INCONTINENCE ‘Don’t make me laugh or I’ll pee my pants’

Incontinence can occur at any stage those that smoke can also have of life from childhood to older an intermittent problem with men and women, however it is continence. Importantly people estimated that more than 70% living with autoimmune illness of people who experience particularly those with muscle, incontinence are women. It can be nerve and connective tissue an intermittent problem but can involvement (e.g. scleroderma, also be a long term concern as lupus, myositis, Sjögren’s, part of changing health and fitness rheumatoid arthritis and multiple patterns. Childbirth and pregnancy, sclerosis) may also have a higher uterine atrophy and prolapse, as prevalence of urinary and faecal well as menopause and post incontinence. In short, incontinence hysterectomy can be common can happen to anyone and may causes in women. Whilst in men need some strategic management the effects of an enlarged prostate, to find a long term solution. prostate cancer and the presence It is important to remember that of hernias can result in an increased urinary incontinence isn’t a disease, pressure on the bladder resulting in it’s a symptom. It can be caused incontinence issues. by everyday habits, underlying medical conditions or physical Incontinence can be increased problems. Incontinence can have a in both genders that have large impact on your quality of life, repeated urinary tract infections, your social interactions and your have obstructions general wellbeing. Some people (bladder or kidney stones, urethral living with incontinence have strictures, tumours). reported to feel embarrassment, Incontinence can also be a shame, increased anxiety and concern for people who depression, low self-esteem and have diabetic neuropathy, confidence, feelings of isolation are overweight, or experience and a loss of desire for intimacy. chronic constipation. In addition, Trying to deal with incontinence people that have a history of heavy can simply wear you down, but lifting or experience persistent incontinence is not dangerous, coughing, such as in asthma, contagious nor something that bronchitis, bronchiectasis or you need to experience for ever. COMMON TYPES Overflow incontinence is due to a worse due to relaxing of the OF INCONTINENCE blockage of the urine outlet, which bladder muscles. Some types of upsets the normal control of antidepressants can also make Stress Incontinence can be an passing urine. Urine pools in the incontinence worse; however others unexpected leaking of urine which bladder behind the blockage, but may help and offer relief of can be brought on by laughing small amounts of urine bypass the symptoms. Diuretics or “water pills” coughing sneezing jogging or blockage and trickle down the are designed to help stabilise lifting heavy objects. Stress urethra. The most common biochemical processes but create incontinence is mainly caused by example is incontinence caused more urine, which can add to the weakening of the muscles and by an enlarged prostate gland problem. Medications given to men tissue around the bladder in men which partly blocks the to reduce the size of an enlarged bladder outlet. prostate can also be helpful in Urgency Incontinence/ Overactive reducing incontinence episodes. Bladder. Overactive bladder is DIAGNOSING INCONTINENCE primarily a problem of the nerves Helpful incontinence treatment can and muscles of the bladder that Depending on the cause, include medication to allow for early contraction during incontinence can be managed and relax the bladder such as the normal relaxation phase of sometimes reversed. Firstly your anticholinergic medications which bladder filling. The bladder’s doctor needs to diagnose what can block the nerves in the bladder. contraction in response to filling type you have so they can provide These are available in both a pill or with urine is one the steps in the the correct advice and treatment. patch form. Botox injections and normal process of urination. The It would be helpful to your GP if pessaries, electrical stimulation, contraction and relaxation of the you kept a diary showing your fluid pelvic floor exercise as well as detrusor muscle is regulated by the intake and how you pee each time surgical support of the bladder can nervous system. Approximately and frequently you have leakage. be helpful in minimising leakage 300 ml of urine in the bladder The GP may perform a number of and more severe incontinence can signal the nerves to trigger physical examinations and may symptoms. muscles of the bladder to require a urine sample, also a coordinate urination. Voluntary medical history. A number of tests A technique/therapy called control of the sphincter muscles at such as ultrasound, cystometry “Biofeedback” which gives you real the opening of the bladder can (which measures bladder pres- time information about your hold the urine in the bladder for sure) may be required. The GP bladder and pelvic muscle longer. Up to 600 ml of urine can may perform a number of physical activity and responses can help to be contained in a normal adult examinations and will probably ease symptoms. By learning about bladder. For those with over active require a urine sample. A number of bladder and pelvic muscle functions bladder, the bladder capacity is tests may be requested such as an you may be able to retrain your typically low (< 200ml). Urinary ultrasound CT, cystometry (which responses and acquire voluntary frequency (having to urinate often), measures bladder pressure). Pelvic control with strategic retraining. nocturia (urinating frequently floor muscle assessment may also Biofeedback therapy is usually at night). be needed, which can be done by a undertaken with expert instruction physiotherapist. from a physiotherapist who has Mixed incontinence is a specialist training in this area. combination of stress and urgency Medications and treatments that incontinence, it is a common form you need to maintain wellness can DID YOU KNOW? of incontinence. The amount of have an impact on incontinence A normal bladder: leakage is usually larger. with some medications such as some high blood pressure empties 4-8 times each day medicines making incontinence (every 3-4 hours)

