About incontinence

The role of the kidneys is to filter unneeded substances from the bloodstream and send them to the bladder, a muscular bag that can stretch to hold up to 500ml when full. At half full, nerves tell the brain that it’s time to urinate and urine passes down the urethra, which is kept closed by two sphincter muscles. The inner sphincter will open when the bladder is full but the outer sphincter muscle can be voluntarily held shut to maintain control over urination. It’s the job of the pelvic floor muscles, which lie beneath the bladder and around the urethra, to keep them working correctly. 1 out of 4 women and 1 out of 8 men experience an interruption to this process at some time in their lives.

Urinary incontinence is a problem of the urinary system, which consists of two kidneys each connected to a bladder via a tube called a ureter. A single tube, the urethra, connects the bladder to the outside of the body.
 
Kidneys remove waste products from the blood and produce urine. The ureters move urine from the kidneys to store it in the bladder until it flows out of the body through the urethra. A circular muscle called the sphincter controls the activity of the urethra.

In normal circumstances, the bladder stores urine until it is convenient to urinate, but incontinence can result when part of the urinary system malfunctions.

The bladder is a muscular sac called the Detrusor muscle, with two important functions:    

• Storing urine produced by the kidneys, and       
• Emptying urine at the convenient time

For normal adults, a typical bladder can contain 300 to 600 ml of urine. However, an elderly person's bladder may hold much less due to the changes associated with normal aging and decreased flexibility of the Detrusor.

Depending on factors like the individual's liquid and food intake or level of perspiration, the kidneys will normally produce around 1000 to 2000 ml of urine over 24 hours. To handle this amount of urine, we need to void, on average, some 4 to 7 times a day.

How does the bladder work?

When the bladder is full, receptors on the inner wall of the bladder submit a signal to the brain via the sensory nerve pathway, through the spinal cord.
The micturition centre in the brain registers the request and we sense an urge to empty our bladder.
At will, a signal is transferred back along the sensory nerve pathway to release the closed muscle of the pelvic floor and bladder.
As the urethra releases the bladder contracts, and voiding begins as the bladder pressure exceeds the pressure in the urethra. Incontinence occurs when either the bladder muscles contract suddenly or muscles surrounding the urethra relax suddenly.

Incontinence means the involuntary loss of bladder or bowel control and is a symptom not a condition in itself. There are a wide variety of conditions and disorders that can bring about incontinence, including birth defects, the effects of surgery, nerve damage, infection, and changes associated with ageing. It can also occur as a result of pregnancy or childbirth.

Incontinence exists among children, men and women of all ages. At some stage during their lives, 1 in 4 women and 1 in 8 men will be affected.

The scale of the condition varies too – in the case of urinary incontinence, from small and infrequent dribbles, to the occasional loss of bladder control or a total inability to hold urine.

Read more here about the different types, causes and treatments of incontinence.

Ageing causes a number of changes in the urinary system that can cause incontinence:

- Less bladder elasticity – lowers capacity and causes more frequent voids
- Higher urine volume – kidneys less efficient at concentrating urine
- Weaker detrusor muscle causing incomplete emptying
- Increase in spontaneous contractions of detrusor muscle
- Less able to postpone urination
- Less urethral closing pressure

However, despite affecting a large number of older men and women, urinary incontinence should not be seen as a normal part of ageing. It is a disruption of the physical and/or mental processes of storing urine and emptying the bladder at a convenient time, a disruption which can often be treated.  

Many older people are unduly affected by the inconvenience and embarrassment of incontinence. Professional care can help many patients and their families manage the condition successfully. Discreet and effective incontinence protection plays a key role in minimising the effects and helping restore normal life.
 

Here are some tips you can pass onto clients and patients to help them achieve a healthy bladder

• Drink plenty of water
• Limit caffeine alchohol and fizzy drinks
• Do pelvic floor exercises
• Don't go to the toilet 'just in case' however also don't hold on too long
• Keep your weight under control
• Don't smoke
• Don't strain when going to the toilet

The frail elderly are often in need of professional continence care – in their own homes or in a nursing home. Clearly the increasing effects of ageing on the urinary system are the main reason for this however there can be other issues such as lack of mobility or dementia. A difficulty in reaching the toilet or in communicating the need to urinate creates a need for continence care.

Achieving continence is particularly important because of the severely debilitating effect of incontinence on the frail elderly. There is an increased risk of skin conditions and bedsores, infections and sleep difficulties, not to mention the emotional distress and social problems that can arise.

The health and happiness of those in need of care can be safeguarded through good management of incontinence episodes. This can often be self-management by working with the patient to help them recognise the best way forward. Caregivers can also re-evaluate their choices of products and routines to ensure the effects of incontinence are minimised.