Urinary incontinence is the accidental, involuntary, loss of urine. In Canada, approximately 3.3 million people experience incontinence – that’s more than 10% of the population. This number is expected to increase as the population ages. That being said, the exact number of people living with incontinence is unknown, as it is often hidden as an embarrassing problem. Many people with incontinence become depressed and socially isolated. Difficulties with toileting and other incontinence issues with older adults may lead to limited mobility and falls. Urinary incontinence is the second most common reason people are placed in a health facility, the first reason being dementia. In addition to personal inconveniences, incontinence also comes with a cost to our health care system (i.e. the cost of incontinence pads, increased laundry, loss of productivity, and increased health facility occupancy).
The Role of a Nurse Continence Advisor
Many people living with incontinence don’t know that it’s treatable and often curable condition. Unfortunately, the topic is still somewhat taboo and many people consider it a normal part of aging. Because of this stigma, many people with symptoms don’t seek help. Approximately 80% of incontinence symptoms are curable with conservative measures and most patients can see a significant improvement without any medical intervention (drugs or surgery).
As a Nurse Continence Advisor (NCA), I regularly see patients with incontinence issues and assess what might be contributing to their condition. I develop an individualized treatment plan based on each patient’s specific needs. This assessment includes questions about their symptoms, medical history, medications, functional assessment, and a physical examination. Managing incontinence is like managing any chronic condition; it requires the patient to follow through with their treatment plan to achieve the best results. If you or someone you know is experiencing symptoms it is important to let your GP know and to discuss the services available from an NCA in your area.
Contributing Factors to Urinary Incontinence
There can be several factors contributing to someone’s incontinence (as mentioned, it is not a normal part of aging). Some conditions pertaining to older adults can predispose someone to experience incontinence symptoms, such as enlarged prostate in men, lower levels of estrogen in post-menopausal women, reduced bladder capacity, urinary frequency at night due to lower levels of anti-diuretic hormone, dementia, diabetes, etc. Incontinence can be a side effect of medical conditions that affect the brain or spinal cord (i.e. stroke, spinal cord injury, Parkinson’s disease, multiple sclerosis, etc.). Other factors that contribute to incontinence symptoms include weak pelvic floor muscles following vaginal childbirth, gynecological or urologic surgery, and certain medications. Diuretics can cause urinary urgency and frequency and anticholinergics can contribute to urinary retention and overflow.
Fluids – The amount and frequency of certain liquids a person consumes can cause certain incontinence symptoms to occur. Caffeine, alcohol, and carbonated drinks can irritate the bladder and cause urinary frequency, urgency, and subsequent incontinence. I often ask patients to gradually reduce their intake of these bladder irritants and to drink more water. How much you drink and when you drink are very important factors. If you are voiding three or more times a night, try limiting your fluid intake three hours before bedtime.
Pelvic Muscles - Pelvic muscle exercises can help strengthen weakened muscles (weak muscles give you less control of your bladder). Pelvic muscles hold your bladder and bowel (continues on next page)
in place and are the muscles used to stop rectal gas or urine flow. Squeeze your pelvic floor muscle for three seconds and relax for three seconds. Do a set of 10 exercises, five times daily. Do not do these exercises when you are urinating or while you’re on the toilet. Patients must be consistent with these exercises and do them properly to see an improvement.
There are other conservative treatments that can be targeted towards specific symptoms. A Nurse Continence Advisor can assist you in assessing and treating urinary incontinence.
By Sam Leung, RN, BSN, MN, GNC(C), CCHN(C), NCA – Nurse Continence Advisor
Sam Leung is a Nurse Continence Advisor and Registered Nurse with over seven years of experience working with patients with incontinence issues. Sam is available by appointment through Nightingale Medical Supplies in the Vancouver area. For more information please call 604.879.9101 or toll free 1.800.663.5111.
1. Canadian Continence Foundation Website - retrieved from: http://www.canadiancontinence.ca/EN/index.php
2. Getliffe, K. & Dolman, M. (2007). Promoting Continence: A clinical and research resource. Edinburgh: Elsevier Health Sciences.