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2017 HCHB_digital

Urinary Incontinence

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. PharmacyToday.co.nz A part of your everyday. New Zealand’s premier pharmacy website keeping you up to date between issues. www.pharmacytoday.co.nz Page 156 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Initial assessment Bladder training, surgery and other procedures can help many people with urinary incontinence so politely enquire if a customer has talked to a doctor about their incontinence when selling incontinence pads or pants. Skin irritation can also occur, and customers should be advised to use a barrier cream to protect their skin, and to keep underwear clean and dry. More information can be found on the NZ Continence Association’s website at www.continence.org.nz. A related site, pelvicfloor.co.nz provides detailed information and advice about maintaining a strong pelvic floor. Treatment In most cases, people with incontinence will need to be referred for further investigations to establish a cause. Products available in a pharmacy for incontinence include absorbent pads and underwear, which may be used as a temporary measure before the customer sees a doctor, or for use in people when the cause has been established but urinary leakage still occurs. Urinary incontinence in children The age at which children achieve dryness varies. Wetting in very young children is common and is not considered incontinence. The term enuresis is often used to describe inability to control urination in those old enough to exercise such control. Daytime enuresis affects around 3%–4% of children between the ages of four and 12 with girls being more commonly affected than boys. Children experiencing daytime enuresis should initially be assessed by a doctor to rule out a urinary tract infection and also constipation, which can also adversely affect bladder function. Some children may also need an ultrasound if structural abnormalities are suspected. In most cases a cause is not identified. Nocturnal enuresis (wetting the bed at night) is not usually diagnosed until age seven and typically resolves with age, with only 1%–2% of 18-year-olds still being affected. It occurs slightly more in boys than girls and tends to run in families with most children having at least one relative who also wet the bed. Information about toilet training and the management of both daytime and nocturnal enuresis for parents and caregivers can be found at www. continence.org.nz. Daytime enuresis may resolve once fluid intake is increased (makes it easier for the child to recognise a full bladder) and bladder retraining techniques are put in place. Alarm systems that wake a child at night have proven to be a good long-term treatment for nocturnal enuresis with a 70% success rate. Refer to a PHARMACIST/DOCTOR If the person suddenly CANNOT pass urine, then they should see their doctor immediately as this may be a medical emergency. Refer all customers presenting with urinary incontinence for the first time to a pharmacist. The pharmacist should then direct them to a doctor to establish a cause. For customers with previously diagnosed urinary incontinence who are purchasing pads or incontinence pants refer any of the following “yes” answers to the pharmacist. • Is the urine leakage interfering with the person’s lifestyle? • Are there any signs of a bladder infection, such as pain in passing urine (see Cystitis). • Is there any blood in the urine? » » advice about toileting outside of the home situation. • Some exercise regimens are not pelvic floor friendly. See pelvicfloor.co.nz for pelvic floor safe exercises. • Customers with incontinence of recent onset should keep a bladder diary before seeing their doctor. » » Record when and how much leakage occurs, how strong the urge is to urinate, what activity was being done when the urge to urinate occurred, medicines taken (prescription, over the counter) and daily fluid intake. • Avoid foods and drinks that can irritate the bladder, eg, spicy foods, caffeine, alcohol, fizzy drinks, chocolate, citrus fruits and juices. • Weight loss may help in people who are overweight. • Community incontinence nurse educators provide education and advice. Advice for customers • Ensure the customer has discussed an incontinence management plan with their doctor which usually consists of several of the following options: »» ensuring an adequate, but moderate, fluid intake (eg, 1000 –1500ml/day) »» a pelvic floor muscle exercise programme »» a bladder retraining and toileting programme »» medicines for incontinence »» incontinence aids (eg, pads, condom drainage, catheters) Page 157

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