Incontinence

What is Incontinence?

Incontinence is leakage of urine, faeces or wind when you do not mean it to happen.

This common and distressing condition affects about 20% of all Australians. It affects men and women of all ages but it is most common in women and older people.

Incontinence can often be cured and even when this is not possible, there is much that can be done to improve it – no matter what your age. Many people, however, are too embarrassed to ask for help.

If you have a problem with incontinence, seek advice from your doctor as soon as possible. Treatments are very successful and, for many people, simple exercises and training programs can help considerably.

Types of Incontinence

The most common types of urinary incontinence are:

  • Urge Incontinence:
    The bladder muscle contracts with little warning and the person often feels that they have “got to go” immediately but it can be difficult to reach the toilet in time. This is often associated with frequency (a need to pass urine often), urgency (an urgent desire to pass urine) and nocturia (a need to pass urine frequently during the night)
  • Stress Incontinence: Urine leaks when the person exerts herself; for instance, when sneezing, coughing, laughing or jumping.
  • Overflow Incontinence:
    Occurs when the bladder fails to empty properly, becomes over-full, and then tends to leak. It may be caused by poor contraction in the bladder muscle, or by certain neurological or medical conditions eg diabetes or by a blockage due to pressure on the urethra.

Faecal Incontinence is the passing of faeces or wind or soiling of underwear without control. This is commonly caused by constipation but may also be associated with diarrhea.

Causes of Incontinence and Urinary Problems

As women age, their pelvic floor muscles – the ‘sling’ of muscles that support the bladder, bowel and uterus – may stretch and weaken. A number of factors may contribute to this weakening, including the long-term effect of pregnancy and childbirth, being overweight, chronic constipation, chronic cough, frequent lifting of heavy objects, and changes in hormone levels after menopause – specifically, a lack of oestrogen.

Loss of oestrogen after menopause can cause thinning of the walls of the urethra, which may stop the urethra from closing as tightly.

Some women find they go to the toilet very frequently simply to try to avoid the chance of leakage.

Prevention

Try the following to reduce your risk of incontinence:

  • Drink six to eight glasses or cups of fluid each day, mostly water.
  • Reduce your intake of caffeine and alcohol
  • Exercise regularly
  • Avoid smoking, excess body weight, and chronic constipation
  • Do pelvic floor exercises and bladder retraining (see below)
  • Treat the causes of chronic coughing or sneezing
  • Have plenty of fibre in your diet each day

Treatment

Pelvic Floor Exercises

Like other muscles in the body, the pelvic floor muscles – the ‘sling’ of muscles that support the bladder, bowel and uterus – can be strengthened by exercise.

Pelvic floor exercises should be done regularly. Ideally, all women should do them throughout adulthood to maintain strong muscles and reduce the risk of incontinence.

Pelvic floor exercises are particularly good for stress incontinence. When combined with a bladder training program, they help to increase the bladder’s capacity.

Women with strong pelvic floor muscles may also have an improved sexual response. You can do the exercises anywhere – while waiting in the car at traffic lights, in a queue at the bank or supermarket, watching television, sitting at a table, cooking dinner etc.

Pelvic Floor Muscles – You may need help

Pelvic floor exercises are not necessarily easy to do correctly. The pelvic floor muscles are complicated muscles that can be difficult to isolate. Practicing the wrong technique will not help incontinence, and can make the problem worse.

Research shows that pelvic floor exercise is effective when done correctly. If doing them yourself doesn’t help, then it’s important to see a pelvic floor physiotherapist or continence nurse advisor to ensure your technique is correct and to help you develop an individually tailored program for your needs.

Exercising the pelvic floor is not a self-help treatment for incontinence. If there is a problem with bladder or bowel control, it is important to be properly assessed as weak pelvic floor muscles are just one of the many causes of incontinence.

Contact the National Continence Helpline on 1800 33 00 66 to find a local continence physiotherapist or continence nurse advisor.

Learning to contract your pelvic floor muscles

These two exercises will help you to correctly identify your pelvic floor muscles.

  • Try to stop the flow of urine mid-stream and then restart it. Only do this to help you determine which muscles you need to exercise or occasionally to check your progress as it may interfere with emptying of the bladder.
  • Practice tightening and relaxing the ring of muscle around the back passage (anus) as if you are trying to control wind – without squeezing your buttocks.

Make pelvic floor exercise a regular habit for life. Improved control may take some time to learn and practice correctly. Results won’t happen overnight, so make sure you keep doing them.

How to do Pelvic Floor Exercises

  • Start by lying down or sitting comfortably in a chair. Tighten the muscles around the anus, vagina and urethra all at once and try to lift them up inside.
  • Try to hold this while you slowly count to five, then let go.
  • Rest while you count to five, then try again
  • If you can’t feel anything happening at all, you may need help from a pelvic floor physiotherapist to learn how to work your muscles effectively.
  • If you can hold for a little longer, do so. Gradually build up until you can hold for 10 counts and rest for 10 in between.
  • Do as many as you can up to 10, then rest for a minute or two.
  • Now do some really strong squeezes – as strong as you can, then let go. Do as many of these as you can, up to about 10.
  • Do the above routine several times a day.
  • Remember don’t bear down, hold your breath or squeeze buttocks or legs together.
  • Don’t practice stopping the flow of urine mid-stream as an exercise. This can send incorrect messages to your bladder and stop it from emptying completely.
Remember: Tighten and draw up muscles – don’t push down.

Bladder retraining

Bladder retraining improves your bladder capacity and enables it to hold more urine. It is useful for women who have frequency of passing urine or urge incontinence.

How to do bladder retraining:

  • Drink six to eight glasses of water daily (avoid caffeine and alcohol).
  • Delay going to the toilet by five minutes, then gradually, over weeks, increase this time to 15 minutes or more.
  • Avoid going to the toilet ‘just in case’ – only go when you need to.
It can be a slow process – so you need to keep working on retraining your bladder.

Hormone Replacement Therapy

In some women, incontinence becomes worse after menopause because of the lack of the hormone, oestrogen.

Sometimes the use of oestrogen therapies, either vaginally or as Hormone Replacement Threapy (HRT), will reduce the thinning of the vagina and urethra, and this may improve continence.

You should also do pelvic floor exercises and bladder retraining exercises.

If these do not improve the problem sufficiently, you may need to be referred to a specialist doctor who specialises in women’s urinary or reproductive problems.

The specialist may be a urogynaecologist, gynaecologist or urologist.

Incontinence Aids

If you have problems with continence, pads and accessories can help you to live a more normal life.
Discuss these with your doctor, pelvic floor physiotherapist or pharmacist. A wide range of aids, to suit varying degrees of incontinence, are available from your pharmacy

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