Incontinence types and therapy
Stress incontinence is the most frequent type of incontinence, occurring primarily among women of younger age. The stress incontinence is often referred to as the „effort“ incontinence, because the uncontrolled urine leaks occur by the rule during physical exertion. The loss of urine varies from a few drops to larger amounts, but a complete loss of urine never occurs.
Reasons causing stress incontinence
This type is linked with the unexercised and weak muscles of the pelvic floor, of the sphincter muscles in the area of urethra or with hormonal changes.
There are several possible treatments against the stress incontinence. Pelvic floor muscles exercise is the first possibility of treatment we can apply ourselves, whereas for other possibilities, such as hormones supply (estrogen treatment), electrical stimulation or surgery, we have to contact our physician. Applying incontinence aids, Abena Light Ultra Mini, Abena Light Mini or Abena Light Mini Plus, provides you with the feeling of safety during therapy.
Urge incontinence or overactive bladder describe the same condition. It is a strong and urgent need to urinate. The bladder is overactive, working even if there is still no need to empty the bladder. Persons with severe urge incontinence go to the toilet 30 to 40 times a day, while it is normal to go about 7 times a day.
The affected person is unable to predict when the urge to urinate and the loss of urine will start. It often happens that the urine is released uncontrolled and suddenly, and it starts with a more or less painful urge to urinate. The amount of released urine is measured in drops, ranging to complete discharge of urine from the bladder. The urine loss occurs even without the urge to urinate.
Reasons causing urge incontinence
The urge incontinence may be caused by a bladder inflammation, an enlarged prostate, lack of estrogen, bladder stones, stroke, some neurological diseases, psychological causes, etc.
It is extremely important to find the cause of urge incontinence. There are several methods of treatment for the urge incontinence.
One of the treatment methods is called the bladder training. The purpose of the bladder training is to increase the capacity of the bladder and in that way reduce the number of toilet visits. This method is very often combined with medications that reduce bladder activity. Local hormone supply (estrogen) is also possible. Other possibilities of treatment are electrical stimulation or acupuncture.
Talk about the possibilities of your treatment with the nurse, with your doctor or contact our Counselling Centre at free phone number 0800 206 206.
During the training it is desirable to use incontinence aids as a kind of security. Depending on the type of incontinence, there are various aids which are adequate for particular individual requirements. For instance, for the urge incontinence, Abri-San Mini, Normal or Midi napkins are applicable.
Overflow incontinence is characterized by a reduced urge to urinate, for which reason urine is released only when the bladder is overflown. A typical overflow syndrome is the constant loss of urine or insufficient loss of urine, related to physical activities (movements). Urine leaks almost constantly in small amounts and in weak streams.
The discomfort and difficulties in emptying of the bladder may lead to the condition in which the bladder is never completely empty and a small amount of urine constantly remains in the bladder. Urine left in the bladder is a breeding ground for bacteria, leading to increased urinary tract infections risk.
Reasons causing overflow incontinence
The cause of overflow incontinence for women is most often long-term suppression of the urge to urinate, whereas with men it is most often caused by enlarged prostate, some disease or old age.
For women it is important to develop healthy toilet habits. It is necessary to avoid long suppression of the urge to urinate, to get acquainted with the network of public toilets in the city, so that they may move around without the fear of sudden urine leakage.
Men’s overflow incontinence is most often treated by surgery, by removal of the prostate. As it is important to completely empty the bladder, it is desirable to use a catheter, which is removed after the surgery.
Before, during and after the treatment, involuntary loss of urine may occur and that is why it is advisable to use incontinence aids, the so-called men’s napkins Abri-Man Formula 1 and Abri-Man Formula 2 or Abri San Micro, Mini, Normal and Abena Light pads for women.
