HELPING WOMEN MANAGE URINARY INCONTINENCY

For some women, maintaining bladder control is a daily struggle. Embarrassment, denial and misinformation keep many from seeking the help they need. Urinary incontinence (U.I.) is so common that half of all the women in the U.S. will experience it at some point of their lifetime. U.I. is treatable with behavioral modifications, medications and surgical interventions.

Urination is a complex process, involving a coordinated effort by the urinary structure, the brain and spinal cord. Women are more likely to have bladder control problems than men because of their anatomy. In the woman, the bladder, bladder neck and urethra are partially supported by the vagina and the striated muscles of the pelvic floor. Muscle tone weakens within childbirth, age, and significant weight gain. As estrogen levels decrease, the urethra loses its ability to compress.

U.I. can be transient (short-lived) or chronic. Transient incontinence is generally related to an acute illness or an infection, it will disappear when the trigger resolves. Chronic incontinence is on going. There are 5 primary types of incontinence. The type often seen in the TBI and the geriatric population are functional incontinence and overflow incontinence. If cognition (mental status), mobility or dexterity is impaired, the female patient may be unable to get to -the bathroom on time. This is an example of functional incontinence. Overflow incontinence occurs when there is leakage of urine between trips to the bathroom if the bladder is not completely empty. This may be the result of neurologic changes, such as those caused by diabetes, or when the urethra is narrowed or blocked.

When evaluating a patient for urinary incontinence, a subjective description and her symptoms are a valuable part of the evaluation. She should observe for incidence, complete a voiding diary and make a list of the medications or medical conditions that could directly affect U.I., especially after childbirth, surgeries or radiation therapy.

Functional disabilities or environmental factors can contribute to incontinence problems for women of any age, but particularly for the elderly. Access and the ability to get to the bathroom, undress and sit before voiding should also be addressed in the assessment.

Once the cause and type of incontinence are known, it will be important to determine the patient's goals for managing symptoms of incontinence. For the elderly or physically challenged woman, getting to the bathroom without fear of falling may be sufficient.

Suggested Behavioral Modifications Implemented to Treat U.I.

1. Identify and eliminate foods or liquids that can cause irritation to the bladder; i.e. coffee, tea, soda, alcohol, artificial sweeteners.
2. Drink adequate fluids, preferably water throughout the day. A person Who has a problem with nocturnal urination (frequent urination at night) can restrict fluids after dinner.
3. Add high fiber foods to the diet to avoid constipation (may cause partial destruction of the urethra).
4. Avoid wiping to vigorously after urinating.
5. Take time to urinate; most females have busy schedules and may not take time to urinate until they cannot ignore the urge any longer. To prevent chronically over distending the bladder, women should urinate every 3 -4 hours during the day and just before bedtime.
6. A woman with impaired mobility could try changing the room arrangement to make it easier to go to the bathroom; add better lighting to make it easier to get to the bathroom; and grab bars to make the bathroom safer, or consider a bedside commode or urinal. Clothing should be easy to remove as well.

Source: Advances in Skin and Wound Care Volume 13 No 6 Nov. I Dec 2000

Reviewer: Marilyn Ramos, MSPT