can hold up to 400-600ml of urine (the sensation of needing to empty occurs at 200-300 ml)

may wake you up once at night to pass urine and twice if you are older (i.e. over 65 years of age)

tells you when it is full but gives you enough time to find a toilet

empties completely each time you pass urine, and

does not leak urine. MANAGEMENT TIPS • Sometimes there may be Useful information and tips can also triggers which send you be found at the • Urine should look like a glass of running to the toilet for e.g. Incontinence Foundation Australia chardonnay not a glass of beer arriving home and putting that key in the door, arising from www.continence.org.au • If your urine looks like water a relaxed state on the couch, Prostate cancer foundation you are drinking too much exercising, bending down, of Australia 1800 220099 • Taking regular sips of water running water, and laughing. throughout the day is better If you do notice triggers try Techniques can also help improve than drinking large amounts to retrain your response or bladder control in one go make strategic decisions to mitigate your urge. Bladder retraining • Refrain from drinking before During bladder retraining, you go to going to be For example, if placing a key the bathroom at scheduled times. in the door prompts an urgent For instance, you might decide that • Cut down on any foods or situation, then simply go to you will go every hour. You would drinks that make your the toilet prior to leaving. make yourself go every hour, even symptoms worse. Some people I am sure we can all remember if you didn’t feel like you needed to. find that spicy and acidic foods, being asked if we needed to You would try to wait until a whole excessive sweeteners including go to the toilet before going hour had passed if you needed to artificial sweeteners, raw on a care trip when we go sooner. Then, once you got used onions, rich creamy dairy were children. Just adopt this to going every hour, you would products and aged cheeses strategy as an adult. increase the amount of time you can all irritate the bladder in waited in between bathroom visits. some people. It is not the same • Another helpful tip is to know Over time, you might be able to for everyone therefore keeping where the closest toilet is in “retrain” your bladder to wait 3 or 4 a diary can be helpful to large halls, shopping centres hours between bathroom visits. identify your triggers. or event venues. Simply by planning you can alleviate Universally reported irritants Pelvic exercises for men & woman are listed as caffeine, some of the stress associated When sitting on the toilet to empty carbonated drinks and with incontinence. your bladder, try to stop the stream alcoholic beverages of all A MacDonald’s restaurant can of urine, and then start it again. Do types, so you may have to be a handy toilet stop as well this to learn which muscles are the consider reducing your intake as local city halls, tourist right ones to use – but only once a of these drinks. Low caffeine centres or service stations. week. Your bladder may not empty drinks and herbal tea, citrus The National Continence the way it should if you stop and fruits and juice are Program has put together start your stream more often than preferable, in particular, a useful tool to help plan trips that. the regular consumption of and locate over 16,000 publicly available toilets cranberry juice has often been Squeeze the ring of muscle around reported to help avoid infection across Australia, the back passage as if you are and cystitis symptoms, including accessibility, trying to stop passing wind. Now however can worsen an opening hours and facilities, relax this muscle. Squeeze and overactive bladder. such as showers & baby let go a couple of times until you change. You can enter the are sure you have found the right • If you are overweight, try to start and end for your journey lose weight as the extra weight muscles. Try not to squeeze your to get a list of toilets along buttocks. places pressure on the bladder the way. • If you have diabetes, keep your You can do this exercise anywhere blood sugar as close to normal National public toilet map e.g. while driving as possible https://toiletmap.gov.au Pelvic muscle exercises can really • If you take medicines called iTunes also has an app for help by strengthening the muscles diuretics, plan ahead as these smart phones available that that control the flow of urine. Sit or medicines increase the need to can list public toilets as well lie down with the muscles of your urinate. thighs, buttocks and stomach • Find out about incontinence https://itunes.apple.com/au/ relaxed. These exercises can help, but people often do them wrong. aids, a lot of improvement in app/national-public-toilet-map/ aids has happened, no more big Ask your doctor or nurse or id323279108?mt=8 bulky pads. physiotherapist to help instruct you how to do them correctly. • Carry an emergency