Emptying of bowel contents (defecation) is a voluntary controlled activity and the loss of voluntary control is called faecal incontinence. There are several factors which play a key role in the defecation control:
- proper function of responsible nerves and muscles enabling the spreading and the fullness sensation of the rectum
- proper consistence of the stool
- possibility of timely emptying of bowel contents
Fecal incontinence is divided into three stages by severity:
– the patient is unable to control gases
– the patient cannot retain soft stool
– the patient loses control over his/her stool altogether.
Reasons causing faecal incontinence
Frequent diarrhoea, constipation, excessive bowel activity and the like may lead to long-term dysfunction in emptying of bowel contents and faecal incontinence. Already when the first signs appear it is necessary to speak frankly with the doctor, to solve the problem on time.
Faecal incontinence may be caused by injury or disease of the spinal chord, congenital abnormalities, accidental injuries of rectum and anus, procidence (complete rectal prolapse), diabetes, severe dementia, hard stool, inflammatory diseases and tumours, obstetric injuries, as well as a consequence of anorectal surgery involving splitting and spreading of the anal sphincter.
The faecal incontinence is most frequent with persons who have suffered or suffer from large bowel disease, with multipara and seniors. The muscles closing the rectum lose or weaken their function and faeces leak, ranging from a couple of stains on the underwear to complete emptying of bowel content.
When the incontinence first appears, it is important to share one’s problems with the doctor because there are efficient methods for the improvement or recovery of full control over defecation.
Making the diagnosis of the cause and severity of incontinence will affect the treatment, including dietary modification, medications, control training or surgery.
In the case of soft stools, a diet rich in fibre may be beneficial, spread over smaller and more frequent meals.
On the other hand, for persons with hard stool incontinence, a diet rich in fibre may have a laxative effect. For them, a regular defecation rhythm is advisable, along with taking plenty of liquid (pure water, magnesium mineral water).
Persons with rectal reflex disorder or reduced anal sphincters efficiency may benefit from exercises of biofeedback and perineal exercises help recognize physiological impulse and strengthening the muscles important for the stool control – so these should be considered for motivated persons before resorting to surgery. Treatment by surgery is rarely necessary and should be done in the case of severe incontinence caused by an injury of the anal sphincter with patient that don’t react to any other therapy.
The most efficient aids are Abri Form and Abri San Forte, Abri San 10 and 11 for faecal incontinence.
Small children have to learn how to control the bladder function, which is often lost in the ageing process and incontinence is developed due to dysfunctions in the central nervous system. Due to damage or disease of the brain or the spinal chord S2-S4 or neural pathways, reflex incontinence may develop.
Reasons causing reflex incontinence
The causes of this type of incontinence may be: tumours, paraplegia, metabolic diseases leading to polyneuropathy, advanced atrophy, apoplectic stroke, particular neurologic diseases.
The spinal chord diseases or injuries break the neural pathways connecting the urination centre in the brain with the bladder and the sphincter muscle. In that case, the function of the lower urinary tract is managed by the non-allocated pathologic reflex channels in the lower part of the spinal chord. The co-ordination between the bladder muscles and the sphincter muscle is lost so they don’t work together any more, but against each other.
The neuropathic bladder can be cured with an intense toilet training. In the case of spinal chord disease or injury, the treatment is either medication or surgery. The aids providing the best protection in the case of reflex incontinence are Abri San i Abri Form.
Mixed incontinence is a combination of stress and urge incontinence. Uncontrolled loss of urine is caused by physical exertion, starting with the urge to urinate.
This type of incontinence, due to its dual character, is a bit more difficult to diagnose and treat, as opposed to other types of incontinence.
Therapy is based on the problems and symptoms of the affected person and it should start with one type of incontinence.
Persons suffering of mixed incontinence often experience losses of larger amounts of urine. It is therefore possible that smaller incontinence aids won’t be sufficient and aids with a higher absorption power should be selected, such as Abri Light, Abri San, Abri Form and Abri Flex.
Functional incontinence refers to the situation when the affected person cannot remember where the toilet is or has difficulties reaching it. This results in coming to the toilet too late and releasing urine in inadequate places.
