Urinary Incontinence is the involuntary leakage of urine or stool. Incontinence is a sensitive condition that affects an estimated 3 million people in the UK. It can happen to people at any age, although it’s more common in women.
Incontinence is not an inevitable part of ageing, although older people can be more prone to bladder issues. In a care home environment it is one of the most common day to day nursing issues. There are several types of urinary incontinence: stress incontinence, urge incontinence, overflow incontinence and total incontinence. Patients can suffer from a mixture of stress and urge incontinence. Incontinence issues can vary depending on the type of incontinence and the health and age of the patient. There are various things that can be done to limit the causes of incontinence in the first place and ways to deal with incontinence once diagnosed.
Types of incontinence
- Stress Incontinence
With stress incontinence urine leaks out at times when the bladder is under pressure such as coughing or laughing. Heavy lifting and some types of exercise can also be a trigger. Despite the name, stress incontinence is not linked to feeling stressed. It’s usually as a result of muscle damage or weakening and stress to muscles. The muscles which help to prevent urination are the pelvic floor muscles and the urethral sphincter. These muscles can be strengthened using specialist pelvic floor exercises (see more details below). The amount of urine passed is usually small, but if the bladder is full, stress incontinence can sometimes cause the passing of larger amounts of urine.
- Urge Incontinence
Urge incontinence is usually the result of overactivity of the detrusor muscles in the wall of the bladder, which help to control the way the bladder works. There is a urine leak followed by a sudden, intense urge to pass urine soon afterwards.
- Overflow Incontinence (chronic urinary retention)
When suffering from overflow incontinence the bladder cannot be fully emptied so this causes frequent leaking. Overflow incontinence is often caused by an obstruction or blockage to the bladder.
- Total Incontinence
With total incontinence the bladder is unable store any urine at all, which causes the passing of urine constantly or have frequent leakage. Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a bladder fistula.
What causes urinary incontinence?
Besides age there are other things that increase the chances of urinary incontinence developing:
- pregnancy and vaginal birth
- a family history of incontinence
Urinary incontinence can be short term or a long term problem, depending on the cause and the type of incontinence.
What is Stress Incontinence?
Stress Incontinence happens when pressure in the bladder, as it fills with urine, becomes greater than the strength of keeping the tube closed that urine passes through to exit the body. This tube is called the urethra. Sudden pressure on the bladder like laughing, sneezing or movement during exercise can cause the urethra to leak. If any of the muscles in this area of the body are weak you may get leakage of urine. Damage to the muscles in the pelvis and the urethral sphincter – the ring of muscle that keeps the urethra closed – can be the cause of leakage.
Stress Incontinence may be caused by:
- damage during pregnancy and childbirth
- increased pressure on the tummy eg obesity
- damage to the bladder or nearby area during surgery
- neurological conditions such as Parkinson's disease or multiple sclerosis
- certain medications
What is Urge Incontinence?
Urge Incontinence is the urgent and frequent need to pass urine. It can be caused by a problem with the detrusor muscles in the walls of the bladder. These muscles relax to allow the bladder to fill with urine, then contract to let the urine out. If the detrusor muscles contract too often, it creates a need to go to the toilet urgently. This is known as having an overactive bladder.
Possible causes for an issue with the detrusor muscles include:
- drinking too much alcohol or caffeine
- not drinking enough fluids which can cause strong, concentrated urine to collect in the bladder, irritating the bladder and causing symptoms of an overactive bladder
- urinary tract infections
- some medications
What is Overflow Incontinence?
Also called chronic urinary retention, Overflow Incontinence, is often caused by a blockage or obstruction of the bladder. When the bladder is obstructed it will fill up as normal but cannot be emptied completely. Pressure from the urine in the bladder builds up behind the obstruction, causing leakage. The bladder can be obstructed for a number of reasons including constipation and bladder stones.
Overflow Incontinence may also be caused by the detrusor muscles in the wall of the bladder not fully contracting. The bladder doesn't completely empty when going to the toilet, so the bladder becomes stretched. These muscles may not contract if there’s nerve damage in the area or when taking some medications.
What is Total Incontinence?
