Continence

Continence is a bigger issue than you may think. There are different types of incontinence (glossary) some are acute and reversable others are chronic and require a more long term approach to planning. The aspects of acute incontinence given below also need to be considered with chronic incontinence as dealing with any of them may reduce incontinence episodes and improve quality of life. Suddenly not being able to control urination can be a devastating experience especially if it not obvious what the reason is. This short overview may help.

Acute (transient) incontinence may become chronic if the underlying reason is not dealt with so knowing the possible causes are fundemental to dealing with the problem.

DELERIUM: if a person is delerious they are not in control of themselves and may be confused as to where they are and the normal behaviour of delaying urination till appropriate will not occur. Delerium can be caused by fever, drugs, psychiatric disturbance.

INFECTION: Any infection may cause incontinence because of fever and delerium but urinary tract infection particularly does because the bladder and urethra (glossary) become inflammed. The irritation caused by infection and inflammation leads to the bladder spasms that cause frequency, urgency and pain. The pain may be low or general abdominal pain plus a burning sensation during urination. If the upper urinary tract is involved, back pain and shooting pains from the kidney to the urethra may be severe.

ATROPHIC VAGINITIS: This condition occurs in women as they progress beyond menapause. The lower urinary tract and vagina become less plump and moist. The soft moist epithelial lining dries and becomes irritated. Sensory urgency and stress incontinence may occur and can be treated using estrogen creams to the area.

PHARMACEUTICALS: There are many medications that can make incontinece more likely. Some drugs used to treat one type of incontinence may cause a different type. 

PSYCHOLOGICAL ISSUES: may lead to incontinence.

EXCESSIVE URINE OUTPUT: this may be from the use of diuretics (that make you pee) or because of excess fluid intake. Glucose in the urine from new onset diabetes or poor control leads to large quantites of urine being produced. Head/brain injury can cause excess anti-diuretic hormone relaease.

REDUCED MOBILITY: This is an important caause of incontinence particularly as the combination is associated with an increase in falls and injury.

CONSTIPATION: When constipated occurs there is increased abdominal pressure and less space. The bladder holds less and more readily contracts.

All of the above should be considered in relationship to all types of incontinence listed below.

Stress incontinence occurs when a person laughs,sneezes, coughs or strains. The leakage is usually small (a tablespoon). It may occur as a one off or happen very often (requiring a protective pad).

Urge incontinence is well defined as "got to go, got to go, got to go right now", though not all people with urgency will suffer incontinence. The amount of urine loss if incontinence results can be considerable, a cup or more.

It is possible to have both stress and urge incontinence combined.

Overflow incontinence is related to retention of urine in the bladder usually because of obstruction (often an enlarged prostate).

Reflex incontinence occurs with an absence of desire to urinate and is associated with neurological conditions such as spinal cord injuries, multiple sclerosis and stroke. Although there may not be a sensation to pass urine some people will sense "something" others will have no sensation or control at all.

Functional incontinence occurs when a person is unable to act on the need or desire to pass urine. They may be sufferring Alzheimers, severe depression, immobile, extreemly ill.

*****************************************************

Link to Kegal exercises

Bladder diary.

What is bladder retraining

Product guide.

Care of an indwelling catheter leaflet