Managing Urinary Incontinence

clear cold drink in glass with cherries floating

Dear Friends,

Many, many people suffer from urinary incontinence--

people who are disabled and non-disabled, male and female, young and old, for hundreds of reasons. 

A sensitive or neurogenic bladder can be hard to manage, but the good news is that we have more remedies than ever before. Educate yourself on, and be sure to consult with your doctor; then relax, and focus on what's important in your life! You deserve it! 

Most likely, your doctor will recommend a combination of things to help you. There are various urological devices, internal or intermittent catheters, disposable inserts, dryness aids, medicine, and even surgeries (from a minor, out-patient procedure, to more complex surgeries), that can greatly improve quality of life.


Types of Incontinence

Stress Incontinence: is a misnomer. It does not mean emotional stress. Any movement that puts pressure on your bladder can cause stress incontinence. In females, the pelvic walls that hold the bladder in place weaken with age, pregnancy or menopause, causing the bladder to slip toward the vagina, weakening the sphincter. The sphincter is a muscle that holds the bladder closed. Laughing or sneezing can trigger your bladder when there is already a weakness. The pressure of a growing fetus also can cause stress incontinence when the uterus leans into the bladder from the weight of the baby. That pressure causes the bladder to leak or empty completely. In males, stress incontinence is caused when the prostate enlarges, making it harder to empty and placing pressure on the urethra.

Urge Incontinence: Patients who have urge incontinence usually have a neurogenic (nervous) bladder: Sphincter muscles become overactive, causing leaks or emptying. A neurogenic bladder is caused by anything from nervousness to stroke, Parkinson's disease, multiple sclerosis, or spinal cord injury.

Overflow Incontinence: When someone is unable to completely empty their bladder due to a weakened sphincter, the bladder can overfill and leak. Overflow incontinence also causes the frequent sensation of needing to empty. It's common to have both urge and overflow incontinence.

Functional Incontinence: The physical inability to reach a bathroom in time, due to either limited mobility, mental, or emotional impairment, can cause functional incontinence. It is not caused by a dysfunction of the urinary tract.



Some solutions sound scary at first, but keep an open mind—the appropriate solution(s) for your situation will become easy to implement. No one has to know about it but you. In fact, online medical supply vendors protect patient anonymity by delivering incontinence aids directly to the home. Supplies are usually covered under private insurance or Medicare.

Dryness Aids: Most dryness aids contain a chemical developed by the National Aeronautics and Space Administration (NASA) for its astronauts, because astronauts must wear bladder protection during space travel, due to lack of gravity The chemical inside protective pads and diapers turns into a solid substance when it gets wet, drawing wetness away from the body. Dryness aids for incontinence contain enough of the chemical to handle big spills. Consumers may choose from light absorbency to heavy or overnight strengths. Neil Armstrong and Buzz Aldren, the first astronauts to land on the moon, never suffered a loss of dignity from wearing bladder protection, so why should anyone else?

Some types of incontinence pads and adult diapers are specifically designed in male and female versions, to fit better. Look for them in the catalogs listed below. No one but you knows you're wearing protection, and it is far better than suffering the consequences, unless you choose another way to effectively manage urine loss. Note: one drawback of dryness aids is skin irritation from the chemical inside. If a product irritates the skin, place paper-toweling or a cloth between the skin and the pad or diaper. The product will protect until patient can reach a restroom to freshen up.

Nutrasweet® Will Send You Running! If you think coffee and tea (well-known diuretics) are the only beverages that cause problems, try this experiment: lay off the diet-soda and artificially sweetened yogurt for a week and see how you feel. You'll probably have a better behaved bladder because Nutrasweet® is a royal irritant to the bladder lining. It seems to bother females the most. Don't spend the day in the bathroom! Drink juice and sparkling water instead; they're refreshing alternatives. Note: some people cannot drink citrus (orange, lemon, grapefruit, or lime) or other types of juices, such as grape juice, because those juices irritate the bladder. Pay attention to changes in the body so you'll know what to avoid.

Medicine: A urologist can prescribe one of several medications that lessen the urge and frequency to urinate. Ditropan™ and Detrol™ pills are available in most affective, time-released versions. There are also medicines prescribed to help one empty the bladder. Consult with your doctor, who will determine which drug is most appropriate for you.

Botox injections: Of course, Botox is prescribed and dispensed at a doctor's office. Botox firms up the bladder and slows it down.

Self-catheterization: Not so terrible! Self-catheterization gives a person control over his or her bladder. Self-catheterization is not painful, though easier for females because females have a shorter urethra than males. A urologist or urology nurse trains patients how to use a catheter. There is a brief adjustment period and then it becomes second nature. After that, patients no longer have to worry about accidents because they can keep the bladder empty. Along with self-catheterization, a urologist may prescribe a medication to lesson urgency or sensation.

