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Urge urinary
incontinence: Also referred to
as "overactive bladder," this type of incontinence is usually
accompanied by a sudden, strong urge to urinate and an
inability to get to the toilet fast enough. Frequently, some
patients with urge incontinence may leak urine with no
warning. Risk factors for urge incontinence include aging,
obstruction of urine flow, inconsistent emptying of the
bladder and a diet high in bladder irritants (such as coffee,
tea, colas, chocolate and acidic fruit juices).
Mixed urinary
incontinence: Mixed
incontinence is a combination of urge and stress incontinence.
Overflow urinary
incontinence: Overflow
incontinence occurs when the bladder does not empty properly
and the amount of urine produced exceeds the capacity of the
bladder. It is characterized by frequent urination and
dribbling. Poor bladder emptying occurs if there is an
obstruction to flow or if the bladder muscle cannot contract
effectively.
Can I be managed without medications or surgery?
Some of the causes of
incontinence are temporary and easily reversible. Reversible
causes include urinary tract infection, vaginal infection or
irritation, medication, constipation and restricted mobility.
However, in some cases, further medical intervention is
necessary. Minimally invasive treatment options are those
treatments that do not involve surgery and should be the first
line of treatment for patients. Sometimes, they may also be
used in conjunction with surgical therapy.
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Fluid
management: This option
consists of instructing a patient to increase or reduce
their fluid intake. Incontinent patients may need to
reduce the amount of caffeine or other dietary irritants
(such as acidic fruit juices, colas, coffee and tea),
while at the same time increase water intake to produce an
adequate amount of non-irritating, non-concentrated urine.
A recommended water intake is six to eight glasses per
day. |
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Bladder
training: A diary is the
starting point for bladder training. Patients are
instructed to record fluid intake, urination times and
when their urinary accidents occur. The diary allows the
patient to see how often they actually urinate and when
incontinence occurs. The diary is also used to set time
intervals for urination. Patients who urinate infrequently
are instructed to do "timed urination" where they urinate
by the clock every one to two hours during waking hours.
By achieving regular bladder emptying they should have
fewer incontinent episodes. Timed urination may be
effective in patients with both urge and stress
incontinence. |
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Bladder
retraining: Bladder
retraining is used for patients with urinary frequency.
The goal of retraining is to increase the amount of urine
that the patient can hold within their bladder. Patients
are instructed to keep a diary to determine their
urination interval. Patients are then instructed to
gradually increase their urination interval by 15 to 30
minutes per week. The goal is to have patients urinating
every two to four hours while awake with less urgency and
less incontinence. |
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Pelvic floor
exercises: Also known as
Kegel exercises, this type of minimally invasive treatment
focuses on strengthening the external sphincter muscle and
the pelvic muscles. Patients who are able to contract and
relax their pelvic floor muscles can improve their
strength by doing the exercises regularly. Other patients
require help from a health-care professional to learn how
to contract those muscles. Biofeedback and electrical
stimulation can be used to aid patients in doing pelvic
floor exercises. During electrical stimulation, a small
amount of stimulation from a sensor placed in the vagina
or rectum is delivered to the muscles of the pelvic floor.
Like any exercise program, the patient must continue to do
the exercises to maintain the benefit. Patients with
stress incontinence benefit from pelvic floor exercises by
increasing resistance at the urethra and by increasing the
strength of the voluntary pelvic floor muscles. Patients
can also be taught to compensate by contracting the pelvic
muscles with certain activities like coughing.
Pelvic floor muscle exercises are effective for urge
incontinence, since a contraction of the pelvic floor can
interrupt a contraction of the bladder smooth muscle and
stop or delay an accident.
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How do I know if I am doing pelvic floor exercises properly?
When you do pelvic floor
exercises only the pelvic floor should move. The pelvic floor
muscles are tightened as if you wanted to stop urinating
midstream or stop the passage of gas. The abdominal, buttock
or leg muscles should not be tightened. By doing the exercises
in front of a mirror or by placing a hand on the abdominal or
buttock muscles you will be able to tell if you are
contracting any of the wrong muscles. If the exercises are
done properly, they can be done anywhere.
What kind of benefits can be expected?
Minimally invasive
therapies can lead to improvement in incontinence but not
necessarily a cure. Improvement generally does not occur
overnight. Patients need time to adapt to behavioral changes.
Results with pelvic floor exercises may take three to six
months. Some patients may notice an immediate effect with
medical therapy, whereas in others an effect may not be seen
for approximately four weeks. Incontinence may also recur
after treatment. Continuing behavioral techniques or
continuing or resuming pharmacologic treatment as well as
practicing preventive strategies may prevent such recurrence.
Incontinence may also be prevented by good toileting habits
including regular urination, pelvic floor exercises, avoidance
of constipation, avoidance of bladder irritants and adequate
water intake.
Tips for Managing Urinary Incontinence
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Get the right
diagnosis - keep a diary for a week of what you eat and
drink, how often you go to the bathroom, how often you
lose urine every day and symptoms that might be affecting
your bladder control (e.g., coughing, laughing, etc.) |
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Eliminate bladder
irritants from your diet - avoid alcohol, coffee,
carbonated beverages, fruit juices, vinegar and certain
fruits (e.g., strawberries, peaches, plums, grapes,
pineapple and guava). |
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Quit smoking -
nicotine is a bladder irritant and it may also cause
coughing, which in turn can cause you to lose urine.
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Lose weight - excess
weight can put pressure on your bladder
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Empty your bladder
completely - Don't strain your muscles but rather stand up
or shift your position, wait a minute or two, and then
urinate again. |
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Keep skin clean
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After a urinary
accident, clean any affected areas immediately
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When bathing, use warm
water |
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After bathing, a
moisturizer plus a barrier cream should be applied.
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Dietary Irritants To The Urinary Tract
ACIDIC FOODS TO BE AVOIDED
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Apples |
Mayonnaise |
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Apple
Juice |
Nutrasweet |
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Cantaloupes |
Peaches |
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Carbonation |
Pineapple |
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Chilies/Spicy Foods |
Plums |
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Chocolate |
Strawberries |
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Citrus Fruits |
Tea |
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Coffee (including Decaffeinated) |
Tomatoes |
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Cranberries |
Vinegar |
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Grapes |
Vitamin B Complex |
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Guava |
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If bladder symptoms are
related to dietary factors, strict adherence to a diet which
eliminates the above food products should bring significant
relief in ten days. The proof is resuming your old dietary
habits followed by the return of symptom complex. Once you are
feeling better, you can begin to add these things back into
your diet, one thing at a time. This way, if something does
cause your symptoms, you will be able to identify what it is.
When you do begin to add foods back into your diet, it is
crucial that you maintain a significant water intake. Water
should be the majority of what you drink every day. ***
Substitutions
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Low Acid Fruits
- Pears, Apricots, Papaya and Watermelon |
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For coffee drinkers
- KAVA (Low Acid Instant) Cold Brew from Starbucks |
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For tea drinkers
- Non-Citrus Herbal Sun Brewed Tea |
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Vitamin C
substitute - Calcium Carbonate Co-buffered with
Calcium Ascorbate |
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