Monday, January 30, 2012

Bladder and bowel incontinence

Bladder and bowel control are important functions of our body though many people do not realize that they can actually control this by their own personal approach a lot of the time. The inability to control bowel or bladder is called as incontinence. In other words, the involuntary elimination of urine or feces is called as incontinence. Incontinence curtails a person's confidence, causing embarrassment and isolation. About 15% of the elderly population have incontinence which is the main reason for their institutionalization in the United States.

Incontinence curtails a person's independence, causing embarrassment, isolation and often institutionalization of the elderly. About half the nursing home residents are either bowel or bladder incontinent or both.

There are different kinds of bladder incontinence. They are urge, reflex, stress, functional, and total incontinence. Each have their own reasons to cause incontinence. Urinary incontinence is exhibited as dribbling of urine on sneezing, coughing, lifting and in worst cases not knowing when they urinated. Bowel incontinence presents with constipation followed by small, frequent oozing of stools, accompanied with abdominal distention (bloating).

CAUSES FOR INCONTINENCE:

* Holding the bladder for more than 6 hours will cause urge or a strong perceived need to void resulting in incontinence.

* Any injury or lesion in the spinal cord that interupts cerebral control will result in incontinence.

* Weakened perineal muscles will permit leakage of urine when there is increased abdominal pressure (Eg: coughing or sneezing).

* Ageing is the next common cause of incontinence. This is because they have a mixer of problems like physical immobility, weak perineal muscles, poor eliminational cues, and various other medical conditions.

* Environmental barriers can also cause incontinence. (Eg: Inability to reach the toilet in time and use them without soiling themselves).

* It is caused when there is cognitive problems like delayed perception of need to void, poor verbalization of the need to void, and inability to learn to control urination.

* It is also caused when there is sudden psychological stress or impairment. Eg: Stupor.

* The medical condition in urinary system which may cause incontinence are urinary tract infection, detrusor instability, bladder outlet obstruction, neurologic impairment or bladder spasm/ contracture.

* Children suffer incontinence because they feel ashamed or scared to ask their teacher in front of other classmates which may result in wetting their pants before they reach the toilet.

* Elders have incontinence because of their inability to get to the bathroom, manipulate clothing, and use the toilet capacity can cause incontinence in any age. Decreased muscle tone and presence of increased residual volumes are a few other reasons that could cause incontinence.

* Various medications can alter eliminational patterns by affecting the volume of urine produced (eg:diuretics), altering sensitivity to bladder cues (eg: sedatives), and causing urinary retention (eg: antocholinergics).

* Incontinence may be caused temporarily in post natal women that can be corrected by kegel's exercises.

* Neurogenic factors like stroke, diminished or lack of sphincter control, diet, and immobility are the four common cause of bowel incontinence.


The involuntary leaking of urine or stools is the common symptom of incontinence. The symptoms may result after a urinary tract infection, detrusor instability, child birth, surgery in bladder/rectum or constipation. Urinary incontinence is classified as urge, reflex, stress, functional, or total incontinence.

The main goal in treating a incontinent person is bringing about regular eliminational patterns.

Promoting urinary continence: This is made successful if the person co-operates well and has an optimistic attitude. Skin integrity is maintained by washing, drying and use of moisture barrier ointment. Fluid intake is not restricted but voiding is scheduled. Fluids are administered 30 minutes before voiding attempt and the intake and output are strictly maintained. In addition, most of the fluids should be consumed before evening to minimize the the need to void frequently during the night.

*Bladder training: This approach for promoting urinary continence is useful for people with urge incontinence. A voiding schedule is formulated which specifies times for the person to try to empty the bladder using a toilet or commode. They are made to void every 2 hours initially and is not encouraged to void between the specified voiding time.

*Barrier free access to the toilet and modification of clothing help the person with functional incontinence to achieve continence.

*Habit training is used to keep the person dry by strictly adhering to the schedule. The caregiver takes the person to the toilet at scheduled time and this is more successful for stress, urge or functional incontinence.

*Biofeedback is a system through which the person learns consciously to contract excretory sphincters and control voiding cues. This is more useful for those with stress or urge incontinence.

*Pelvic floor exercises strengthens pubococcygeus muscle. The person is instructed to tighten the muscle for 4 seconds 10 times, 4 to 6 times a day.

*Clean intermittent catheterization is appropriate for those with urinary retention and distended bladder.

*Indwelling catheters is avoided in most cases to prevent infections. However, short-term use is needed during treatment of severe skin breakdown.

*External catheters like condom catheters are useful for male patients with reflex or total incontinence.

*Incontinence pads are used as a last resort. The pads must be changed frequently to avoid skin breakdown.

Promoting bowel continence: A bowel training program is helpful for people with bowel incontinence. A time is scheduled, preferably after breakfast. The reflexes are stimulated by rectal suppository(glycerine) 30 minutes before trying or by mechanical stimulation using a lubricated gloved finger. The stimulation will not be necessary once the bowel routine is established. The person should assume normal squatting position and bedpans should be avoided. A diet high in fiber with adequate fluid is required to promote regular bowel elimination.

As incontinence is symptom, it is hard for the person to miss out something that is happening in his own body. Once you realize there is something wrong, feel free to talk to your doctor about it because there are simple exercises that could solve this problem.


History plays a major role in diagnosing incontinence. The doctor and the nurse will enquire about the daily intake of fluids and the eliminational pattern, eating habits, perception of urination and defecation cues, about the intake of alcohol, any psychological problems, pregnancy and postpartum, ingestion of any regular medication, and the relationship of incontinence to other activities and factors. Presenting the above information will help the medical personal to identify the type of incontinence and treat them accordingly.

The main idea of treating incontinence is to promote continence and produce a regular eliminational patterns. It is achieved by various exercises like bladder training, habit training, pelvic floor exercices, eating a well balanced diet (rich in fiber), and improving physical activity. For no reasons fluids should be restricted. Severe and untreatable cases may need the use of clean intermittent catheterization, insertion of indwelling catheters, use of external (condom) catheters and incontinence pads for urinary incontinence and use of rectal suppository, stool softeners and digital evacuation for bowel incontinence.

Incontinence is normally an inability to control bowel and bladder and not a significant problem in human body. It is not a disease, it is just a symptom. If you feel you have incontinence, don't isolate yourself from social activities. Take necessary precautions and go on to lead a normal life.

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