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Dealing with a weak bladder
A man holding his stomach to supress urine. Urinary incontinence is any involuntary leakage of urine. Photo/FILE
One of the first things we are taught as children is the ability to control our bathroom urges. However, occasionally, one may lose this ability in a condition known as urinary incontinence.
This ranges from an occasional dribble to continuous uncontrollable wetting.
Types of incontinence:
Stress incontinence As the name suggests, this is when one involuntarily passes urine when the bladder is put ‘under stress’. For example, when one is coughing, sneezing, laughing, exercising or lifting something heavy. It usually occurs when the muscles responsible for closing the bladder (known as sphincter muscles) weaken.
Urge incontinence
In this condition, one gets a sudden overwhelming urge to urinate. Often, one does not even have time to get to the bathroom. Most people with this type of incontinence find themselves going to the toilet many times in a day. For this reason, this condition is sometimes known as an overactive bladder.
Over-flow incontinence
In this situation, people often find themselves dribbling urine even without the urge to urinate. They often complain that they feel as though they are unable to fully empty their bladders.
Functional incontinence
This is common in the elderly. The person usually has either physical or mental limitations which cause them to occasionally wet themselves. For example, a person with severe joint problems (arthritis) may wet themselves as they try to unbutton their trousers or pull down their panties.
Causes of incontinence
Age
As we age, most of us find that we often need to empty our bladders more often. This is as a result of weakening of bladder muscles and changes associated with menopause.
Infection
When one gets an infection in the bladder, its delicate lining gets irritated causing one to constantly have the urge to urinate. Often, the urine will produce a burning sensation when being passed. In some cases, especially in children and the elderly, there is incontinence.
Childbirth
Sometimes, after childbirth, a woman may find herself having problems controlling their bladder. This is particularly common after a difficult or long labour. This can easily be corrected with pelvic floor exercises in most cases.
However, in some rare cases of very difficult labour, pressure from the baby’s head can damage the mother’s bladder and uterus. This causes urine to leak continuously through her uterus in a condition known as fistula (VVF).
This is sadly very common in the rural parts of our country especially in the northern areas where pregnancy is rampant among very young girls who have limited access to good healthcare.
Surgery
Surgery to the organs in the pelvis can occasionally result in incontinence. Common culprits are surgery to the prostate, bladder and uterus.
Nerve damage
People with spinal injury or tumours in the spinal cord or brain can have incontinence. In addition, one can become incontinent if the nerves at the bladder area are damaged either as a result of disease, surgery or an accident.
Cancer
Cancer of any of the organ in the pelvis can potentially cause incontinence if it spreads to the urinary system. This, however, usually occurs in advanced disease.
The most common are advanced cancer of the cervix, bladder and prostate. In addition, radiotherapy treatment used for cancer can lead to incontinence.
Incontinence can also be a complication of conditions such as diabetes, stroke and parkinsons disease or in severe cases of constipation especially among the elderly.
Certain drugs used in the treatment of high blood pressure, heart disease and muscular conditions have been associated with incontinence. Sex
Some women empty their bladders during orgasm. The amount passed can range from small quantities to complete emptying of the bladder.
Treatment
Treatment depends on the type, the severity and the underlying cause of the incontinence. The following options have been used with varied success.
Dietary changes
People with incontinence are encouraged to cut down on alcohol, caffeine and acidic food and drinks such as citrus products.
Bladder training
When one has an urge to urinate, they are instructed to hold it in for a few minutes before going to the bathroom. The amount of time one holds in the urine is gradually increased with time. The goal is to try and be able to comfortably empty the bladder once every 2-4 hours.
Another way of bladder training is to pass urine, wait a few minutes then urinate again. This ensures that the bladder is completely emptied. This is good for people with overflow incontinence.
Scheduled toilet visits
This involves going to the toilet using a schedule. In other words, you go to the toilet every 2-4 hours whether or not you feel like it.
Pelvic floor exercises
These are popularly known as ‘kegel exercises’. Contrary to popular belief, they are not just for women after childbirth. They can also be used to treat men. The exercises strengthen the muscles which help control urination. The easiest way to start is in the bathroom. One usually tries to successfully stop urinating while midstream. Once one has learnt the concept, these exercises can be done anywhere and any time.
Women can also use special vaginal cones which produce the same effect. These cones are best used under the care of a doctor and are available at leading pharmacies.
Urethral plugs
These are special devices for women which look like tampons that are put into the tube that carries urine out of the body (the urethra). They are not meant to be used for long durations due to risk of infection. They are rather worn for short periods of time e.g. during exercise then removed. They are best only used under the care of a doctor.
Medication There are certain drugs which act on the nerve supply to the bladder and help prevent unwanted urination. Botox injections are also being looked into as a solution for certain types of incontinence. Occasionally one may be required to use a catheter (tube inserted into bladder) which they can use to periodically empty their bladder.
Surgery is usually used as a last resort in cases which have failed to respond to less invasive methods.