Continence and Incontinence these are two sides of the coin which can be the difference between independence and a prisoner in your own home.

It is a subject as we roll beyond our fifties we probably would rather not think about. However, it is a very relevant and intrinsic part of our daily lives. It can be dramatically affected if we do not take proactive measures.Confidence can so quickly be lost and it is so easy to become a prisoner in your own home because you fear going out in case of an accident. If you are experiencing problems the earlier it can be addressed the quicker your will receive help and have your self-assurance return.

What is Continence

This is the ability to control the bladder and expel urine and have your bowels open when it is convienient. The bladder collects urine throughout the day  and if you are drinking the recommended amount of approximately two litres of water you will expell this at intervals. The average bladder holds between 400mls – 600mls and you will visit the toilet approximately 4 – 8 times during a day. When the bladder is over half full a message is sent to the brain and the response is the urge to pass urine. When you have good bladder control  you are able to hold onto this urine until you visit a toilet. You will be able to control when the urine is released and with good bladder control you are able to stop the flow if you need to – (for the collection of a midstream specimen of urine- MSU) you will also be able to ensure your bladder is completely empty.

Urinary Continence problems occur when this regularityand ability alters. It can change due to several factors:

Childbirth – damage can occur during delivery which affects continence, this can worsen as you age

Pregnancy – the weight of carrying a child or having an episiotomy may have an affect on the muscles, which will have left the muscle group weakend

Illness – a stroke, Urinary tract infection or a tumor  can interfere with the signals transmitted to the muscles which tell the brain when you need to empty your bladder

Constipation – long term constipation can lead to lax muscles this can possibly lead onto a prolapse where either the bowel, or uterus may cause pressure on the bladder. This sagging or heavy  feeling should be investigated to reduce the chance of further damage.

Overweight – being over weight can have an impace on all your muscle groups but unfortuantely it can exacerbate muscles which may already be struggling.

Types of Urinary Incontinence

Over Active Bladder – it is also known as irritable / unstable bladder

Symptoms

Needing to go to the toilet frequently
Not managing to get to the toilet in time
Urgency needing to get to the toilet immediately
Getting up in the night for the toilet
Having accidents in the bed at night

Stress Incontinence – also know as SUI  - Stress Urinary IncontinenceUrgency

Symptoms

Leakage of urine when you cough, sneeze or laugh
Leakage when exercising

Urinary Tract Infection – also known as a UTI

Symptoms

Frequency is the main problem with this the bladder lining is irritated which makes you feel as if you need to go to the toilet little and often.
Blood may be visible in the urine – this is due to the infection

Overflow Incontinence – 

 Symptoms

Difficulty with passing urine
Weak or slow flow
Frequency during the day and night
Possible constant dribbling
Having accidents in the bed at night
Constant feeling of a full bladder

Bladder Investigations

Initially you may be asked to provide a urine specimen / urinalysis which can be tested at the surgery or clinic this can tell the continence advisor / doctor if you have an infection.

Physical examination – your doctor may perform and internal examination by placing if you are  a lady two fingers inside your vagina and asking you to squeeze as tightly as you can; or if you are a gentleman a finger will be inserted into your rectum to examine both your ability to sqeeze and to asses the size of your prostate.

Urodynamics are performed to asses how well your bladder functions, these investigations will be performed at a specilised clinic or hospital.

You will be asked to arrive with a full bladder, then asked to void in an adapted toilet which measures flow.

Cystometry this is where you will have apair of fine catheters inserted into your bladder. Another catheter will be placed either in your vagina or rectum. Your bladder will be filled with sterile fluid, measurements and pressures will be taken and recorded from both of the catheters. You will be asked questions during the procedure about how you feel, to cough, move and then you will be able to empty your bladder again.

Bladder diary

Keeping a bladder diary can be a really good way of letting either your doctor or continence advisor know how your life is being impacted by your continence problem. There are different types of bladder diaries but the one below gives you an idea of what information is required.

Pelvic Floor Muscle Exercises

The aging body has much to answer for especilly if we have not ben doing quite the ammount of exercise we should have. In ladies it can affect specifically the pelvic floor muscles as after the  menopause this muscle may become significantly weaker.

However men too are affected and it is advisable to try to do these exercises as part of your daily routine before you begin suffering from incontinence.

Locating your pelvic floor muscles – when you next need to go to pass urine try and stop the flow once you have started. If you are able to stop your flow then you have good pelvic floor muscles if not it might be a good time to begin some exercises. They are very easy to do and can be practised in all sorts of situations once mastered!

1. Sit comfortably with your legs slightly apart and squeeze the muscles which you located earlier. It can feel like tightening around your anus but they are slightly forward of those.
2. Try not to hold your breath, tighten your buttocks or tense your legs as this is ineffective in helping your pelvic floor.
3. Imagine you have a piece of string tied around your bladder inside which you pull up though your body, pull it up gently and hold for the count of three initially  then relax. Repeat this five times, and then relax for the count of ten you will feel all your muscles relax. Repeat the process again relax again and then for a third time. You should ideally aim to do this at least twice a day.
4. Gradually increase the time you hold up to the count of five, no more.
5. In time you will notice that when you relax that the muscles do not relax quite as loosely. This will show you are making progress; it may be slow but keep it up and the quicker you will see results.
6. Results can be measured by your ability to stop the flow of urine when you next go to pass urine.  Do not expect overnight results.
7. Do not overdo this exercise but don’t give up either.

Once mastered this exercise can be performed when standing up, waiting for the bus, doing the washing up, waiting for the kettle to boil or indeed sitting watching the telly no one will know you are doing them.

Continence Advisors

These are qualified nurses who have specialist training in assisting you with any continence problem you may be experiencing. People suffering from any continence problems can often feel embarrassed about it and delay seeking help. The staff will be experienced with putting you at your ease and will be supportive and effective in helping you either cope or improve your specific problem. Continence advisors often collaborate with other health care professionals such as physiotherapists, pharmacists and occupational therapists to help improve your circumstances.

Resources

http://www.bladderandbowelfoundation.org

Bladder and Bowel Foundation 24hr helpline 0845 345 0165

NHS direct