Urinary Incontinence Basics

Urinary incontinence may affect millions of people, but it is so much more personal if your loved one is among the millions. It’s embarrassing, can interfere with daily routine, and reduce the quality of life. Managing it often becomes a concern and a complication for you, as well. It’s important to separate truth from myth regarding urinary incontinence, understand approaches and interventions, and access any available assistance from your loved one’s health plan.

Urinary Incontinence Facts

• A lack of complete bladder control and a person leaks urine by accident

• Over 25 million American adults have temporary or chronic urinary incontinence

• It can occur at any age, though is more common in older adults, especially post-menopausal women who have had vaginal birth(s)

• It is the #1 reason for placement in long-term care (nursing home)

• It is the #1 contributor to urinary tract infection (UTI) in the elderly

• Contrary to popular belief, even held by physicians, incontinence is not just a “normal” part of aging, especially total loss of bladder control (LINK)

4 Common Types of Urinary Incontinence

Stress incontinence occurs when activity or movement causes urine leakage or when pressure is exerted on the bladder by coughing, sneezing, or laughing. This is the most common type of incontinence and is experienced by women of all ages.

Urge incontinence occurs when there is a strong, usually sudden, urge to urinate that is difficult to delay and results in an inability to get to a toilet in time.

Overflow incontinence occurs when the urge to urinate results in only a small release of urine. The bladder gets too full and “overflows”. This can cause a constant urine leak or dribble. Men are more likely to develop overflow incontinence because of urinary retention from a bladder obstruction, enlarged prostate, or other problems.

Mixed incontinence a mixture of 2 or more types of incontinence, typically stress and urge incontinence.

There is also urinary incontinence associated with medical conditions such as severe diabetes and those that disrupt nervous system function.

Symptoms

• Urine leakage that began or continued after surgery

• Leaking urine during exercise or movement

• Leaking urine with coughing, sneezing, or laughing

• Inability to delay urination for any period, and/or needing to rush to the bathroom

• A feeling of wetness without the sensation of urination

• A feeling of inability to completely empty the bladder/a constantly full bladder

Your Loved One’s Concerns

Your loved one may be embarrassed when an "accident" happens in a public place or other social settings, such as family gatherings; therefore, they may withdraw from activities and gatherings to avoid embarrassment. Likewise, they may not invite others into their home because they're worried about the odor of urine on themselves or throughout the house. Using incontinence products may also lead to a loss of self-esteem and, when coupled with social embarrassment, can result in shame, isolation, and depression. Additionally, as incontinence is the #1 reason for institutionalization, your loved one may fear hospitalization or nursing home placement.

Your Concerns

While you may also be embarrassed by urine odor on them, in their home, or even in your home, it is likely you have different and greater concerns that center on safety. There is potential for injury if the floor is wet with urine, or them falling while rushing to the bathroom. Skin problems that result from moisture, and the risk for skin and urinary tract infections. Maybe you worry about the cost of incontinence products, the increase in laundry, and the physical (and emotional) demand of constant clean-ups after incontinence episodes, as well as the additional time involved in these tasks.

Treatments: Non-medical

Limit fluids after dinner

Evening fluid limitation may help with overnight bathroom trips and nighttime incontinence.

• Do not limit fluids throughout the day – only after dinner

• Ensure that there is adequate hydration throughout the day, and start liquids again in the morning

• Avoid caffeinated drinks whenever possible, especially in the evening

Schedule bathroom breaks

Scheduling routine bathroom breaks may help eliminate rushing to the bathroom and better manage or eliminate unintended urine release.

• Every 3-4 hours (setting a timer helps)

• After each meal or snack

• Before activities

• Before naps

• Before bed

• First thing in the morning

This process is sometimes referred to as “toilet training” or “toileting schedule.”

Take diuretic medications (“water pills”) in the morning

Taking this particular medication early allows for enjoyment during the later part of the day and reduces incidences of overnight urination.

Incontinence wearables, bed pads, and containment systems*

Implementing urine containment products, such as pads for the bed and briefs to wear, can be difficult for your loved one and you.

For your loved one, it is a reminder that they have lost control over their body, and it may add to their embarrassment or take away their self-esteem because they feel the products are not discreet (i.e., it is obvious to everyone they are wearing them).

For you, this is a hard discussion to have with the person you are caring for because that person may feel disabled or that they are a burden. It can be especially difficult when there is a reversal in caretaking roles (the child is now caring for the parent).

Help them understand that incontinence is a common issue dealt with by millions of people, that products today are very comfortable and discreet, and that using products can return their independence and ability to participate in what they enjoy. Also, help them to have a very frank discussion with their provider about their incontinence experience.

*The BD PureWick urine collection system is the only one of its kind on the market. It is an external female catheter that manages overnight incontinence for better sleep, reduced risk of falls, and dryer skin.

Bedside commodes

These come in many configurations, including bariatric sizes.

• Placed directly at the bedside overnight

• Helps prevent some incontinence episodes caused by nighttime urgency

• Prevents rushing to the bathroom

• Avoid falls or injury due to poor night vision or limited mobility

• Avoid wet bedding and wet skin, and having to change products during the night

• To maintain your loved one's dignity, during the day, place the bedside commode out of sight in the tub/shower or nearby closet

Walking and core muscle exercises

Multiple studies have proven that walking reduces, and in some cases eliminates, all forms of incontinence.

• 30 minutes, at any pace, 5 days per week

• Weight loss also promotes bladder control

Pelvic floor muscle training (PMFT)

Also known as “Kegel exercises” or simply “Kegels."

• Strengthen the pelvic floor, which includes muscles of structures attached to the bladder and the bladder itself

• Loose or weak pelvic floor muscles cause the bladder to "fall" when full, releasing urine

Yoga and/or Pilates

Strengthens the core muscles of the abdomen and pelvis, which helps with bladder control

Treatments: Medical

Appropriate medical treatment for urinary incontinence starts with your keen observation of your loved one’s urinary habits, including issues and changes, that are then reported to your loved one's provider.

An incontinence care plan should include:

• Collaboration and cooperation with a provider

• Your loved one’s opinions and preferences

• Realistic expectations and goals

• Medical and non-medical interventions

Therapies recommended by a provider may include:

• Behavioral therapy / Bladder training

• Pelvic muscle rehabilitation

• Diet modifications

• Medications

• Nerve stimulation

• Surgery