How to Cope with Incontinence?
Contrary to popular belief, incontinence is not a condition faced just by the elderly. Due to the wide range of causes that may lead to incontinence, it is a condition that can affect any one of any age group. In India, close to 20 million people suffer from incontinence. Women are more likely to suffer from incontinence than men.
‘Incontinence’ is a term used to describe the accidental or uncontainable discharge of urine or feces. The incontinence can range from small leakage that has occurred due to laughing, sneezing or other such actions to completely losing control over urinary or bowel movement. Temporary incontinence can be caused by certain foods, medications and lifestyle changes. Temporary Incontinence might also be caused by urinary tract infections (UTIs) and prolonged constipation. Persistent urinary incontinence is usually caused by medical conditions such as menopause, hysterectomy, enlarged prostate, prostate cancer, childbirth, pregnancy and with advancing age.
Certain factors may increase the risk of a person to develop incontinence. Women are more likely to develop stress incontinence, while advancing age, being overweight and having a family history of incontinence may significantly increase the chances of developing this condition.
There are several types of incontinence.
- Stress Incontinence – During stress incontinence, there is an outflow during certain physical activities such as sneezing, laughing, lifting something and sexual intercourse. Stress incontinence results from weakening of either pelvic floor muscles or the sphincters responsible for control. The muscles are weakened by a number of causes such as injury to the urethra, post childbirth and menopause. The condition worsens before the menstrual period. Women are more likely to suffer from stress in-consistence than men. Treatment for stress incontinence includes performing exercises which strengthen the pelvic floor muscles such as Kegel exercises. Biofeedback therapy may be used along with changes in lifestyle such as reducing consumption of caffeine, regulation of the amount of fluid consumption and maintaining an active lifestyle.
- Urge Incontinence – It is also referred to as an overactive bladder. There is involuntary urinary loss due to a sudden urge to urinate as the bladder contracts earlier than it should. Urge incontinence results due to factors such as infections of the urinary tract, nerve problems like multiple sclerosis, improper functioning of bladder due to conditions like diabetes, Parkinson’s disease and bladder cancer.
- Functional Incontinence – This type of incontinence occurs due to the inability of the patient to reach the toilet on time due to various underlying diseases like arthritis and Parkinson’s disease.
- Overflow Incontinence – Overflow incontinence occurs when the bladder is unable to empty completely and that leads to constant dribbling of urine
- Mixed Incontinence – Mixed Incontinence occurs when more than one type of incontinence is present
The management and treatment of incontinence depends upon certain factors like severity of the problem, type of incontinence and if any underlying cause is the reason for this condition. Various treatments and management strategies can be adopted to treat the patient and enhance the quality of life.
- Behavioral techniques – Behavioral techniques for the treatment of incontinence involve following behavioral changes which can reduce the symptoms associated to incontinence. This includes techniques such as bladder training and restraining, periodically scheduling a trip to the toilet, managing diet and fluid intake and practicing techniques which allow for the complete emptying of the bladder.
- Medications – Medications may supplement the treatment of Incontinence. Anticholinergics, alpha blockers and topical estrogen are commonly prescribed medications.
- Interventional Therapies – These therapies include implanting devices or injecting substances which can help with incontinence. This includes implantation of nerve stimulators, botox injections into the bladder muscle and injecting bulking material into the tissue surrounding the urethra.
- Surgery – Surgery may be recommended for people who have not responded well to other treatments. Bladder neck suspension, prolapse surgery and implantation of artificial urinary sphincter are often the surgeries of choice.
- Absorbent Pads and Catheters – These products greatly reduce the discomfort associated to incontinence. These include absorbent pads and garments and urinary catheters.
Absorbent Pads/Adult Diapers
Absorbent pads, also known as adult diapers are helpful for people who suffer from the problem of incontinence, bladder control and other health issues and find difficulty in controlling their urinary function. Adult diapers are also useful for those people who cannot access the toilet frequently such as being on bed rest. There are usually two types of adult diapers:
- Brief/ Panty Style Adult Diapers – These adult diapers have tabs on the sides and a cloth-like or plastic backing. Cloth backing ones makes less noise than plastic and is the preferred type.
