2017 HCHB_digital

Urinary Incontinence
Urinary incontinence, or loss of bladder control, is when urine accidentally leaks
from the bladder. In some people, just laughing, coughing or sneezing can cause
leakage. The amount of urine that leaks can range from just a few drops up to
the entire contents of the bladder.
More than 1.1 million (25%) of New Zealanders experience bladder or bowel
control problems. Urinary incontinence has been identified by the World Health
Organization as a major health issue in developed and developing nations.
Stress incontinence
This is when the bladder leaks due to physical pressure, usually from lifting,
exercising, coughing, sneezing or laughing. It happens when a person has weak
pelvic floor muscles or a weak urethral sphincter.
Pelvic floor muscles hold all the pelvic organs in their correct positions, and
also help keep the urethra closed, preventing leakage. The urethral sphincter is
a band of muscles around the urethra that, for the majority of the day, remain
tightly squeezed, keeping urine in the bladder. Nerve endings in the bladder
send a message to the spinal cord and brain for urination to occur once a certain
amount of urine has accumulated in the bladder. This results in relaxation of both the
sphincter and pelvic floor muscles. In people with stress incontinence, these muscles
are not strong enough to withstand the extra pressure lifting, exercising, coughing or
sneezing places on them. They involuntarily relax, allowing urine to escape.
Causes of stress incontinence include pregnancy and childbirth, menopause,
constant coughing, lots of heavy lifting, being overweight, straining to empty the
bladder or bowel, ageing, a lack of fitness or extreme exercise.
Urge incontinence
This is when there is a sudden, strong urge to pass urine and the person is unable to
hold on until they reach the toilet. People with urge incontinence may also feel the
need to urinate more often, including at night, even though their bladder is not full.
Urge incontinence occurs as a result of inappropriate contraction of the
urethral sphincter muscle, or the detrusor muscle of the bladder wall. Often these
contractions occur regardless of the amount of urine that is in the bladder.
Causes include urine infections, stroke, Alzheimer’s disease, Parkinson’s disease,
diabetes, certain medications and prostate problems. A "Can't Wait" toilet card is
available free from www.continence.org.nz for people with a medical condition
who need to let strangers discreetly know that they need a toilet quickly.
Overflow incontinence
This happens when the bladder is unable to fully empty itself. It becomes too
full, causing it to overflow and regularly leak or dribble small amounts of urine.
Causes include prostate problems, diabetes and certain medications.
Incontinence due to physical/neurologic abnormalities
Anatomic or neurologic abnormalities may affect the urinary system and cause
incontinence, such as fistulas (an abnormal opening between the bladder and
another structure).
Damage to the nervous system that regulates bladder control can also occur
due to trauma, disease or injury. This may cause the bladder to be underactive
(unable to contract and empty completely) or overactive (contracting too quickly
or frequently).
Other causes
Incontinence can also be a result of surgical procedures such as prostate or rectal
surgery and caesarean surgery. Some people (mostly women) can experience
both stress incontinence and urge incontinence simultaneously.
Incontinence can also occur simply due to a person’s inability to physically get
to a toilet, or to communicate this need to a caregiver.
Overactive Bladder Syndrome
Overactive bladder (OAB) syndrome is a general term used to describe the
symptoms of urinary urgency with or without urge incontinence, including the
frequent need to go to the toilet, and having to urinate more than once at night.
In summary, OAB is the condition, and urinary incontinence is a symptom of OAB.
TREATMENT OPTIONS
Category Examples Comments
Incontinence pads/pants
Furniture liners
eg, Attends range, Comforts Pads,
Confitex, D-Brief range, Depend range,
Molicare range, MoliMed, Poise Pad
Rrange, Tena range
eg, DryLife Absorbent Bedliner, DryLife
Seatliner
Minimise contact between urine and skin. May be reusable or disposable. Useful for temporary incontinence,
before seeing a doctor, or if medical options have been unsuccessful or are not appropriate. Most provide high
absorbent capacity with little bulk. Menstrual pads are not suitable for urinary incontinence since their absorption
capacity is limited and they become lumpy and leak when sodden. Consider the customer’s needs (light, moderate
or heavy) and whether assistance is needed to use and change the product.
Draws in and traps moisture, protecting bedding or furniture and minimising wetness. Absorbs 2.5L over eight hours.
Machine washable.
Barrier products
eg, dimethicone (Silic 15), zinc
(Sudocrem), zinc and castor oil, vitamin A
and calamine (Ungvita Cream)
Silicone or zinc-containing barrier creams protect the skin from the irritating effects of urine. Wash urine off
the skin with a mild cleanser and water before applying.
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Page 156 HEALTHCARE HANDBOOK 2017-2018 Common Disorders