pair of Planning ahead can help breaking underwear and clothes bad habits and also ease stress of little mishaps in social outings. FAECAL/BOWEL gastroenteritis, can lead to loss It is important to tell your health INCONTINENCE of liquid stool. In many cases, if professional about incontinence the diarrhoea is treated, the issues as solutions and Approximately one in twenty person will be able to control improvements can often be found. people have poor bowel control their incontinence. First seek medical advice with your and feel shame, embarrassment GP or specialist to assess what • Chronic constipation causing and depression. It is often difficult might be causing either your long term straining can damage to talk about, and because of this urinary or faecal incontinence. anal sphincters and muscles people delay or fail to ever seek Extra specialised help can also increasing faecal incontinence help. Faecal/Bowel incontinence be obtained by contacting symptoms. is more common in older people but can affect young people and • Medications such as antibiotics the Continence Nurse advisors on is often associated with urinary and pain killers can also have an the National Continence Helpline incontinence. Continence requires influence on bowel habits and 1800 33 00 66 . the normal function of the lower incontinence. digestive tract, the nervous system, These nurses are able to listen to anal sphincters along with the pelvic • Unknown causes — in some your concerns, give you information muscles that surround the end of cases, the cause of faecal and help devise a personalised the digestive tract. All of these incontinence cannot be management plan to help you deal systems work together to efficiently identified; this is called with your incontinence symptoms. move food and digestive contents idiopathic incontinence. The helpline staff can also advise through the body from the mouth Idiopathic incontinence most on support program to help to the anus. The anal sphincters commonly occurs in with financial assistance for and pelvic muscles have the middle-aged and older women. incontinence aids. vital role of creating a barrier to prevent incontinence. GETTING HELP Having a management plan and There are many possible causes of adopting some lifestyle changes faecal incontinence; The first thing to do is to see your can greatly reduce your symptoms, GP and begin investigation into any anxiety and reduce the number • Damage to the anal possible reasons for the underlying of incidents. Better management sphincters damage or pelvic cause of the incontinence. can allow you to re-engage with a muscle weakness which can be The GP can give you a full full and active life and improve your caused by childbirth, surgery, assessment including diet and fluid overall quality of life. radiation therapy or aging. intake, potential mobility change I strongly recommend a book • Autoimmune illnesses influences, and medications. called Women’s Waterworks particularly those with muscle, Physical examination will likely (Curing Incontinence) By Dr Pauline nerve and connective tissue include a rectal examination to Chiarelli, to order the book go to involvement such as myositis, assess sphincter tone. In females, www.womenswaterworks.com lupus and scleroderma. a pelvic examination will also be performed. Diagnostic tests or contact ARRC if you cannot • Neurological diseases such as such as ultrasounds, MRIs, obtain a copy and will try an assist MS, Parkinson’s, spinal cord inju- colonoscopies, nerve and in obtaining one. We do have one ry Inflammatory bowel disease, muscle conduction studies may copy available in the office ulcerative colitis and Crohn’s be considered. disease. Life can be a whole lot Once the cause of the incontinence • Impaction - When hardened better when you ask for help is diagnosed then the faeces accumulates in the appropriate treatment can be rectum, this can cause the anal Judy Knapp Clinical Trial Nurse instigated. This may involve sphincters to relax and allow Information obtained from being referred to other health liquid stool to escape around Incontinence Foundation Australia professionals such as specialists, the blockage. Faecal impaction www.continence.org.au physiotherapists, or a specialised is a common cause of Up to Date www.up to date.com incontinence nurse. It may involve incontinence in older adults. Mayo clinic www.mayoclinic.org dietary, lifestyle and/or medication Factors that make impaction changes including an exercise more likely include certain regime to improve the pelvic mental health conditions, muscles, techniques such as immobility, and loss of biofeedback therapy or surgery rectal sensation. may be recommended. Seeking • Diarrhoea of various causes, help can immensely improve your including irritable bowel quality of life through modifying syndrome, active inflammatory your daily habits and adopting bowel disease, or acute better management strategies.