Reasons causing functional incontinence
- low vision
- reduced mobility
- lack of fine motoric abilities and having difficulties undressing
- lack of will to go to the toilet due to depression, anxiety or rage
- living space, poor lighting, low chairs making it difficult to stand up, difficult toilet accessibility.
The most effective aids in the case of functional incontinence are Abri Flex (because it resembles underwear), Abri San and Abri Form.
Nocturnal enuresis or bedwetting is involuntary urination while asleep in bed by children over five years of age (with no organic disease) and by children over three years of age during daytime.
Nocturnal enuresis is frequent among children. According to the data of our pediatricians, 20% of five-year olds suffer from nocturnal enuresis, 10% of ten-year olds and 2% of fifteen-year olds. The rate of spontaneous disappearance of nocturnal enuresis is 15% per year. About 3% of children remain enuretic in their adult age.
Parents have to be very tactful and patient in communication with their child suffering from uncontrolled urination. They should not scorn or blame the child, because the child is simply unable to overcome the problem, it is beyond the child’s control. In their dicsussions about enuresis, they should encourage the child to monitor and take notes of the number and time of urinations in children’s drawings or in symbols that the child is able to understand, give the child less liquid before sleep, encourage it and teach to monitor the signals of its own body that announce emptying of the bladder.
You may protect the bed with Abri Soft disposable bed pads. During nocturnal enuresis you may use the aid Bambo Nature 16-30kg or Abri Form XS2 and Abri Flex S1 (similar to underwear).
Nocturnal enuresis of older persons (nocturia) refers to frequent night urination (more than two toilet visits).
Waking up once or more every night for the purpose of urination increases with old age. It has been established that every other woman and two out of three men in the age between 50 and 59 have problems with nocturia. The problem increases with old age – seven out of ten women and nine out of ten men over the age of 80 suffer from nocturia.
Reasons causing nocturia
Nocturia generally depends on the quantity of liquid intake before bedtime. Nocturia increases with old age. The causes may be of different origin:
- the usual problems with heart and kidneys
- swelling of the ankles
- diuretic pills taken in the evening
- intake of large amounts of liquids, alcohol and caffein drinks (tea, coffee) in the evening before going to bed
- badly managed diabetes (type 1 or type 2)
- diabetes insipidus (a rare hormonal problem causing heavy thirst and frequent urination)
- change of position (standing during the day, lying during the night, means heavier bloodflow through kidneys, so more urine is crated during the night)
- irritated or oversensitive bladder (for instance bladder infection)
- overly active bladder (for instance after a stroke)
- interrupted sleep, for instance going to the toilet only because one is awake and/or constipation or enlarged prostate pressing the bladder neck, disabling its emptying
For safety and calmer sleep we recommend aids of smaller dimensions, Abri San Mini and Normal as well as Abri Flex M0 or L0 (similar to underwear).
Pregnancy is a stress for a woman’s body and such strain over longer periods may lead to changes and difficulties in bladder and uterus functions and also weakening of the pelvis floor. Since during pregnancy the uterus grows and presses the bladder, uncontrolled excretion of urine may easily occur. The problem gets more serious if such excretion continues after pregnancy, because it means that the pelvis floor muscles probably haven’t fully recovered and returned into their original condition. If you happen to experience problems of this kind, you may contact our Counselling Centre at free phone number 0800 206 206.
With incontinence problems during pregnancy and after it, it is not advisable to use the usual sanitary napkins because of their specific composition intended for short usage. We recommend the napkins that, due to their specific composition, won’t irritate the mucous membrane of the vagina, that are breathable and intended to absorb urine, such as our Abri Light napkins.
- What is incontinence?
- Incontinence types and therapy
- Causes of incontinence
- Who suffers from incontinence
- Assistance with incontinence
- Skin care and incontinence
- Maintaining the health of the pelvic floor muscles