Urinary Incontinence: Introduction & Behavior ModificationWHEC Practice Bulletin and Clinical Management Guidelines for healthcare providers. Many people suffer from urinary incontinence. Yet, because of embarrassment or the belief that it is a normal part of growing older, people do not seek help. It is estimated that 50% of women and 18% of men over the age of 65 experience some type of urinary incontinence. It is not a problem of old age. The onset of this embarrassing problem is very gradual, but never unnoticed. The important fact is - incontinence is curable. The purpose of this document is to consider various types of incontinence and the role of behavior modification. Overactive bladder (OAB) / urge incontinence is a common condition that becomes even more prevalent as people age. It is associated with significant psychological and physical morbidity as well as increased healthcare costs. The prevalence of stress incontinence represents a spectrum, depending on how incontinence is defined. There is racial and ethnic variation in the prevalence of urinary incontinence in women. Many people find it difficult to discuss their incontinence problems, even with a nurse or doctor. Urinary incontinence is common and very treatable. Fortunately, millions of men and women are being successfully treated and even cured. Leaking urine is neither normal nor acceptable, and your problem just may be the beginning of what becomes a downward spiral where loss of bladder control goes hand-in-hand with loss of self respect, as well as anxiety and depression. Here is some general information about urinary incontinence. Causes of Urinary Incontinence: Urinary incontinence can be caused by a number of physical conditions. About half of all cases of incontinence are temporary and can be reversed once the cause is identified and treated. You must consult with your healthcare provider for accurate diagnosis and treatment. Some of the most common conditions are: Incontinence that is not a result of infection, impaction, or reaction to medication often has a more fixed cause. Some of the most common fixed causes to incontinence include: Once identified, these conditions can be successfully treated and incontinence cured. Your health care provider can help to identify the exact cause of your incontinence. Types of Incontinence: There are also many different types of incontinence, and often the type of incontinence is related to the cause. Some people have more than one type of incontinence. Three different types of incontinence are Urge Incontinence, Stress Incontinence and Overflow Incontinence. The symptoms are described below: Finding the Cause of Urinary Incontinence: Once a patient tells her healthcare provider about the problem, finding the cause of the urinary incontinence is the next step. The patient's medical history and urinary voiding habits are discussed and noted in detail. Physical examination and urine tests are routinely done. There are other tests that can be done to find out how well you empty the bladder, to verify that there is a leakage, to test how well your bladder works (Urodynamic Tests) and to actually look into your bladder for abnormalities (cystoscopy). These tests will help the healthcare providers to find out the exact cause of patient's problem and choose the best treatment. Other chapters in this section will explain these tests, especially Urodynamic Tests (UDTs), in detail. Bladder Retraining: These tips for controlling the urge to urinate might be helpful. Behavior Modification is an essential part of the cure. These suggestions might be useful for patient education. The cornerstones of Behavior Modification are: control fluid intake, change voiding pattern, bowel care, weight loss and removal of transient causes. Make sure you consult your healthcare providers first, for accurate diagnosis and management. Diet Modification: Take steps to change all those things which you are able to. Aim to follow a nutritional program that will ensure weight loss, if necessary, and a high fiber content to prevent constipation. Nonsurgical treatments: All these modalities will be discussed in detail in separate chapters. Surgical treatments: Bladder neck suspension, slings, and radio-frequency are the most frequently used surgical procedures for the treatment of Stress Incontinence. These will be discussed in separate chapters in detail. Editor's Note: Behavioral therapy, including bladder training and prompted voiding, improves symptoms of urge and mixed incontinence and can be recommended as non-invasive treatment in many women. Pelvic floor training appears to be an effective treatment for adult women with stress and mixed incontinence and can be recommended as a non-invasive treatment for many women. Pelvic muscle exercise, also called Kegel and pelvic floor exercises, are performed to strengthen the voluntary periurethral and perivaginal muscles (voluntary urethral sphincter and levator ani). Bladder training is widely used with no reported side effects and does not limit future treatment options. Also known as bladder drills or timed voiding, it generally is used for the treatment of urge incontinence, but it also may improve symptoms of mixed and stress incontinence. Healthcare providers can teach patients the correct method of distinguishing and contracting the pelvic muscles. Suggested Reading: |