Gotta go, gotta go, gotta go!” So sing the voices in the background of an ad featuring a taxi driver who is desperately looking for a bathroom. This is the fourth article in a series about frequently ignored health problems. The focus this time will be urinary problems, specifically urinary incontinence. That is not to say that the person is unaware of the problem, but often they buy some sort of incontinence pad and embarrassingly go about their business to some degree. Usually, many social situations are avoided because of the problem. Sometimes they are too embarrassed to discuss it completely with their medical professional. Consequently, they may not find a complete solution.

     More than 13 million adults have some type of urinary incontinence. It is probably more, because many people are too embarrassed to admit it. Urinary incontinence is the term used when the flow of urine cannot be controlled. Incontinence is one symptom of any one of a variety of medical problems. The main types are stress, urge, overflow and functional.

     Stress incontinence happens when the sphincter (round muscle that closes in a circular squeeze) does not close completely. Sudden pressure can cause leakage. The sudden pressure can be from coughing, sneezing, laughing, lifting or just standing. The activity causes pressure of the full bladder on the sphincter. There are several reasons the muscles can weaken, for instance, childbirth, aging, changes in hormone levels, high impact exercise and some drugs.

     Urge incontinence is also known as overactive bladder. It contracts more than normal, giving the feeling of needing to urinate. There are several reasons for this type of incontinence, central nervous system damage as with a stroke, multiple sclerosis, spinal cord or disk injury or Parkinson’s disease. In addition, infections, anxiety or the aging process can cause an overactive bladder. According to an online article in CBS HealthWatch by Medscape, “One interesting study found an association between depression and urge incontinence. Researchers posited that the connection may lie with altered levels of the neurotransmitter serotonin, which plays a role in both depression and in bladder contraction.”

     Overflow incontinence occurs when normal flow is affected, causing incomplete emptying of the bladder. This can be from a blockage or improperly functioning bladder muscles. The bladder becomes distended, or overly full. This stretches the sphincter, opening it enough to allow leakage. There are many reasons for this also. A few of them are medications, prostate problems, scar tissue, spinal cord injury, diabetes, multiple sclerosis and shingles.

     With functional incontinence, the urinary system is normal but other physical disorders affect the person’s ability to use it. Some of these disorders are, Parkinson’s disease, mental disease, Alzheimer’s disease and other forms of dementia. Mental confusion can prevent recognition of the need to void and finding a bathroom. According to the previously quoted online article, “Severely depressed people may become incontinent because they are indifferent to continence.”

     Temporary urinary incontinence can be caused by urinary tract infections, excess fluid intake, constipation, depression and restricted mobility.

     There are more than one reason for incontinence and numerous causes for those reasons. That is why it is important for you and your physician to put together a good medical history. Report to her or him: how long you have been experiencing problems; when you notice it the most; do you have to get up at night; what your fluid intake is and how much alcohol and caffeine you drink, and when. Make note of whether there is pain; what kind (burning); color of urine; whether you notice blood and if you have trouble starting and/or stopping your urine stream. No less important is past medical history; medications, including supplements, vitamins and herbal. With a good history, your medical professional can then decide whether you need further testing, medicine, exercises and a few changes in your routine, hygiene, diet and fluid intake.

     There are things that anyone should be doing as part of a normal routine. Make sure you void regularly, so that you do not go around with a “full tank.” That can make you more susceptible to urinary tract infections and leakage. Drink adequate fluids, but space them out during the day. Avoid loading up on fluids before you go to bed. Avoid drinking or eating at least a couple of hours before you go to bed. Do not start out in the car with a full bladder. The pressure of the lap belt on a full bladder, if you were in an accident could cause injuries. Do not let this be an excuse not to use seat belts. Use proper hygiene. Discuss this with your medical professional.

     Be an advocate for yourself, and your optimum wellness level. You and your physician are on the same team. Share your health concerns and goals with her or him, and go for it!

© 2001 Joy B. Burch, RN All rights reserved

This is the fourth in a series of articles about often ignored health problems.