Thu 26, May 2016

Old Hands

Some of the measures taken by people with arthritis to avoid urinary leakage, may in fact be exacerbating their incontinence. 

Not getting to the toilet in time:

Limited mobility can result in people with arthritis not reaching the toilet in time. Some of the measures people take to avoid accidents can actually make their incontinence worse. For example, they may go to the toilet before they get the urge to urinate in order to avoid accidents later. While this may work for the short term, it can lead to the bladder losing its volume capacity over time, resulting in it having to empty more frequently in increasingly smaller amounts.

Some people will reduce their fluid intake in the hope it reduces the number of trips required to go to the toilet. While this appears logical, the reverse is true. Insufficient fluid intake causes urine to become concentrated, which can cause the bladder to become irritated, leading to it emptying its contents more often. This can result in frequency and urge incontinence.

Joint stiffness

Stiffness, particularly in the hands and wrists, can make removing underwear and outer clothing difficult. Again, going to the toilet more often or before feeling the urge, or reducing fluid intake, can all risk frequency and/or urge incontinence.

Overactive bladder

The bladder empties as a result of the bladder muscle contracting and pushing urine out through the urethra. As people get older, the bladder muscle can become overactive, resulting in more frequent contractions, along with the urge to urinate. The two main symptoms of overactive bladder - frequency and urge incontinence - can worsen over time, to the point where leakage occurs before reaching the toilet.

Constipation

People affected by arthritis frequently develop constipation, either because they are not as active as they used to be, or because they are limiting their fluid intake to manage their bladder control problems.

Constipation is one of the main causes of incontinence, particularly in older people. An overfull bowel restricts the bladder’s volume and capacity to hold urine, which can lead to frequency and urge incontinence. In addition, straining on the toilet due to constipation can stretch and weaken the pelvic floor, which can lead to stress incontinence.

Preventing and managing incontinence

More than 4.8 million (one in four) Australian adults experience some form of incontinence. It has far-reaching impacts and can negatively affect a person’s work, social and sexual relationships and their quality of life. It is also associated with depression, particularly in women.

Incontinence is not normal, and should never be ignored. Fortunately, in the majority of cases, there is a great deal that can be done to prevent or better manage incontinence, simply by adopting a few healthy lifestyle habits.

The Continence Foundation of Australia recommends these five steps for good bladder and bowel control:

Eat well

Eat a balanced diet that incorporates at least 30g of fibre daily, which can be made up with two to three serves of fruit, five serves of vegetables and five serves of cereals and breads. It is important to get the balance right, because just adding fibre to the diet without increasing the fluid intake may make constipation worse. If constipation persists, consult your GP.

Drink adequate fluids every day

Drink to satisfy your thirst, typically 1.5–2 litres of fluid a day, unless told otherwise by your doctor. Cut down on the amount of alcohol and caffeine you drink, as these can irritate your bladder. Caffeine is present in chocolate, coffee, tea, and fizzy drinks such as cola and sports drinks.

Exercise regularly

Movement is important for arthritis, so aim for about 30 minutes of exercise each day, and remember, walking is great exercise. Maintain a healthy body weight, because being overweight also increases the risk of stress incontinence.

Keep your pelvic floor toned

Toned pelvic floor muscles help control your bladder and bowel, and can help control urgency.  Learn how to do pelvic floor exercises at pelvicfloorfirst.org.au

Practise good toilet habits

Empty your bladder when you feel the urge. Don’t go “just in case” (except just before bedtime), and relax and take the time to completely empty your bladder.

Similarly, empty your bowel when you get the urge, which usually occurs 20 minutes after a meal and is most strongly felt after breakfast, and avoid holding on (which risks constipation). To adopt the correct position, sit on the toilet leaning forward, elbows on knees, with your feet up on a small footstool so your knees are higher than your hips, as this straightens out the colon (see picture).

 If you are affected by incontinence, speaking to a Nurse Continence Specialist on the free National Continence Helpline (1800 33 00 66) is a good first step to getting help. 

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