Urinary Incontinence

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1. What is Urinary Incontinence (UI)?

UI causes involuntary leakage of urine.  This can lead to wetting of clothing, bedding  and furniture.  UI can cause skin irritation and discomfort. It can be a major source of embarrassment and restrict a person’s activities out of fear of “having and accident”.

2.  How Common is UI?

UI affects 15%-30% of elderly adults and 60%-70% of people living in nursing homes. Women are more commonly affected than men

3. What Causes UI?

UI can be caused by many factors and is often classified by the associated symptoms :

  • Urge Incontinence- is characterized by  a sense of urgency to void and difficulty holding the urine prior to reaching a toilet. People with Urge Incontinence often have a smaller bladder capacity and get bladder contractions when their bladder is only partly filled.  Chronic neurological conditions  and acute illness may also cause urge incontinence
  • Stress Incontinence- refers to leakage of urine with a change in position or anything that may increase pelvic pressure, such coughing or sneezing. It is usually caused by a change in  anatomy from childbirth or pelvic surgery
  • Overflow Incontinence- is when people are unable to completely empty their bladder.  This results in overfilling and stretching the bladder resulting in dribbling. Obstruction caused by an enlarged prostate or damage to the nerves in the bladder may lead to this condition
  • Functional Incontinence – refers to people who leak because they are unable to get to the toilet on time. This may be caused by physical disability leading to slow mobility or cognitive problems

4. What Can I do for UI?

  • Kegel Exercises can strengthen your Pelvic Floor and improve incontinence. 
    • Locate your pelvic muscles by stopping the flow of urine midstream.
    • Empty your bladder, lie down, squeeze and hold these muscles for a count of three, then relax them for a count of three.
    • Repeat  this 10 times.
    • Try to do at least three sets of 10 each day
    • Fluid Management-  most people will require 1.5-2 litres of fluids per day. Some people avoid drinking for fear of incontinence and waking up at night. You can try splitting up your fluids into smaller volumes and drinking most of it before 6:00 in the evening
  •  Caffeine and alcohol -  Caffeine is present in green tea, chocolate and some medications like acetaminophen with codeine, in addition to coffee. You may wish to restrict your caffeine intake to see if this helps
  • Medications- some drugs like diuretics may increase your incontinence. Speak with your doctor if you are concerned about this
  • Incontinence pads and products may prevent leakage into your clothing.  There are many products available. Speak to your nurse or pharmacist for specific advice
  • Proper skin care to prevent chafing and rashes

5. What Can my Doctor do for  UI?

Depending on the type of incontinence, your doctor may recommend medications or even surgical procedures

  • Urge Incontinence- Your doctor may prescribe anticholinergic drugs which slow down bladder emptying. These drugs rarely stop incontinence but can reduce the frequency and night time trips to the bathroom.  They usually have a small effect and may cause side effects such as dry mouth and constipation.  Botox has helped some people with Urge Incontinence.
  • Overflow Incontinence – it is important to relieve obstruction if it is significant.  Prolonged obstruction can damage the kidneys. Obstruction of the prostate can be treated with medications that relax the urethra (e.g. tamsulosin)  or shrink the prostate gland (e.g. finasteride). Some people require surgery to relieve the obstruction. A tube called a urinary catheter may be  permanently inserted into the bladder for people  with obstruction or a bladder that can’t empty
  • Stress Incontinence-  Your doctor may refer you for a  surgical procedure performed by a urologist
  • Functional Incontinence – may be improved by optimizing fitness, treatment of diseases and  geriatric care. Your doctor may refer you for a comprehensive geriatric assessment.  Various toileting regimes may help people with dementia who may need reminders to go to the bathroom

6. Where can I find out more information about UI?

The Canadian Continence Foundation

The Continence Foundation (UK)

The Simon Foundation for Continence

National institute on Aging

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

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