Dealing with bladder weakness Print E-mail
Written by Kimberly Clark   
An estimated six million people in the UK have bladder weakness. While the popular belief is that the condition is only a problem of old age, this is not necessarily the case. One in three adults will have problems controlling their bladders at some time in their lives[1], a condition that is more prevalent in women than in men. Bladder weakness does not have to take over a person’s life. Whatever the root cause, bladder weakness can be easily managed or treated, allowing people to focus on the positives of life and continue to do the things they love, free from any worries.

Impact


Many people experiencing bladder weakness are hesitant about things other people don’t think twice about. It can have a huge impact on everyday activities such as shopping, going to the cinema or attending social events. Unless well managed, it can have major implications on personal relationships. Additionally, people with incontinence are more likely than others to suffer with sleep disturbance and lack of energy, and can become isolated by their problem.

The healthy bladder


On average, the kidneys produce around 1.5 litres (two to three pints) of urine every 24 hours, varying with the amount of food and liquids consumed and rate of perspiration. As the bladder fills, it expands gently. The outlet valve (the sphincter) is closed, and the muscles and ligaments of the pelvic floor support the bladder and the bowels (and, in women, the uterus), and so help keep the urethra closed. The brain subconsciously monitors how full the bladder is and eventually a feeling of needing to empty the bladder arises – well before it is actually full. The amount a bladder can hold depends on how it has been trained from infancy onwards. Most people need to empty their bladders 4–8 times a day. When water is passed, the sphincter muscle relaxes, opening the urethra. At the same time the muscles in the wall of the bladder contract strongly and squeeze the urine out. Then the process starts all over again.

Loss of control


There are different types of incontinence:

Stress incontinence
This is the most common form of urinary incontinence. It is not caused by emotional stress, but by physical stress to the pelvic floor muscles that support the bladder and bowel. It is more common in women than men. Prevalence increases in older women and 15–20 per cent of women over the age of 40 have some degree of stress incontinence, resulting from weakness in the pelvic floor muscles and/or the urethral sphincter. Leakage results from laughing, sneezing or coughing, exercise, or even when lifting heavy shopping bags, because these activities cause an increase in abdominal pressure.

It can be a problem during pregnancy or after childbirth. Hormonal changes after the menopause also contribute. Oestrogens are essential for maintaining strength and elasticity of tissues; falling levels cause dryness and thinning of the tissues and laxity of muscles, affecting the pelvic floor and urethral sphincter. Obesity and smoking are also contributing factors.

Urge incontinence
This occurs because of an overactive bladder, which causes involuntary muscle spasms that force urine out of the bladder. Urge incontinence results in a sudden feeling of the need to use the toilet or a feeling of being unable to reach the bathroom in time. It includes urinary frequency – a tendency to pass urine often. Frequency can be common during urinary tract infections but settles once the infection is treated. Some people may experience both stress incontinence and urge incontinence at different times.

Overflow and drip incontinence
Most common among men, this is caused when the bladder doesn’t empty completely, so urine starts to build up and muscles become weak, leading to urine loss drop by drop with little sensation or warning. It is commonly associated with an enlarged prostate gland, but women can suffer too, particularly if they become constipated.

Nocturnal enuresis or bedwetting
This occurs mainly in childhood, but can affect adults too. Some people suffer with nocturia, which is the need to get up several times a night to pass urine.

Neurogenic incontinence
This occurs through damage to any of the nerves supplying the urinary system. Damage can be accidental, sometimes through surgery, or may be associated with degenerative diseases like multiple sclerosis. Most people who suffer with incontinence will already have a good idea of the type they have, but doctors and continence nurses can help to identify the cause, often through careful questioning and simple tests.

What can be done?


Pelvic muscle exercises (Kegel exercises)
Stress incontinence, the most common type, can be improved greatly by exercising the pelvic floor muscles. Simple exercises, which take only a few minutes a day, can strengthen the muscles near the urethra. Details of exercise techniques are available from websites (see “Resources”).

Bladder training
Training the bladder to hold urine better can also decrease the urge to urinate. Following a timetable to store and release urine strengthens the pelvic floor muscles.

Losing weight and keeping active
Sometimes excess weight causes bladder control problems. A good meal plan and exercise programme can lead to weight loss.

Eating and drinking the right things
Some drinks and foods may make urine control harder, including drinks with caffeine (coffee, tea, cola or chocolate) and alcohol.

Electrical stimulation
Devices are available to stimulate the muscles around the urethra, making the muscles stronger and tighter.

Biofeedback
This takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a television screen. This helps to detect if the right muscles are being exercised.

Drug therapy
Incontinence arising from detrusor instability is managed by combining drug therapy with pelvic floor exercises and bladder training where appropriate. Drugs used are mainly antimuscarinics that reduce detrusor contractions and increase bladder capacity. Treatment should be reviewed after a few months.

Incontinence products


Customers with incontinence will require your help and advice in choosing the right product. However, as there are so many taboos surrounding this most basic of body functions, it can make sufferers reluctant to seek treatment. But attitudes towards bladder problems are changing. Incontinence pads and pants are available in all shapes and sizes. A crucial aspect of staying in control of bladder weakness is ensuring that the correct protection is used. Some products are suitable for slight leakage while others are useful for more severe problems.

More than two million people in the UK use the wrong product to cope with bladder weakness, resorting to feminine hygiene products that are simply not designed to cope with urine. Incontinence pads are specifically designed to deal with bladder weakness; they help to neutralise and protect against embarrassing odours and keep moisture locked away.

The right product will depend on the degree of bladder problem and on lifestyle. Some customers have active lifestyles while others will need help with personal care, or may have mobility and dexterity problems or poor vision. Some simply need a product for occasional use, such as when travelling. People’s needs may vary throughout the day. They may, for example, use a smaller pad during the day and a more absorbent one at night.

You can help


It is important that you are well-informed about different products and are knowledgeable about how they work. Customers need tact, good advice and understanding to help them purchase the correct incontinence product.

It is essential to have easy-access, well-stocked displays of incontinence pads and pants. Above all, it’s important to make your pharmacy a place where customers feel they can receive informed advice and can talk about this embarrassing subject without feeling uncomfortable. Information leaflets near the incontinence products (and perhaps by feminine hygiene) and in the waiting area near the dispensary are useful. The charity Incontact provides leaflets and its website is a good information resource.

People with incontinence for whom these products are inadequate may benefit from various appliances available on prescription. They should be referred to GPs who may treat them or refer them to locally based NHS continence services.

Reference


1. Royal College of Physicians. Incontinence: causes, management and provision of services. London: 1995.Resources
1. British National Formulary: www.bnf.org
2. Help the Aged: www.helptheaged.org.uk
3. Incontact: tel: 0870 770 3246 www.incontact.org

 
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