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Incontinence



Definition

Involuntary urination, or urination without knowing you have lost urine.


Causes

The key to successful treatment of urinary incontinence rests in proper evaluation of the underlying condition.

1. Infection
If the incontinence is associated with cloudy urine or pain, burning or urgency in urination, the incontinence may be the result of infection.

2. Food sensitivity
If foods are involved in causing the incontinence, or in causing an inflammation of the bladder called cystitis, this may be the source of the incontinence. Infection is most frequently associated with a food sensitivity, the irritation from the food weakening the lining of the bladder which then allows a germ to infect the bladder.

3. Stress
If the incontinence is brought on by coughing, sneezing, laughing, exercise or strong emotions such as intense grief, the diagnosis is stress incontinence.

4. Cold
"Cold foot cystitis:" If the incontinence occurs mainly during cold weather, it may be caused by chilled feet.

5. Muscle weakness
If the incontinence occurs mainly when you are reaching for the bathroom door or removing your clothing, it may be due to weak control of the voluntary muscles, and a strong detrusor muscle in the bladder (involuntary) which squeezes the bladder while the voluntary muscle control is not at its peak.

6. Nerve damage
If the condition began following surgery or radiation, there may have been nerve or muscle damage which may be more or less permanent.

7. Over-hydration
It can be helpful to keep a voiding diary recording the times of voiding, the volume voided, any incontinence episodes, the severity of the leakage, and whether it occurs at night or on a regular daily schedule at a certain period during the day. Keep the diary for one week. If your incontinence comes on only after drinking large quantities of water, some degree of fluid restriction may be helpful. If the urine volume is 2000 to 3000 cc. per day (two to three quarts), the diagnosis may be over

8. Chemical irritants
Urinalysis and blood tests should be performed to determine if there are systemic problems such as diabetes, nephritis. If the laboratory test results show abnormalities in some of the chemistries, this can be the cause of incontinence. Sugar in the urine or too much calcium can both aggravate incontinence. When elevated calcium causes mental confusion, this condition can result in interference with urination.

9. Low thyroid
Hypothyroidism has been associated with irritability and instability of the bladder.

10. Dehydration
If the person becomes chronically dehydrated and has very concentrated urine, the waste chemicals in the urine can irritate the bladder and cause incontinence.

11. Nervousness with residual urine
If the urinary bladder is not completely emptied with each urination and there is a significant "residual urine," this can lead to incontinence. Nervousness or being in too big a hurry to finish urination can cause residual urine.

12. Drugs
Some drugs change urethral pressure preventing effective bladder emptying, urinary retention, or challenge the bladder with excessive fluid load--antihypertensives, antidepressants, antipsychotics, sleeping pills, caffeine, muscle relaxants, antihistamines, diuretics, hormones (progesterone, thyroid hormones). in one study over 70 percent of nursing home residents with incontinence took drugs. In another study it was 90 percent.

13. Invalidism or urge incontinence
Patients who cannot move about very well may not have time to get to the rest room to prevent an accident.

14. Bladder tumors
An examination of the pelvis, or abdomen, may detect masses, suprapubic fullness, or tenderness.

15. Irritation of perineum
A pelvic exam should be performed to evaluate the perineal skin for rashes, and the vagina and urethra for evidence of estrogen deficiency leading to irritation of the urethra or bladder. Some women respond to treatment with herbs and diet for low estrogen (about 50 percent of symptoms are relieved).

16. Urethral diverticulum
The urethral diverticulum often gives tenderness in the vaginal wall. Prolapsed uterus can cause pressure on the bladder resulting in a small capacity for urine.

17. Urethral function
Muscle function should be tested in the urethra, as well as the perineal muscles. Check the anus and note the quality of the pressure on the examining finger which can easily reveal the strength of all perineal muscles including urethral muscle strength.

18. Self-neurologic testing
Neurologic function should be assessed by perineal sensations, whether pin pricks appear sharp or blunt. This checks the nerves. S2, S3, S4 evaluates the strength of the lower limbs by simple actions requiring strength. Gentle stroking of the perianal region with a pencil eraser will produce the "wink" reflex from reflex contraction of the perineal muscles.


Treatment

1. Water drinking
Drink plenty of water to keep the urine diluted as concentrated urine can irritate the bladder. The color of the urine must be pale straw colored, or you are not drinking sufficient water.

2. Warm extremities
Keep the extremities constantly warm. Chilled feet and legs cause a reduction in blood flow to the pelvic organs, and retard healing of the bladder.

3. Kegel exercises
Six times daily for one minute each time, practice contracting to the full extent of the power of the musculature of the perineum, buttocks, thighs, and lower abdomen for cutting off an imaginary urinary stream. These exercises should follow each other as rapidly as is possible to get a full and intense contraction. Then relax fully before repeating the contraction. At least 20 contractions should be done during the one-minute. This is best done twelve to fifteen times a day when one is not urinating, and only occasionally when urinating to test the effectiveness of your efforts. While passing the urine, after urination has been fully established, practice stopping the urine flow. Then start it up again, and a second time practice stopping the urine flow totally. Then empty the bladder and press the remaining urine from the bladder with a straining action. The Kegel exercises for genuine stress incontinence has been shown to be beneficial in all patients who have tried the exercises. A group of 14 women had supervised pelvic floor exercises for four weeks and all received benefit. It has been shown that most women, even though they have benefit from the exercises in a four-week period, failed to continue the exercises over a long term period. It appears that motivation for the exercises is fairly low. Reference: Southern Medical Journal 88(5):547-550 May, 1995

4. Strengthen thighs
Practice the habit of crossing the legs and squeezing the pelvis together in order to strengthen voluntary control over the bladder.

