Urinary incontinence or involuntary leakage of small or large amounts of urine at the wrong place and at the wrong time is a problem that occurs in many women. Urinary incontinence or involuntary leakage is a consequence of overactive bladder. However, overactive bladder and incontinence can well be treated with a bladder training, in which the woman is trained to control the bladder and reduce the frequent need to visit the bathroom.
When there is a bladder-storage dysfunction that results in frequent urge to urinate, it is called an overactive bladder. In this case, the woman finds it difficult or almost impossible to control her urge and there is an involuntary leakage of urine.
Approximately 40% are found to have overactive bladder and up to 70% women have urinary incontinence. Although it is not a life threatening problem, it can still last for several years. The normal frequency of visiting a bathroom in a single day is seven times; visiting more than this can be a symptom of an overactive bladder.
Usually the 300 to 400 millilitres of urine can be held by a normal and healthy bladder, during the day time. At night, it can hold up to four cups or 800 millilitres of urine. Usually, a healthy bladder would feel the urge to urinate as the person wakes up from sleep in the morning, three times throughout the day and once before going to bed. But of course, it is normal to urinate seven times in a day. Urinating more than eight times is considered to be an overactive bladder.
Incontinence and its Types:
Any accidental or involuntary loss of bowel motion, urine from the bladder, wind from the bowel or even faeces from the bowel is known as incontinence. Incontinence can be non-severe with 'just a small leak', as well as extremely severe with complete involuntary leakage of bowel and urine.
There are two types of incontinences, depending on its leak and they are –
- Urinary Incontinence – When the person has little or no control over the urinary bladder and involuntarily leaks urine, it is known as urinary incontinence. It can range from less severe to extremely severe in which occasional leakage may include leaking when laughing or coughing and complete leakage and becoming wet. When you suddenly leak a little due to coughing and laughing or sneezing, it is called stress incontinence. If without any indication, your bladder compels you to rush to the toilet and you don't get the time, it is urge incontinence. If the bladder is not emptied completely, it is called overflow continence. However, a combination of both urge and stress incontinence is known as mixed incontinence.
- Faecal Incontinence – When a person cannot control bowel movement or passes air involuntarily at the wrong place and wrong time, it is known as faecal incontinence. Almost 1 in every 20 persons is found to have faecal incontinence.
Symptoms of Incontinence and Overactive Bladder:
For urinary incontinence, the symptoms include –
- Sudden and uncontrollable urge to urinate
- Frequent need to wake up during sleep at night
- Complete leakage of urine.
For faecal incontinence, the symptoms include –
- Sudden passing of bowel or faecal wind involuntarily
- Staining of the underwear
- Complete leakage of bowel.
Causes of Incontinence and Overactive Bladder:
A number of causes can contribute in the overactive bladder, urinary and faecal incontinence. The very basic factor is that the muscles of bladder contract involuntarily. This happens even when there is not enough urine in the bladder, but still you feel the urge to urinate. The causes include –
- Neurological disorder
- Diabetes or kidney dysfunction and excessive production of urine
- Certain medications that can increase urine production rapidly
- Consumption of caffeine or alcohol
- Accidents and spinal cord injuries
Bladder Training for Women to Prevent Incontinence and Overactive Bladder:
Bladder training is the best way to prevent urinary incontinence. It can significantly reduce the need to go to toilet. It can also help you to gain the control to wait until your bladder is full. As you start the bladder training programme, it can bring you effective results within a few weeks of the start of the programme. However, depending on the severity, it can also take a few months.
Usually, the healthcare provider or the doctor will determine the right time and place to start the bladder training programme. He might ask you to maintain a diary to record the frequency and time gap of urge to urinate. This helps the doctor to determine the suitable programme for you.
Bladder Training Technique for Women #1: Visit the toilet only on scheduled times
If your diary shows that you visit the toilet in every 2 to 3 hours, you must try and increase the time by 15 minutes for every visit and hold the urge to urinate until this scheduled time. In this case, it is very important to keep in mind that you go only when the scheduled time has come, but not before that and positively go on the scheduled time, even if there is no urge to urinate. Maintaining this routine will teach your bladder that it must urinate only when it is supposed to and not always and anytime.
Bladder Training Technique for Women #2: Delay the Urination Time
As you find that the average delaying of 15 minutes on your scheduled routine has been achieved, you must try to increase the delay time by 5 minutes and gradually more, to increase the gap by 15 to 30 minutes between two urination urges, in every week. With a gap of 3 to 4 days, you must also try to increase this delaying time by 5 more minutes and continue this process until you can hold it for 3 to 4 hours. When you feel an urgent need, divert your mind in doing some other tasks and start counting back.
At this time, monitoring the amount of leak is very important. If you find that the delaying training has lead to a damped pad from a saturated pad that you usually had, it should be considered as a good sign. Otherwise, the same schedule should be continued for another week.
Bladder Training Technique for Women #3: Kegel Exercise
Kegel Exercise is one of the most important parts of the entire Bladder Training Program. In this, you will learn techniques to strengthen the muscles that are used to start and stop the flow of urine. Kegel exercise requires you to contract and squeeze the muscles i.e., the floor muscles of your pelvis that help you to empty your bladder and also hold the urination urge. As you contract and squeeze the pelvic floor muscles, try to hold the contraction for 5 seconds and then let it relax for another 5 seconds. Gradually try to increase the contractions by 10 seconds, with a relaxation period of 10 seconds. Continue this process to make three sets of 10 contractions and relaxations each day.
Bladder Training Tips for Women to Help Suppress the Urge:
As you start your bladder training, you will find that on some days, you are performing well and on some days, it is not working out. You must continue to practice your bladder training schedules. To control your frustration and to suppress the urge, you can –
Bladder Training Tips #1: Sit straight and breathe slowly, but deeply to fight with your urges.
Bladder Training Tips #2: Avoid food and fluid intakes that can trigger the urge to urinate and in that case, avoiding alcohol, caffeine, spicy foods and highly acidic food will help your bladder to suppress the urge.
Bladder Training Tips #3: One thing that most people do is reduce their fluid intakes, but that must not be done. Continue regular fluid intakes. Remember, producing less urine is not the solution. You might still feel the same urge. However, of course, drink a moderate amount of fluid.
Bladder Training Tips #4: Focus on other things when you feel the urge.
Other Treatments for Urinary Incontinence
Usually, the bladder training helps a lot in most cases. Yet for those, who find it not working so well or are in the need for some additional support can use medications such as Tolterodine (Detrol), Oxybutynin gel (Gelnique), Darifenacin (Enablex), Trospium (Sanctura) etc. Botox injections are also very useful. It is a protein that partially paralyses the bladder muscles. However, the action of botox injections last only for a few months and they are not recommended for those, who have neurological diseases. Sometimes, in order to improve the impulse control, the doctor inserts thin wires close to the sacral nerves to send electrical impulses to your bladder, in order to control its urges.
When none of the other treatments work, there are the surgical treatments in which the bladder capacity is increased by taking a portion of the bowel to expand the capacity of the bladder. However, in extreme cases, the bladder is removed and a bag is attached to the skin instead, to collect the urine.
Nevertheless, with regular practice and with determination, the bladder training alone can be very useful.