Total Incontinence happens when the bladder can't store any urine at all. This means either the constant passing of large amounts of urine, or passing urine occasionally with frequent leaking. Total incontinence can be caused by:
- a problem with the bladder from birth
- injury to the spinal cord which can disrupt nerve signals between the brain and bladder
- a bladder fistula, which is a small, tunnel-like hole that can form between the bladder and a nearby area
Medications and incontinence
Some medicines can disrupt normal bladder processes, or increase the amount of urine produced. These include:
- angiotensin-converting enzyme (ACE) inhibitors
- some antidepressants
- hormone replacement therapy - HRT
Risk factors for urinary incontinence
A risk factor is something that may increase the possibility of developing an issue but may not be the specific cause of the problem. With urinary incontinence some of the main risk factors are linked to age, particularly in older people over 80. However family history and genetics can also be an influencing factor to being more at risk, as can Lower Urinary Tract Symptoms or LUTS.
Lower urinary tract symptoms (LUTS)
The lower urinary tract is made up of the bladder and the urethra, the tube that urine passes through going out of the body. Lower Urinary Tract Symptoms (LUTS) are common in men and women as they get older and include problems with storing, passing and after passing urine. Experiencing LUTS can make urinary incontinence more likely.
How to treat urinary incontinence
Some simple measures can help to improve the symptoms of urinary incontinence including losing weight, altering how much fluid is drunk each day and cutting down on caffeine and alcohol. There are also exercises that can be done to train the bladder and pelvic floor areas. This training focuses on ways to wait longer between the need to urinate and pass urine, and on the pelvic floor muscles, where they are exercised by squeezing. This bladder training and pelvic floor or kegel exercises can be taught by specialists but can then be adapted into an everyday routine. Read more about pelvic floor exercises here
Watch an example of pelvic floor exercises.
Want some tips and tricks for dealing with incontinence in everyday life? http://www.tena.co.uk/tenalady/living-with-bladder-weakness/how-to-deal-with-incontinence/
Surgical and non-surgical treatment for urinary incontinence
Surgery may be an option, depending on the type of incontinence. Treatments are used to reduce pressure on the bladder or strengthen the muscles that control urination, enlarge the bladder or use devices to stimulate the nerve that controls the detrusor muscles.
Medication can be used to control urinary incontinence and there are various non-surgical treatments available. With electrical stimulation a device that measures and stimulates the electrical signals in the muscles is inserted into the body.
How to prevent urinary incontinence
It's not always possible to prevent urinary incontinence, but there are ways of reducing the likelihood of suffering from it:
Being obese can increase the risk of developing urinary incontinence so it’s recommended to follow a healthy diet and exercise routine.
Depending on the particular bladder problem, a GP can advise about the amount of fluids that should be drunk. Cutting down on alcohol and caffeine drinks like coffee, tea and cola can help, as caffeine causes the kidneys to produce more urine and irritate the bladder.
Pelvic floor exercises
Focusing on strengthening the muscles that surround the bladder and pelvic area can help to prevent urinary incontinence.
Incontinence care from Fairfield Care
Incontinence pads, pants and diapers
We stock a range of liquid-absorbing pads and pants of various sizes and styles. https://www.fairfieldcare.co.uk/Nursing-General-Nursing-Products-&-PPE-Incontinence-Products/c22_39_76/index.html
For all nursing disposables requirements around incontinence including gloves and wipes visit https://www.fairfieldcare.co.uk/Nursing-General-Nursing-Products-&-PPE/c22_39/index.html
Protecting bedding and furniture
Fairfield Care can supply a range of bed and chair protection, such as chair pads, specialist PVC sheets and bedding, and bed pads in different sizes to help those with incontinence issues to have a more comfortable environment. These items provide an absorbent surface which contains the fluid and keeps the patient dry. https://www.fairfieldcare.co.uk/Nursing-General-Nursing-Products-&-PPE-Stay-Dry-Bed-&-Chair-Protection/c22_39_77/index.html
To clean urine spills and stains from fabrics, carpets and surfaces, Fairfield Care can supply janitorial cleaning products. https://www.fairfieldcare.co.uk/Janitorial-Carpet-Cleaning-Floor-&-Carpet-Cleaning-Chemicals/c24_132_141/index.html