CONTINENCE ASSESSMENT
A normal healthy bladder stores 400-600ml of urine. A healthy bladder will fill urine and store urine. Generally, you won’t think about your bladder until it ‘triggers’ you that it is time to go to the toilet. When your bladder is ‘full’ you are signalled to go to the toilet, but you can wait until it is socially appropriate and there is a toilet before you empty your bladder. When you pass urine, you should empty to completion. You should not leak urine between voids. This is referred to as being ‘continent’.
Leakage of urine can range from a tiny after pee dribble, to a leak on occasion with certain activities to no ability to hold urine. Urinary incontinence can be managed effectively with appropriate product selection, reduced by lifestyle interventions and in many cases completely rectified. Treatment depends on the type of incontinence and often involves lifestyle modifications, fluid modifications, pharmacological intervention (drug therapy) and sometimes referral to other practitioners such as Pelvic Floor Physiotherapists or Urologists.
Leakage of urine referred to as ‘stress urinary incontinence’ (SUI) tends to happen with activities which increase abdominal pressure such as physical activity, coughing, sneezing, and laughing. A whole new meaning to ‘I laughed so hard I did a wee’.
Lifestyle factors like obesity and medical conditions such as diabetes, constipation, and conditions which cause a chronic cough can contribute to SUI. Many women complain of SUI following childbirth as pregnancy and birthing can impact on the pelvic floor muscles which support the pelvic organs. Older women who have been through menopause often complain of changes to their bladder and sometimes SUI due to lower oestrogen causing the urethra (pee tube) to not be as plump.
Men who have a radical prostatectomy to remove the prostate, or some men who have had surgery for a large obstructive prostate ‘a bore out’ can have SUI. Men with SUI experience drips with certain activities like coughing, sneezing, laughing, and bending. SUI is like not having a washer on your tap. Please see our service section ‘Post Prostatectomy Incontinence’ for a more detailed summary of post prostatectomy incontinence recovery.
Urgency and urge incontinence present as a frustrating and overwhelming ‘urge’ to go to the toilet and in some cases, if you are unable to respond to that urge, leakage occurs. Leakage can range from a dribble to a squirt to the entire bladder contents.
Urgency is often associated with triggers, such as running water or ‘key in the front door’. The bladder is temperamental and the more you respond to these ‘urges’ typically the more urgent it becomes.
Simple things like caffeine, alcohol, fizzy drinks, and citrus fluids (all the fun fluids!) can exacerbate urgency. Men with large obstructive prostate glands and people with constipation often present with urgency. Many other health conditions can contribute to urgency, conditions such as stroke, Parkinson’s and MS often cause urgency
The dreaded post pee drip! Many men complain of a post pee dribble if you don’t ‘shake it’ at the end of urination. This problem tends to be an issue for men with poor pelvic floor contractility and men who have undergone surgery on the prostate. Often men who complain of penile shortening due to lack of erections will complain of a post pee dribble. Men also sometimes report issues with urine pooling around the head of the penis if the foreskin does not retract properly.
A post pee dribble can be managed conservatively by shaking or milking the penis after you have finished passing urine. You can also apply pressure to the perineum – the area between the scrotum and the anus. Sitting to pass urine is often helpful if there is a cubical free!!
Often people present with mixed incontinence, a combination of stress urinary incontinence and urgency or urge incontinence. Sometimes the issue is largely behavioural, someone for example may start with stress urinary incontinence and then because they go to the toilet ‘just incase’ to avoid leaking, this creates an urgent temperamental bladder!
A comprehensive assessment of YOU is needed. We need to look at your medical history and your current medications to see if a cause of your incontinence can be established.
A urine flow study (conducted in the office) is a simple and extremely useful study, an ultrasound (conducted in the office) and sometimes a physical assessment is needed.
Questionnaires are often done (not to bug you with yet more paperwork), but to provide an objective assessment and to also be used for comparison as your symptoms improve.
If indicated sometimes investigations with blood tests or imaging may be indicated. If there are any concerns about specific symptoms which warrant further investigation, you may be referred to a urologist for further investigation or consideration of surgical intervention.
Treatment ranges from simple education and lifestyle modifications such as fluid modification, weight loss and exercise. Pharmacological (tablet) medication is sometimes used for certain types of incontinence, such as urge incontinence. Bladder calming techniques are often useful for urgency. Pelvic floor physiotherapy is often indicated and for some symptoms further investigation may be indicated and sometimes referral to a urologist for further assessment or consideration of surgical intervention
Navigating the never-ending range of continence products can be difficult. It is important to have an individualised assessment and discussion as your individual situation needs to be considered. For example, when considering intimacy, washable ‘normal underwear’ looking continence products are preferrable. For convenience of just whipping out the pad and not taking off your pants, disposable stick in pads are easier. Swimming? No worries, there are continence swimming shorts available.
Men’s disposable pads are specially designed for men and look like ‘padded cricket boxes’. There are also ‘underwear style’ pull up men’s pads available. Most men however prefer the ‘cricket box’ style disposable pads which just stick into your normal underwear (presuming you do not wear baggy boxer shorts!!)
You can purchase pads from your local pharmacy or supermarket; however, most men prefer to order them online. They can be purchased online through a chemist, or at a major product wholesaler such as Independence Australia or Surgical House. Tena, Depend and Molimed are common brands. Pads also come in different sizes relevant to the volume of urine they hold – we can help you decide what volume pad you need.
Men’s washable underwear and swimmers are also available, you can purchase these online through Night N Day Comfort. They work with common underwear brands to develop ‘normal’ looking and feeling continence underwear. This company also stock continence bed linen.
There are various other continence aids such as penile clamps and condom drainage systems which can be discussed with you and implemented if needed. Penile clamps (terrible name!) are excellent for men who just want to not feel themselves dribbling in certain situations. Great examples are while exercising, while attending meetings or while at social events.
There are various government funding schemes for continence products for eligible patients who fit certain criteria.
As registered Clinical Continence Advisors, we can provide a continence assessment, implement a management plan and establish funding for continence products.