Incontinence
Have you stopped taking an aerobics class because you're afraid you might have an accident. Do you worry when it's time to take a long car trip on highways with few roadside rest areas. Do you dread sneezing, coughing, even laughing, because you're not sure if you'll stay dry.
Rest assured, you're not alone. Help for incontinent people (HIP), a not for profit organization in Union, South Carolina, estimates that at least 12 million, and perhaps as many as 20 million, people in the United States and Canada suffer with urinary incontinence, often times in silence. Indeed, it's a problem that's only been recognized relatively recently in America as a treatable condition and not merely an unavoidable symptom of old age. As a matter of fact, other cultures in times past seemed to have been much more aware of the problem. The ancient egyptians developed products for incontinence, and in Great Britain around the turn of the century, it was perfectly acceptable for a woman to hold what was called a slipper under her dress to relieve herself during a long church service.
The loss of bladder control is not a disease but a symptom with any of a host of causes. It can affect anyone at any age from children to the elderly, both women and men. Women, however are three times more likely than men to be incontinent, due in part to the physical stresses of childbearing and a decrease in estrogen after menopause. The cause of incontinence may be as minor as an infection triggered by a cold or the use of certain prescription or over the counter medications. Incontinence may also be the result of sagging pelvic floor muscles. This set of muscles located at the bottom of the pelvis supports the lower internal organs and helps them maintain their shape and proper function. Childbirth and certain types of surgery, such as a hysterectomy in a woman (removal of the uterus) or a prostatectomy in a man (removal of the prostate gland), can cause these pelvic floor muscles to become deficient.
Exercises for Incontinence for help in toning up and strengthening the pelvic floor muscles.) Incontinence reveals itself in a number of ways, and one person can suffer from more than one form of it. Stress incontinence occurs from rigorous or spontaneous activity, like playing tennis or sneezing. Urge incontinence is marked by a sudden need to go but possibly not making it to the bathroom in time. Over flow incontinence is a full bladder that begins to dribble. And reflex incontinence is marked by an unawareness of the need to urinate (caused by an enlarged prostate gland, for example), which results in leakage. Here are ways to cope.
Keep a Diary : This is very helpful in establishing symptom patterns, says Katherine Jeter, Ed .D, E. T., executive director of HIP. By maintaining a voiding diary, or uro-log, you'll have a record of when you urinated and the circumstances causing it. The diary should include: the time of day of urination or leakage, the type and amount of fluid intake that preceded it, the amount voided in ounces (pharmacies carry measuring devices that fit right inside the toilet bowl), the amount of leakage (small, medium, or large), the activity engaged in when leakage occurred, and whether or not an urge to urinate was present. Keeping such a diary for at least four days, if not a full week, before you see a doctor can help him or her to determine what type of incontinence you have and the course of treatment. When you see a doctor, take along a list or the actual bottles of any prescription or over the counter medicines you have been taking, because some medications can cause incontinence.
Watch what You Drink : Experts are not entirely sure why some beverages seem to irritate the bladder lining and, as a result, cause bladder leakage. But you may want to eliminate certain substances from your diet or at least decrease your intake of them to see if your urine control improves. The caffeine in coffee, for instance, may irritate the bladder, and the ingredients that give coffee its distinct aroma (also found in decaffeinated varieties) can be irritating, too. Tea, another favorite breakfast drink, is not only a diuretic, which means it pulls more water from the kidneys as it passes through, but also a bladder irritant. (HIP recommends substituting hot grain beverages, found in your grocer's coffee and tea aisle.) Citrus fruits and juices, such as grapefruit and tomato, can be a problem. Carbonated sodas may be irritating, too, according to HIP (you might be able to tolerate seltzer water, which is not as highly carbonated as sodas). And, finally, alcoholic beverages should be avoided. Your safest bet: water, perhaps with a twist of lemon for flavor (a few drops of lemon should not be enough citrus to cause or aggravate an incontinence problem).
Try These Juices : Grape juice, cranberry juice, cherry juice, and apple juice are not irritating to the bladder and may, in fact, control the odor of your urine. And surprisingly, orange juice is not an irritant, because it is metabolized by the body in to a more alkaline, or less acidic, fluid before it reaches the bladder, says Jeter.
Keep drinking : Too often, people who suffer with incontinence limit their fluid intake, believing that the less they take in, the less they'll urinate. But dehydration can occur, warns Thelma Wells, Ph.D., R. N., F.A.A.N., F.R.C.N., a professor of nursing at the University of Rochester School of Nursing in Rochester, New York. Dehydration can lead to constipation, which in turn can irritate nearby nerves that will trigger the bladder to void. The result incontinence. Instead of cutting back on how much you drink, schedule the time that you drink. Having liquids at set intervals during the day will keep your bladder from becoming too empty or too full. The bladder becomes irritated if it, fluid level is too low or too high, explain wells. A normal bladder holds about two cups of fluid, problem bladders may hold as little as half a cup or as much as a quart and a half. If you find yourself constantly waking up in the middle of the night to go to the bathroom, you might try to taper off your fluid intake between dinner and bedtime, says Wells. Experts suggest an average total fluid intake of six to ten 8-ounce cups a day.
