
Damages to nerves that control the bladder, urethra sphincter and pelvic floor muscles ( so that the bladder cannot empty properly)
Diabetes, MS, stroke and Parkinson’s disease (these conditions can interfere with the sensation of a full bladder and with bladder emptying)
Some medicines can interfere with bladder function, including herbal products

Other problems can cause or worsen urinary incontinence:
l Urinary tract infections are usually associated with pain or burning when passing urine. They cause urgency and frequency during and sometimes following the infection.
l Not drinking enough makes urine more concentrated. This irritates the bladder to give a feeling of urgency and causing it to contract or squeeze.
l Going to the toilet more often than you need to or “just in case” trains the bladder to store less than it should be able to store.
l Constipation puts pressure on pelvic floor organs. This can obstruct the urethra or move the bladder or bladder-neck into a |position where it cannot completely empty, or causes frequency.
l Caffeine drinks (such as tea, coffee and cola) upset the bladder lining.
l Alcohol increases production of urine and causes frequency.
l Medicines can affect your bladder and bowel. For example, water tablets (diuretics) make the kidneys produce urine more |quickly, increasing urgency.

What you can do if you have urinary incontinence?
l Do drink normally- – 6-8 cups of fluid per day are recommended unless you have been advised differently by your doctor.
l Drink more if the weather is hot or when exercising. Drink |mostly water.
l Reducing your fluid intake definitely makes things worse not better.
l Cut down on caffeine drinks, carbonated beverages, |and alcohol.
l Avoid constipation through regular exercise and this promotes bowel activity and try to maintain an ideal body weight.

ASST PROF DUANGMANI THANAPPRAPASR is an Obstetrician-Gynaecologist at Samitivej Sukhumvit Hospital. Call (02 711 8555.