Caregivers: De-Stigmatizing Urinary Incontinence

Too often caregivers feel that their loved one’s incontinence is a natural result of aging, dementia, medication or disability. They may not seek help because they assume that nothing can be done. But that might not be entirely true. Let’s learn about this too-little-talked-about condition.

First of all, we need a basic anatomy lesson. The urinary system contains a urethra, a bladder, two ureters, and two kidneys. A circular muscle called the sphincter can play a role in incontinence, but it is not an official part of the urinary system. The kidneys remove waste from the blood and turn it into the urine. The muscular ureter tubes move the urine from the kidneys to the bladder. The balloon-like bladder stores the urine until it’s released through the urethra. If any part of this system malfunctions, incontinence could occur.

More often than not, incontinence in women occurs because of problems with muscles that aid in holding or releasing urine. While urinating, bladder wall muscles contract, forcing urine from the bladder into the urethra. While this is happening, sphincter muscles surrounding the urethra relax, letting urine pass from the body. If bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax, incontinence will occur.

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Many things can cause incontinence—some temporary, some not. The temporary causes may include constipation, medication side effects, urinary tract infections, and vaginal irritation or infection. Causes that aren’t temporary could include a weak bladder, weak urethral sphincter muscles, weak pelvic floor muscles due to pregnancy and childbirth, overactive bladder muscles, nerve disorders, immobility, a blocked urethra(sometimes because of an enlarged prostate), or a hormonal imbalance(especially in menopausal women). As you might be able to deduce from that list, twice as many women experience incontinence as men.

There are several types of incontinence: stress incontinence, functional incontinence, overflow incontinence, and urge incontinence. If your loved one has a combination of two or more types, they are said to have mixed incontinence. Another type, transient incontinence, is the temporary type, triggered by the temporary causes in the previous paragraph. Let’s explore the different types in more detail.

Stress Incontinence The stress here is physical, not emotional. Stress incontinence is the most common form of incontinence in women. It is normally the result of the pelvic floor muscles stretching after childbirth, certain surgeries or weight gain. The neck of the bladder drops due to this stretching and the neck may open when any pressure in the abdomen on the bladder causes leakage. The leakage is worse during a woman’s menstrual period and during menopause. That’s because the decrease of estrogen leads to lower muscular pressure around the urethra. Pressure on the bladder while laughing, sneezing, coughing, lifting, running, or getting out of a bed or chair may cause leaking.

Functional Incontinence With this type of incontinence the person has normal bladder control but, due to a physically limiting disorder, they are unable to reach a toilet in time. For instance, someone in a wheelchair might be blocked from getting to a toilet on time or someone with Alzheimer’s may not think well enough to plan a trip to the bathroom. This is a big problem in many nursing homes.

Overflow Incontinence Here the bladder is always full, so small amounts of urine leak out. It feels as though your bladder is never completely empty or you may feel the need to empty it and you can’t. Small amounts of urine are often lost during the day and night, frequent trips to the bathroom may produce only a small amount of urine leaving the feeling that the bladder is still partly full, and a long time spent on the toilet may produce a weak, dribbling stream of urine.

The causes of overflow incontinence can be a loss of normal bladder control in a person with diabetes, obstruction of the urethra due to an enlarged prostate gland, or tumors and urinary stones that may also block the urethra. This is a serious condition that requires immediate medical attention. If left untreated, it can cause urine to flow backward from the bladder to the kidney that raises the risk of kidney infection and even permanent damage. This type of incontinence is rare in women.

Urge Incontinence Urge incontinence is an overpowering urge to urinate followed by leakage of a large amount of urine. The muscles that help control the bladder spasm which can be scary because it happens too quickly to get to a bathroom. Some medical professionals might describe such a bladder as “unstable,” “spastic,” or “overactive.” Also, this condition is sometimes called reflex incontinence.

If you have urge incontinence, you may leak urine when you drink even a small amount of liquid or even when you hear or touch running water. Usually, you go to the bathroom very often and you may even wet the bed. It’s best to drink very little after 6 pm.

Urge incontinence is often caused by nerve damage, alcohol consumption, bladder infection, or some medications. It is common in menopausal women, people with diabetes, multiple sclerosis, dementia, Parkinson’s disease, and those who have suffered strokes. Others have chronic pelvic tension in the muscles surrounding the urethra due to sexual abuse, or vaginal or urinary infections, and they don’t pick up on weak signals that their bladder is full. Some people have bladders that contract spontaneously, without warning causing loss of urine.

If you or your loved one are experiencing any of these symptoms or conditions, we urge you to see your primary care physician. Incontinence can be cured or at least alleviated.