Watch what you eat : Again, experts are not sure why certain foods aggravate the bladder, but you may want to try cutting back on the following foods to see if it helps, hot spices and the foods they're used in, such as curry powder and chili, tomato based foods, sugars, such as honey and corn syrup, and chocolate.
Try a recipe for success : If you are constipated, adding fiber to your diet may relieve your constipation, and in trun, your incontinence here's an easy to make snack recipe from HIP that may help. Combine one cup of applesauce, one cup of oat bran, and a quarter cup of prune juice. Store the mixture in your refrigerator or freeze premeasured servings in sectioned ice-cube trays. Begin with two tablespoons every evening, followed by a six to eight ounce glass of water or juice (one of the acceptable varieties mentioned previously). After seven to ten days, increase this to three tablespoons. Then, at the end of the second or third week, increase your intake to four tablespoons. You should begin to see an improvement in your bowel habits in about two weeks. The extra fiber may cause increased gas or bloating, but this should decrease after a few weeks. Be sure to keep up your daily fluid intake in addition to using this fiber recipe.
Lose Weight : Obesity can cause muscle to sag, including the pelvic floor muscles, which aid in proper voiding.
Do not smoke : Here's another reason to give up the habit. Nicotine can irritate the bladder, and for heavy smokers, coughing can contribute to stress incontinence.
Buy yourself some insurance : There are numerous products on the market today that will absorb any accidents, whether urine or a bowel movement, and at the same time, protect your clothing or bedding from wetness. Specially made disposable and reusable briefs, diapers, liners, inserts and linen protectors can add a measure of confidence. For some people, sanitary napkins or panty liners may be an acceptable alternative that provides enough protection. And a new product may be on the market soon. With in the next year or two, urethral plugs, which can block the flow of urine during every day activities, will be available in the United States, says Peter K. Sand, M.D., associate professor of obstetrics and gynecology at Northwestern University School of Medicine and director of the Evanston Continence Center at Evanston Hospital in Evanston, illinois. These plugs now in use in Europe, can be inserted by the user and later removed by means of an attached string.
Be confident on the road : External collecting devices that are specially designed for use by females or males can make traveling a little more comfortable. These on the go urinals, which are also convenient for bedside use, are available at medical supply stores and pharmacies and through medical specialty mail order.
Go Before You Go : Empty your bladder before you take a trip of an hour or more, whether you have the urge to go or not.
Then go Again : After voiding, stand up and sit down again. Then lean forward, which will compress the abdomen and put pressure on the bladder, to help empty the bladder completely, suggests Wells.
Wear Clothes That are Easy to Remove : Women's clothing, in particular, can pose a problem. Jumpsuits or unitards can slow you down when you're in a hurry to go because these one piece out fits must be removed from the top down. Skip such suits or look for ones with a snapped opening at the crotch for quick and easy removal. Carry extra clothing with you so that you can change if an accident occurs. If your clothes happen to become stained with urine, soak them for three hours in a mixture of one gallon of water and one cup of dishwashing detergent.
Weight for Results : Resistive exercise when force is exerted against a weight can be applied to the sphincter muscles of the urethra and rectum, which are important to regaining continence, says Wells. Cones that are about the size of a tampon and that come in varying weights are designed for use in the vagina (women) or rectum (men). When a cone is inserted, the sphincter muscles must contract in order to hold the weight and not let it drop. Over a few months and with progressive use of the varying weights, the pelvic floor muscles should get stronger, says Jeter. These weight sets are available from physicians, who can guide your use of the cones, or from medical supply stores. Be sure to carefully read and follow the accompanying instructions on proper use for best results. Start by holding in the lightest weight for 15 minutes, two times a day. Once successful at that weight, try the next heaviest weight for the same amount of time. Some versions of these cones come with an electronic biofeedback system, called a perineometer, which reports on the amount of pressure you're applying to the inserted cone.
Take Control of Your Muscles Every Day : To prevent leakage, contract the pelvic floor muscles when coughing or sneezing or when carrying or lifting something. Do so by standing close to the object to be lifted with your feet slightly apart, one foot just in front of the other. Then, bend your knees but keep your back straight. Lean forward slightly as you contract, or tighten, your pelvic muscles. Then lift the object.
Be Wary of Exercise Gimmicks : Carefully investigate any exercise contraption that claims to help decrease incontinence. A company may promote the fact that its gadget will tone the pelvic floor muscles, but the device may actually exercise an unrelated muscle group, if it does anything at all. An exerciser for use between the thighs for instance, will not strengthen the pelvic floor muscles. If you're not sure if a certain exerciser will benefit your incontinence problem, don't waste your time or money. Check first with your health care provider.
Make a Phone Call : Call1-800 bladder a toll free number sponsored by HIP, for details on how to receive a free packet of information on services and products for incontinent people.
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