External catheters for males: have traditionally been used for managing urinary incontinence due to surgery, injury and disease. These "condom type" devices are placed over the penis and attached to a collection bag or bedside drainage bag.

External Catheters for males and females: Wouldn't it be great to get through an entire movie without a bathroom break, after paying the $12.50 admission? You could even have a soda, if you're using an external catheter. It's always nicer to focus on a symphony, opera, play, or romantic dinner, without worrying about getting to a restroom! Imagine picnics at forest preserves, outdoor activities, and sports. For people who don't already have internal catheters, incontinence is manageable with an external catheter sold by BioRelief and other companies, listed below. A male catheter is shaped like a condom, while females have a small pouch with a locking drain at the bottom.

Kegel Exercises: Kegel exercises work as long as there isn't a more serious condition than a weak sphincter muscle. Practice stopping urine flow a couple of times when urinating to strengthen the sphincter muscle.

Portable Urinals: Portable urinals are useful for persons with limited mobility or who are bed-ridden; it's often a lot easier to empty the bladder into a urinal than find and negotiate a bathroom. It's easier on care-givers too. Portable urinals are available through catalogs that offer home remedies.

Commode Seats: A commode seat is another useful option for persons with limited mobility. It's best evaluated by a physical therapist to determine whether a patient can or cannot safely transfer independently. It may be necessary to have assistance. Commode seats may be ordered from one of the catalogs below.


Surgeries and Surgical Procedures

Supra Pubic Catheter: A supra pubic catheter with a leg bag can give one back his/her life, when more conservative methods have been exhausted. A supra pubic catheter or SPC tube, for short, is a surgical procedure done in an operating room on an outpatient basis. The patient is given general anesthesia and doctors create a space to insert an internal catheter. A catheter is inserted every 4-5 weeks that runs from the bladder through a small opening in the abdomen, just above the pubic bone. The opening is more like a wound than a stoma. It must be kept clean, but requires much less time and bother than practically anything else.

If this is an option doctor and patient agrees is appropriate, SPC patients are free to think of many more things, other than his/her bladder! Patients must remember to drain it a few times a day and the catheter must be replaced at a doctor's office every four or five weeks. Some patients learn to change their own SPC tube, if they're able to reach it. The risk of urinary tract infection is greater because there will always be some bacteria present. However, if patient gets an infection, doctors only treat it if there's a fever and/or other symptoms because certain bacterias become resistant to antibiotics. A sulfurous odor develops during infection. Take your temperature with a reliable thermometer and notify the doctor if you have a fever.

Urostomy: A Urostomy is a complex surgery usually given to patients with bladder cancer: The surgeon attaches the ureters (the tubes that carry urine from the kidneys to the bladder) to either the small intestine or to the abdominal wall. The bladder is either repositioned or removed. Then a stoma (opening) is made in the lower abdomen using patient's skin; the stoma provides a way to empty the bladder or artificial bladder.


More Surgical Options

 As you will see below, there are many surgical procedures and surgeries that have been designed to correct or aid patient's incontinence symptoms. They are briefly described here, but your doctor can tell you much more about these procedures, plus others, as they relate to your treatment.

Artificial inflated sphincter (AIS) An AIS is implanted in the body to keep urine from leaking when patient's own sphincter no longer functions well. A cuff on the artificial sphincter is loosened when patient wishes to urinate. This surgery is used for males after prostrate surgery.

The anterior vaginal wall can be repaired.

Collagen implants— Injections of collagen will strengthen the urethra.

Retropubic suspension— This is a surgery to control urine leakage caused by stress incontinence.

Tension-free vaginal tape- Placement of tension-free vaginal tape is another procedure to help control stress incontinence.

Electrical-stimulatory therapy- electrical impulses that mimic those that would normally be delivered by nerves if they were undamaged.


A Word on Bowel Incontinence:

Bowel incontinence is easy to correct because maintenance is only done once a day, and because it involves solid waste, rather than liquid. Talk to your doctor and explore home health care remedies, such as digital stimulation. Digital stimulation is a method of evacuating the bowels, typically at the beginning of each day, removing the problem before it starts. 

Some people manage their bowels with a fiber supplement, mild suppositories, or stool softeners. There are plenty of options; one will be right for you. 

It's also advisable to watch diet. Be sure to drink plenty of water and eat enough fiber, but use discretion—if you're about to take the train to work, don't have a large meal or drink just before leaving. Wait until you arrive, and avoid coffee completely.