For information on a particular condition or topic try our health Topic Finder with links to this and other Jean Hailes websites or use the website search function.
Everyday lifestyle changes are a more realistic and effective way than dieting to manage weight and prevent long-term weight gain.
Health Professionals Medical Observer Urinary incontinence: managing a serious issue - 17 June 2011
Urinary incontinence: managing a serious issue - 17 June 2011
| 
|
Patients can be taught ways to deal with and manage this common problem.
Introduction
One in 20 Australians experiences regular urinary incontinence; however, of these, only 31% report having sought help from a health professional.1
Women are more likely to be affected than men, with 50% of women aged 45–59 having experienced incontinence in the past three months.
Within the general population, 19% of children and 10% of men report urinary incontinence.2 Once patients reach the age of 75, 40% will be incontinent of urine.
The simple question, ‘How are your waterworks?’, may remove the barrier patients perceive in seeking ongoing assistance. Urinary incontinence affects a person’s quality of life and can affect his or her mental health.
Types
- Urge incontinence: associated with or directly preceded by urgency
- Stress incontinence: leakage with exertion, coughing or sneezing
- Mixed incontinence: both urge and stress symptoms
- Overflow incontinence: associated with over-distension of the bladder or poor emptying.
Causes
- UTI
- Childbirth, menopause, prolapse
- Benign prostatic hypertrophy, benign stricture
- Local trauma or surgery
- Neurological disease: CVA, Parkinson’s disease, MS
- Diabetes
- Medication, e.g. prazosin, diuretics
- Chronic straining, e.g. lifting heavy weights, constipation
- Neuropathy
- Bladder tumours
- Functional causes, e.g. impaired mobility or cognition.
Management
Excluding a UTI is essential, as is inquiry about fluid intake. Encourage 6–8 glasses of fluid a day and reduction of caffeinated, carbonated and alcoholic drinks to no more than 2–3. Often patients will have reduced their fluid intake in the hope of reducing leakage episodes, almost always without success.
Evidence suggests that weight loss will significantly reduce incontinence.3
Patients who strain regularly are at risk of weakening their pelvic floor, so effective management of constipation is important, as is advice to avoid repetitive heavy lifting, such as heavy weights at gym.
A chronic cough may also weaken the pelvic floor, so this needs investigation and intervention where possible.
Referral to a continence clinic where a multidisciplinary team approach is taken is extremely useful. Here, a continence nurse will assess and manage the patient and refer on to physician, physiotherapist, occupational therapist and others.
There is Level 1A evidence to support physiotherapy teaching of pelvic floor training in the management of stress incontinence.4 Physiotherapists may take a detailed history, discuss the causes of incontinence, assess bladder function with a bladder diary and possibly measurement of post-void residuals. They will aim to assess pelvic floor function and prescribe an appropriate home program with reviews as necessary.
Other management techniques used may be the teaching of correct voiding or evacuation dynamics and bladder retraining to gradually increase bladder capacity and reduce urgency.
Simple advice for your patients
- Commencement of pelvic floor muscle training as per the Continence Foundation of Australia (CFA) fact sheet, ‘Pelvic Floor Muscle Exercises for Women/Men’, available free of charge.
- For stress incontinence, encouraging the knack manoeuvre or pre-bracing of these muscles before coughing and sneezing can be helpful. Muscle strengthening takes a minimum of three months, so patients should be educated that results will take time. If they are not making progress, referral on is essential.
- For urge incontinence (if UTI and retention have been excluded), a bladder diary can be useful to demonstrate volumes consumed and volumes voided at each void over a three-day period. In addition, urgency deferral techniques such as sustained pelvic floor contractions, perineal pressure and distraction can be employed to gradually increase voiding intervals and volumes stored.
CFA pamphlets are available outlining all of these techniques.
Tips for preventing incontinence |
|
1. Ask all patients about bladder control. 2. Encourage good bladder habits, especially fluid intake. 3. Manage constipation. 4. Encourage a healthy weight. 5. Be aware of at-risk patients, i.e. women who have had a baby but particularly during pregnancy and the post-partum period, perimenopausal women, women after gynaecological surgery, men after prostate surgery, patients with neurological disease, patients with diabetes. 6. Discourage repetitive heavy lifting. |
Refer to continence clinic, pelvic floor physiotherapist, urologist or urogynaecologist as appropriate.
Case Study |
|
She also stated that sometimes she just didn’t make it in time. To help, she had reduced her intake of fluids and started straining at the end of voiding to try to completely empty her bladder. She was trying pelvic floor exercises but with little effect on leakage. She commenced a pelvic floor training program specific to her muscle function. Biofeedback was used to assist in isolation of correct muscle action, particularly with coughing and bending. She saw that returning to a normal fluid intake did not worsen her symptoms and she learned correct voiding techniques to avoid straining. After four months, she was dry with all activities. |
Maureen, aged 62, presented to my practice following referral from her GP. She complained of incontinence of urine with coughing, sneezing and laughing. This had been a problem for over 10 years, but had worsened since a recent URTI.Resources
The Continence Foundation of Australia has many useful resources, from patient information pamphlets to a helpline as well as Continence Resource Centres which offer education and resources in most states.
National Continence Helpline 1800 33 00 66
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
http://www.toiletmap.gov.au/ (National Public Toilet Map)
http://www.physiotherapy.asn.au/ (For local Continence Physiotherapist)
Talking Women Urinary incontinence 160.99 Kb
References
1. Byles, J. et al.(2003).”Help seeking for urinary incontinence: A survey of those attending GP waiting rooms.” Australian and New Zealand Continence Journal. 9(1):8-13.
2. Hunskaar S. et al. (2004). “Prevalence of Urinary Incontinence.” BJU International. 93:324-330.
3. Subak,L. Et al. (2009). “Weight loss to treat urinary incontinence in overweight and obese women.” N Engl J Med.360:481-490.
4. Neumann, P.B.et al. (2005). “Physiotherapy for female stress urinary incontinence: a multicentre observational study”. Australian and New Zealand Journal of Obstetrics and Gynaecology. 45(3): 226-232.
Content updated June 17, 2011
 |
Our websites
Search this website
Email updates
GP & HP Webcast
Community webcasts
Follow us
 |
 |
 |
 |
 |
