According to The National Association For Continence (NAFC), over 25 million people deal with a type of incontinence, and it’s important to note that incontinence itself is not a disease, but a symptom. A symptom that, for many, brings on feelings of embarrassment, humiliation and can progressively keep them from living their daily lives as they normally would. The first few dribbles might be written off as the result of having a good laugh or strong sneeze, but as incontinence progresses, the haunting fear of an “accident” can interfere with activities from going to the grocery store, on vacation or even work. More on how to “avoid avoiding” to come.
Since you’re already here at the Treatment Diaries mecca, you know how hard it is to manage any medical condition without some type of support. Because incontinence is still riddled with stigma, reaching out to others can be difficult, even in an anonymous forum such as this. Try to remember that millions share the same challenges as you, including embarrassment, which should help diminish your own embarrassment. The education, inspiration and encouragement available from support groups help in ways that only become tangible once you reach out. The simple act of being able to talk openly about what you’re facing frees you from built up stress and can provide new insight into coping mechanisms.
Let’s start with incontinence basics: What are the different types of incontinence and why do they occur?
Stress Incontinence: Though the namesake seems to imply a state of mind, being stressed is at most a symptom of the symptom. But take a deep, relaxing breath. Following these descriptions will be a multitude of ways to help reduce incontinence and its most stressful components. The “stress” in stress incontinence refers to stress that occurs to the pelvic floor in both men and women when they sneeze, cough or lift something heavy, thus putting pressure on the bladder causing leakage. For women, for whom urinary incontinence is more common than men, this can be due to vaginal childbirth, menopause or hormonal imbalances. Male stress incontinence can be caused by a benign tumor on the prostate, prostate surgery or from treatment of prostate surgery. Some causes span the sexes and include weakening of the bladder or its surrounding muscles, weakened or damaged pelvic floor and damage to the nerves that control bladders due to stroke, Parkinson’s, multiple sclerosis (MS) and pelvic cancers.
Urge Incontinence: Other names for this type are reflex incontinence or overactive bladder (OAB); however, keep in mind that you can have OAB and not incontinence. In either case, the urge to urinate comes on strong, suddenly and frequently. It is most common in the elderly population, but can affect anyone at any age when the nerves between brain and bladder have been damaged. The damage can be due to MS, Alzheimer’s, stroke and other neurological disorders that cause the bladder to suddenly contract. The need to vacate the bladder may be uncontrollable when this happens. Other urge incontinence stimuli can be an inflamed bladder wall, inflamed prostate, prostate removal or hysterectomy.
Mixed Incontinence: Though there are other types of incontinence, mixed incontinence is usually a combination of stress and urge incontinence. Its reasons can stem from any mixture of the aforementioned causes for both stress and urge and the cause of each type may very well be unrelated.
Functional Incontinence: This is the most common type of incontinence in older adults. Due to lack of mobility or neurological function (Alzheimer’s, Parkinson’s and arthritis are the biggest culprits) the person is not able to make it to the bathroom on time or can’t undo their clothing before the urine is released.
Many people have temporary incontinence caused by recent surgery or childbirth, certain medications and urinary tract infections.
Because of the social and individual stigmas, there is an unspoken epidemic of adults who wait years before talking to their doctors about incontinence, if they ever have the conversation at all. This is dangerous, as incontinence can be a symptom and indicator of something much more serious. The NAFC website (www.nafc.org) has wonderful resources that help make talking to your primary care physician much easier, including the “UroLog,” basically an easy to use dietary and bladder diary to be filled out 2-4 days before your doctor’s appointment—or to simply monitor how your food and liquid intakes are effecting incontinent episodes. The UroLog is just one of the free brochures NAFC provides about incontinence, how your diet may affect your bladder and the basics of pelvic muscle exercises. Pelvic muscular atrophy happens as we age if we don’t keep the muscles in shape. An extra benefit of pelvic exercising is an enhanced sex life.
Speaking of pelvic muscle exercises: do your Kegels! This free, first line of defense against incontinence is as simple as flexing the muscles around the bladder, uterus and sphincter. You can do them while watching TV, while at work or anytime they cross your mind, just be sure your bladder is empty before you begin. Simply squeeze up as if trying to cease a flow of urine, hold for 5-10 seconds and gently release. Repeat ten times up to five times a day. The strengthening of these muscles should make it easier for you to contain urine. Here are some more helpful tips for enhanced daily living:
- The greatest fear of incontinent persons usually is being found out, either by odor or visible stain. There are many very effective products these days to take care of both of those issues.
