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Urinary Incontinence

Urinary Incontinence

Urinary Incontinence

Urinary incontinence is leaking of urine that you can’t control.  Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don’t want to be too far from a toilet. Urinary incontinence can keep people from enjoying life. Many people think urinary incontinence is just part of getting older. But it’s not. And it can be managed or treated.

Risk factors

For women:

  • Aging
  • Pregnancy
  • Cesarean section (c-section) and vaginal delivery
  • Number of children
  • Menopause

For Men:

  • prostate problems

generally:

  • Obesity
  • Diabetes
  • Stroke
  • high blood pressure
  • Smoking

Types of urinary incontinence

Stress Urinary Incontinence (SUI)

With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.

SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking may happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.

Overactive Bladder (OAB)

OAB is another common type of urinary incontinence. It is also called “urgency” incontinence. With OAB, your brain tells your bladder to empty – even when it isn’t full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.

The main symptom of OAB is the sudden urge to urinate. You can’t control or ignore this “gotta go” feeling. Another symptom is having to urinate many times during the day and night.

OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB.

Mixed Incontinence (SUI and OAB)

Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.

Overflow Incontinence

With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.

One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called “dribbling.”

This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.

Treatments

Indwelling Catheters

A catheter is a flexible tube placed in your bladder. An “indwelling” catheter stays in your bladder all day and night. There are two types of indwelling catheters. Indwelling “Foley” catheters are placed in your urethra. Indwelling “suprapubic” catheters go above your pubic bone through a small surgical cut in the belly. With both types, a balloon holds the tube in your bladder. They both also drain urine into a bag outside the body.

A health care provider will place the Foley catheter in your urethra. The catheter can be managed by home care nurses when used long term. A urologist places the suprapubic catheter with minor surgery.

A Foley catheter should only be used for less than 2 years. If you need an indwelling catheter for a longer period of time, you should consider a suprapubic catheter. Because the suprapubic catheter is only in the bladder, there is less risk of bacteria growing (because it is away from the vagina and rectum). That means less risk of urinary tract infections, especially in women.

Both Foley and suprapubic catheters need to be replaced with a new catheter at least once every month. This also lowers the risk of infection. Both catheters can cause complications if used for a long time. Bladder, testicle (males), and kidney infections, bladder stones and bladder cancer can occur. Foley catheters can cause permanent damage to the urethra.

Foley and suprapubic catheters should be taped or strapped to the upper thigh or lower belly. This lowers the chance of injury if the catheter is tugged accidentally.

Catheters are made from latex with Teflon coating or silicone. The choice depends on a person’s allergies and the health care provider’s preference. Some catheters are coated with antibiotics to prevent infection. There is debate about whether this works.

Indwelling catheters vary in shape, tube size and tip. They are sized using the French (Fr) scale. Size 14 Fr is the most common size. A balloon is inflated once the catheter is inserted. This keeps the catheter from falling out. The balloon is usually filled with about 2 teaspoons of sterile water.

External Collecting Systems

For men, there are external collecting systems called condom or Texas catheters. These special condoms are rolled over the penis. They are kept in place by adhesive or straps. The condoms have holes at the tip. A tube goes from the hole to a drainage bag. Urine from incontinence collects in the drainage bag. Newer condoms are usually silicone. They come in sizes, with a sizing guide.

This device may be hard to use if you have problems with finger dexterity. A caregiver or family member would need to apply the condom catheter. Adhesive pouches may be better for men whose penis has retracted (drawn back).

An external collection device for women funnels urine from a pouch through a tube to a collecting device. These must be stuck to the outside of the labia. They are rarely used as the labia do not form a good water tight seal, so urine leaks.

Urine Drainage Bags

Both indwelling and external collecting devices are connected to drainage bags. They collect urine coming out of the bladder. Drainage bags come in different sizes. Overnight bags hold 1500 to 2000 milliliters (1.5 to 2.0 liters) of urine. These are large and cannot be hidden.

A leg bag is a smaller drainage bag. It holds 500 to 800 milliliters. It allows more freedom of movement. It can be hidden under clothing. It can be strapped to the thigh or calf. A new type, called the Belly Bag, is strapped to the belly. Drainage bags work by gravity. So, they should be strapped somewhere below the bladder.

When choosing a bag, make sure the strap is not too restrictive or tight. The valve that drains urine from the bag should be easy to open.

Drainage bags can be cleaned and deodorized. Soak 20 minutes in a solution of two parts vinegar and three parts water.

Catheters for intermittent catheterization (IC)


Intermittent catheterization is also called “in and out” catheterization. It is also called “clean intermittent catheterization” (CIC). Because it is clean you don’t need gloves and sterile preparation.

A catheter is inserted in the urethra 3 to 5 times a day. After you empty your bladder, you remove the catheter and throw it away. You or a caretaker can insert the catheter. You don’t have to wear it all the time. This lowers the chance of infection. And these devices don’t have a balloon like the indwelling catheter.

Older men and women can perform CIC and should be on a routine schedule. The amount of urine in the bladder should be 15 ounces or less. Catheterization may be needed four to five times a day. Most healthcare insurances and Medicare will pay for 4 catheters a day (120 a month).

Most IC catheters are straight. Some (called Coudé catheters) have a curved tip. It may be easier for a man to advance a curved tip past the prostate gland. Catheter lengths are 6 inches for women and 12 inches for men.

You can get catheters and other supplies, such as lubricant, packaged together. These packages are helpful if you need to use the catheter at work. Catheter supply companies deliver catheters and other supplies by mail.

Reference:

https://www.urologyhealth.org/urologic-conditions/urinary-incontinence

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