Urinary Incontinence is a significant social and public health concern. Many myths surround this condition as well as its diagnosis and management. It is a common misconception that incontinence is a normal part of aging and is something that must be lived with. There are many treatment options available and are not all surgical.
Prevalence and Misconceptions
It is estimated 33 million people in the United States experience urinary incontinence. Urinary incontinence is defined as the involuntary leakage of urine. It can be distressing and disabling and affects every aspect of a person’s life. The incidence of urinary incontinence is felt to be under-reported for reasons of embarrassment or the myth that it is a normal part of aging and there is no effective treatment.
Today there are many effective treatments for the properly evaluated and diagnosed patient. Unfortunately, many who come forward with complaints of urinary incontinence are told to live with it. The Simon Foundation (www.simonfoundation.org), a non-profit organization dedicated to promoting continence and changing lives developed an anti-stigma campaign to aid in bringing incontinence out of the closet (www.labelmenot.org). Nationwide consumer research on the topic of incontinence was conducted by the National Association for Continence (www.nafc.org) and published in 2005 in Urologic Nursing. Some astonishing highlights from that article are:
- One third of men and women ages 30-70 believe that urinary incontinence is a part of aging to accept.
- Consumer research shows 1 in 4 women over the age of 18 experience episodes of leaking involuntarily.
- Two thirds of men and women ages 30-70 have never discussed bladder health with their doctor.
- Only 1 in 8 Americans who have experienced urinary incontinence have been diagnosed.
- Two thirds of individuals who experience urine loss do not use any treatment to manage their incontinence.
How the Lower Urinary Tract Works
The lower urinary tract is made up of the bladder and the urethra. The storage and evacuation of urine are the primary functions of the lower urinary tract. The bladder is a hollow muscular organ. The muscular layer of the bladder is made of smooth muscle and is called the detrusor muscle. This muscle should be elastic and stretch easily and accommodate to being filled. In a normal voluntary urination the detrusor muscle contracts to empty urine while the outlet relaxes.
Types of Urinary Incontinence
The most common types of urinary incontinence include stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI). Stress urinary incontinence (SUI) is urine leakage occurring with increased abdominal pressure, such as coughing, sneezing or lifting something heavy. In people with SUI, that increase in pressure overrides the closure mechanism. Urge urinary incontinence (UUI) is urine loss associated with an urgent need to urinate. This leakage is caused by abnormal and involuntary contractions of the bladder muscle. Mixed urinary incontinence (MUI) is when there is a combination of symptoms of both stress and urge urinary incontinence.
Fortunately today treatment options for urinary incontinence vary greatly and do not always mean surgery or medications. Dietary changes can often help with lower urinary tract symptoms. One should consume adequate fluids. Too few fluids can cause concentrated urine that is irritating to the bladder while too many fluids obviously increases urinary output. Adequate fluid intake is 1800-2400 ml/day in adults and 1500-2000 ml/day in older adults. Decreasing the intake of known bladder irritants can also decrease lower urinary tract symptoms. These include caffeine, carbonated beverages, alcohol, citrus fruits and juices, spicy foods, tomato based products and artificial sweeteners. Managing constipation can also have a significant affect on urinary incontinence. Pelvic muscle rehabilitation uses pelvic muscle exercises (also known as Kegel exercises). A specific technique for stress urinary incontinence involves teaching the patients to squeeze (or perform a pelvic floor muscle contraction) before the cough or sneeze. Urge suppression techniques involve rapid quick squeezes of the pelvic floor muscles to interrupt the urge from the brain.
Medications for overactive bladder and urge urinary incontinence are effective as they decrease involuntary bladder contractions. There are many different drugs of this type available. Primary side effects with these medications include dry mouth and constipation.
Surgical therapy is still considered the gold standard for the management of stress urinary incontinence. The aim of this surgical intervention is to reposition the urethra (or urine channel from the bladder) and/or create a backboard of support to stabilize it. In years past surgery involved a somewhat major operation, sometimes with an abdominal incision and many weeks of recuperation. In recent years minimally invasive mid-urethral slings have developed. These procedures are often done as day surgery and the recovery time is very minimal. Periurethral bulking agents (such as collagen) involved injecting a substance under cystoscopic guidance in an attempt to bulk the outlet. This therapy is typically performed in the office and can be a good option for those who are not surgical candidates. In overactive bladder another treatment option is sacral nerve stimulation. This type of neuromodulation almost functions as a “pacemaker” for the bladder. An electrode is placed at the sacral nerves and is attached to a pulse generator that is set in the subcutaneous tissue of the buttocks.
Urinary incontinence is a significant health issue. It can affect every aspect of a person’s life. It is not a normal part of aging. In the properly evaluated patient urinary incontinence can be effectively treated with a variety of therapies.
Tamara Dickinson, RN, CURN, CCCN, BCIA-PMDB
Immediate Past President of the Society of Urologic Nurses and Associate
Senior Research Nurse in Continence and Voiding Dysfunction, UT Southwestern Medical Center, Dallas