- Adult diapers and briefs need not be bulky or noticeable anymore, even with heavy incontinence. Super absorbent core technology has given rise to a number of options that are discreet, comfortable and keep odors at bay. Measure your waist before purchasing, as the right fit goes a long way in both protection and comfort. Also be sure to choose products with the right amount of absorbency for your personal situation.
- Incontinence pads, liners and male guards can be used with regular underwear for light leaks or as supplemental protection in a diaper or adult brief. Flow through pads fill to capacity and then flow through to the next pad (stackable variety) then into the core of the protective diaper. You may be able to simply change the liner if the brief is still dry.
- There are a variety of cleansers on the market made especially to dissolve bodily waste and eliminate odor. If bedridden or with impaired mobility, perineal cleansers are gentle to the most fragile of skin and make maintaining personal hygiene easy for patient and caregiver alike.
- The disposal of diapers and other disposable incontinence products doesn’t require room spray anymore. The innovative Akrod Incontinence Disposal Pail is hands-free and seals off the continuous liner refill with every deposit.
- If you don’t have a high tech disposal system, not to worry. A number of room deodorizers, like this one from Medi-aire®, nicely rejuvenate the air.
- Keeping skin healthy is a big contributor to quality of life. Aside from using the proper cleansers, barrier creams moisturize and protect skin from incontinence while preventing irritations like diaper rash and chafing.
- If struggling with excess weight issues along with stress incontinence, losing weight can have asignificant positive impact on bladder control, not to mention the other health benefits of maintaining a healthy weight, nutritious diet and exercise (if able).
- Develop a restroom routine with increment goals. Try to hold off a little if you can to retrain your body how to wait. Keep a journal of how frequently you use the restroom and how often you don’t make it on time, this will help to make realistic schedules and goals. Be sure to have a protective pad or diaper in place while implementing, just in case.
- Protect furniture and bedding to reduce personal aggravation and your material investments. Underpads or bed pads come in lots of sizes and levels of absorbency and can be used discretely. For chairs and wheelchairs, pick an underpad with a pattern to hide stains while also enhancing the decor. Fitted protective bed sheets and zippered mattress covers come in all mattress sizes, including hospital beds, and will hold up through a multitude of washings. If using a bed pad between the sheets and mattress cover, remember that you’ll need to launder the sheets if a nighttime accident occurs, but your bed will be safe. Multi-layer strategies like these protect not just your bedding, but also enhance sleep quality and reduce the amount of attention needed by you or your caregiver in the morning.
- If you are a caregiver, be sensitive to your caree’s needs and feelings. Always make eye contact with and ask before putting your hands in their most personal of areas, whether changing a diaper or applying barrier cream.
Living with incontinence does not mean you can’t have a meaningful work life or take vacations!
Work/Volunteering: Incontinence affects many workers and volunteers around the world. It can detract from self-confidence and be distracting, especially if you’re spending a lot of time worrying that you’re in the bathroom too much or that someone will find out about your medical condition. First off, remember that you are not alone, you are still you–not your condition or its symptoms, and that having a medical problem does not take away from your worth as a person. Retraining yourself with the aforementioned bathroom schedule may take a little time, but it should eventually have a positive impact on your personal work environment. Use of the right products is also of utmost importance. Prevail Boxers make many men feel more comfortable, and they have a maximum absorbency core that is body close. Lady Dignity makes a “Feel Pretty” washable pink lace panty with flower accents that also features a moisture-resistant pouch in which to insert absorbent liners. If you’re still not comfortable, but you are comfortable with one of your managers or supervisors at work, you may find relief in talking to them openly; you’re likely to gain an ally who understands why you might need to use the restroom more often and who may be able to make accommodations in your work schedule.
Travel/Social Life: Whether going cross country, jetting off to another country or–very important–maintaining an active social life, plan ahead before leaving home. Isolation and incontinence have both been linked (together and on their own) to feelings of depression. Map out routes and find out where public bathrooms are along the way. Have extra briefs or pads on hand, as well as a change of clothes for peace of mind. Use the toilet before going out–double vacating is also a good idea. This is when you empty your bladder, stand up, then sit back down and vacate a second time. Often there are at least a few dribbles left, and the fewer dribbles the better, right? If taking a flight, choose an aisle seat near the facilities. Again, map out public toilets along your itinerary: shopping malls, restaurants, museums and other public attractions almost always provide an available bathroom.
Mary Otte is a staff writer for Parentgiving.com, a comprehensive website serving adults, seniors and their caregivers via thousands of products, hundreds of informative articles, timely news flashes and a wealth of practical tools that help allow persons to age well at home and maintain independence.
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