- Pull Up Adult Diapers – These pull on like underwear and have no tabs for attachment. They are much easier to take on and off in comparison to the brief style adult diapers.
What to look out for in a good Adult Diaper
- High Retention Capacity – Prevents build-up of waste in the diaper and warrants skin safety. Thereby avoiding any irritation, skin rashes and pressure sores
- High Absorbency – Should be highly absorbent to limit the contact time with the skin preventing any rashes and sores
- Control Of Microbial Growth – Some adult diapers have agents which prevent the growth of microbes. The atmosphere of an adult diaper is a breeding ground for bacteria that can grow and multiply causing serious complications such as urinary tract infections (UTIs)
- Odour Control – Odour control is a very critical feature of adult diapers. Odour not only makes the patient uncomfortable but may also induce unnecessary embarrassment. If a diaper has microbial growth control, the odour is significantly reduced
- Discreet – An ideal adult diaper is discreet and should not be too bulky. It should fit snugly without causing any discomfort to the user
- Leak Proof – Diapers with super absorbent polymers should be bought as they prevent any spillage and leakage
- Cost – Since adult diapers have to be used frequently by the wearer, they shouldn’t be extremely expensive and be affordable for the patient
A urinary catheter is a flexible hollow tube that drains the contents of the urinary bladder into a drainage bag. Urinary catheters are used by patients with urinary continence, urinary retention, post-pelvic area surgery, obstruction and prostate related complications. They can also be used to maintain the hygiene of bed-ridden patients. There are three types of urinary catheters – foley catheter, nelaton catheter and male external catheter
Indwelling Catheters (Suprapubic Catheters)
Foley catheters are the most common form of indwelling catheters. These are placed in the bladder with an inflatable balloon. The balloon is inflated with water to prevent the catheter from moving out of place once inserted. This catheter can be used for short or long periods of time.
Foley catheters can be further classified depending on the type of tip, number of ports or the material used
- Based on Number of Ports –
- Two Way: Two way Foley catheters have two ports for drainage and inflation
- Three Way : Three way Foley catheters have an additional port for irrigation
- Based on the type of Tip –
- Coude Tip: A 45-degree bend at the tip to bypass an enlarged prostate
- Council Tip: A small hole at the tip due to which they can pass over a wire
- Based on the Material –
- Latex – Foley catheters are commonly made from latex and very cost effective
- Silicone or silicone coated: These are considerably more expensive but are extremely useful for patients with latex allergies
Male External Catheters
These catheters are commonly known as condom catheters and are placed outside the patient’s body. This type of catheter consists of a sheath coated with an adhesive, a convolution and a tip which attaches to the urinary tubing. The catheter is connected to a urine bag which is usually attached to the leg. The risk of damaging the urethra is least with male external catheter. However, latex infection and soreness can be a risk external catheters usually need to be changed daily but can be easily self-administered without the assistance of a caregiver or nurse. These catheters are commonly used for patients that don’t have urine retention problems but other functional or mental disabilities
Intermittent Catheters (or Short Term Catheters)
Nelaton catheters are the most common type of short term catheters. These types of catheters are also known as in and out catheters. Nelaton catheter consists of a catheter tip, drainage eyes and funnel end which attaches to the tubing of a drainage bag. The patient is taught by a medical professional how to use such a catheter themselves or with the aid of a care giver. This catheter is inserted into the body through the urethra or a small hole created in the lower abdomen. Nelaton catheters reduce the risks associated with indwelling catheters as they don’t stay in the bladder continuously. They also reduce the risks of urinary tract infections (UTIs), male infertility and urinary strictures. These catheters are very frequently used to help patients drain their bladders after surgery. The catheter to be used should be recommended by the physician. It is imperative to maintain good hygiene and follow the medical professional’s guidelines to make sure no complications arise due to the use of the catheter.
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Dealing with Incontinence
Not only can dealing with incontinence influence a person’s social and personal life, it can also lead to several medical complications like urinary tract infections and skin problems. Incontinence is an easily manageable condition. The stigma associated to this condition should be eradicated and people should find treatment at the right time to prevent the condition from progressing. Dealing with incontinence shouldn’t be a secret struggle; a person living with incontinence can lead a normal life by managing the condition with the help of a physician and the incontinence products available in the market.