5. Protective pads
Use pads or other protective devices if necessary.

6. Bridging
While lying on the back on a carpeted floor, support the entire weight of the body on the heels and the shoulders by lifting the hips and thighs, head and arms, off the floor. This exercise should be maintained for three seconds only on the first day. if no discomfort arises from having done the exercise, the second day may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute.

7. Winging
While lying face down on a carpeted floor, lift both the lower and the upper extremities, shoulders and head, off the floor behind your back, supporting the weight entirely with the abdomen. This exercise should be maintained for three seconds only on the first day. If no discomfort arises from having done the exercise, the second day may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute.

8. Urination schedule
Schedule a certain time for passing urine, every hour at first, trying to abstain from voiding at any other time. After ten days increase the interval between voidings, the goal being an interval of two and a half to three and a half hours.

9. Positions
(1) Knee chest position - Kneel on the bed or floor, bend over to rest head and arms on the bed. Try to actually get your chest on the bed. This position allows the organs inside the abdomen to move toward the head which promotes good circulation and stretches the muscles of the perineum, encouraging good tone. Hold the knee-chest position for 1-5 minutes. (2) Stand, sit, and lie with good posture. When performing any physical function, whether it be exercising out-of-doors, chopping vegetables in the kitchen, doing shop work, or sitting at the computer, good posture should always be maintained. If the head and shoulders are carried forward during walking, it can lead to neck or shoulder pain. The skeleton should be entirely balanced, one vertebra held directly perpendicular to the one below it as much as possible so that the back and neck are in the "neutral position," the cheek bones directly over the collar bones, and the knees relaxed, not hyperextended. Mental and emotional benefits, grace and dignity, self-possession, courage and self-reliance, are all promoted by an erect bearing. Keep the shoulders back and down, and the head erect.

10. Deep breathing
Practice breathing deeply before sleeping, while sitting at one's desk, working in the house, or exercising out-of-doors. Every time you go through a door, take a deep breath. This action soothes and strengthens the abdominal organs and muscles.

11. Food sensitivities
Many people are sensitive to certain foods or beverages, causing the bladder to become unusually sensitive. Then upon stress or filling, the bladder gets such a stimulus to contract that the voluntary muscles are unable to prevent loss of urine. In order to prevent this sensitivity, one may discover those foods to which one is sensitive and remove them from the diet. Eliminate the following list of foods for 28 days, or until the incontinence stops: Dairy products (causing over 60 per cent of all food allergies), chocolate, colas, coffee, tea, eggs, pork, beef, fish, all flesh foods, legumes, peanuts, soybean products, citrus fruits and juices, tomatoes, potatoes, eggplant, peppers, corn, cornstarch, corn products, rice, wheat, oatmeal, yeast, cane sugar, cinnamon, irritating substances, spices, beer, alcohol, food colors (both artificial and natural), strawberries, apples, bananas, nuts (all kinds), seeds, lettuce, garlic, onion.

As soon as the 28 days are up, or the incontinence ceases, whichever comes first, start adding the foods back one at a time every five days until the incontinence returns. Make a list of all those foods causing the incontinence.

12. Herbal Remedies
(1) Horsetail or Shavegrass - 1/4 cup steeped for half an hour in one quart of boiling water. Use one quart a day for soothing the bladder.
(2) Corn silk - 1/3 cup to one quart boiling water Remove from heat and steep for 30 minutes for soothing the bladder.
(3) Buchu tea - One teaspoon of tea in a cup. Pour one cup of boiling water onto the leaves. Steep for 30 minutes. Drink one to eight cups daily as needed for soothing of the bladder.
(4) Uva-ursi tea - make and use as you would the buchu.
(5) If you have a urinary tract infection take golden seal and echinacea, one tablespoon of each boiled gently in one quart of water. May be mixed with marshmallow root.
(6) Take one to six cups of catnip tea daily for its soothing effect on the bladder, along with marshmallow and buchu tea. Put one tablespoon of marshmallow root in a quart of gently boiling water and simmer 20 minutes. Pour it all up into a container having one tablespoon of buchu and one tablespoon of catnip. Steep 30 minutes. Strain and drink over the next twelve hours. Make up fresh daily.

13. Cervical diaphragm
A recent report in a medical journal indicates that a cervical diaphragm, such as is used for contraception, may control stress incontinence in women almost completely. It will require fitting by your doctor. Cut away the part that fits over the opening of the cervix, leaving just the ring around the cervix. The ring will press against the bladder neck and control most leakage. It can be easily inserted by the person herself. Remove once a week, rinse well in cold water and reinsert.

14. For stress
For stress the best hope for control is frequent emptying of the bladder and wearing a protective pad anytime it is expected intense emotions might be felt, or when you are in the grip of coughs or colds.

15. Treat other conditions
Treat appropriately any hormone or metabolic condition such as hypothyroidism or diabetes.

16. Complete emptying
Take plenty of time to completely empty the bladder with each urination, as the bladder can "squeeze" itself somewhat, which encourages shedding of the dead superficial layers of cells much in the same way the skin sheds. Try to encourage complete emptying by gentle straining and by gentle pressure on the lower abdomen.

17. Cytology
If a tumor or a cancer is suspected, contact a laboratory to do cytology studies on freshly voided urine. They will provide a fixative solution for you to collect the urine in for transport to the lab.

18. Discontinue drugs
Any drugs being taken, and many nutrient supplements, should be discontinued if possible to test whether the pill is causing the incontinence.






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