Incontinence

Overactive bladder is a urological problem in which patients experience strong, sudden urges to urinate. People who suffer from this condition typically experience frequent urination, nocturia and sometimes urinary incontinence. This means that sufferers urinate more than eight times each day and are often woken up by their urges at night.

While dealing with an overactive bladder can be frustrating, there are many ways to manage this condition. One way to manage an overactive bladder is to strengthen your pelvic floor muscles. These muscles can be strengthened by regularly performing Kegel exercises. Kegel exercises are simple exercises that require a person to flex and hold their pelvic floor muscles. Within six to eight weeks of performing Kegels, many people notice an improvement in their ability to hold urine. Special vaginal weights can also be used to enhance the effectiveness of these exercises.

It is also possible to improve your condition by retraining your bladder. To begin retraining your bladder, avoid going to the bathroom after feeling an urge to urinate. At first, make yourself wait at least five or ten minutes before heading to the bathroom. As this becomes easier, slowly lengthen the amount of time you force yourself to wait. Many people find that it helps if they schedule their trips to the bathroom instead of going when the urge hits. With practice, you should be able to go three to five hours without urinating.

A few lifestyle changes can also make a big difference. People with overactive bladder should limit their fluid intake, avoid caffeine and start double voiding. Double voiding is a management technique that requires patients to urinate twice within a few minutes. People who suffer from overactive bladder sometimes have a difficult time voiding, or emptying their bladder. Urinating twice in a short time frame can make it easier to completely empty the bladder. If double voiding does not help your condition, you might want to talk to your physician about periodically using a catheter. This should help you retrain your bladder to empty itself and reduce the frequency of your urges.

External incontinence devices are products, called appliances, worn on the outside of the body to protect the skin from constant leakage of stool or urine. Certain medical conditions can cause a person to frequently lose control of their bowel or bladder.

Condom catheter; Incontinence devices; Fecal collection devices

Although there are several different products available, the general features of these products are described below.

FECAL INCONTINENCE DEVICES

Several devices are available for managing long-term diarrhea or fecal incontinence. These devices have a drainable pouch attached to an adhesive wafer. This wafer has a hole cut through the center that fits over the anal opening (rectum).

With proper application, a fecal incontinence device may remain in place for 24 hours. It is important to remove the pouch if any stool leakage has occurred. Liquid stool is very irritating to the skin.

If leakage has occurred, always clean the skin and apply a new pouch.

The device should be applied to clean, dry skin:

• A protective skin barrier (such as a paste) may be prescribed by your healthcare provider. You apply it to the skin before attaching the device. You can put the paste in the skin folds of the buttocks to prevent liquid stool from leaking through this area.
• Spread the buttocks apart, exposing the rectum, and apply the wafer and pouch. It may help to have someone assist you. The device should cover the skin with no gaps or creases.
• You may need to trim the hair around the rectum to help the wafer stick better to the skin.

An enterostomal therapy nurse or skin care nurse can provide you with a list of products that are available in your area. (See also: Skin care and incontinence)

URINARY INCONTINENCE DEVICES

Urine collection devices are primarily used by men. (Women are generally treated with medication and disposable garments like Depends.)

The systems for men usually consist of a pouch or condom-like device that is securely placed around the penis. This is often called a condom catheter. A drainage tube is attached at the tip of the device to remove urine. The drainage tube empties into a storage bag, which can be emptied directly into the toilet.

Condom catheters are most effective when applied to a clean, dry penis. You may need to trim the hair around the pubic area so the device attatches better.

You must change the device at least every other day to protect the skin and prevent urinary tract infections. Make sure the condom device fits snugly but not too tightly. (If it's too tight, skin damage may occur.)

Payne CK. Conservative management of urinary incontinence: Behavioral and pelvic floor therapy, urethral and pelvic devices. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 63.

Rao SSC. Fecal incontinence. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 17.