Urine is a solution of waste products from the body. It is produced continuously day and night in the kidneys and passes through tubes (ureters) to the bladder where it is stored.

Incontinence can be defined as the passing of urine in the wrong place, unintentionally, and involuntarily.

There are many types of incontinence, some more difficult to treat than others. The three main types of incontinence are briefly described below.

URGENCY

This is when the bladder needs to be emptied in a great hurry, and often the person is unable to get to the toilet in time (especially if the person has mobility problems). This is often called 'urge incontinence'.

FREQUENCY

This occurs when the bladder can only hold a small volume and has to be emptied inconveniently often. Frequent emptying of the bladder can become a habit which eventually prevents the bladder from 'stretching' to its full capacity and can exacerbate the problem.

Frequency and urgency can both be caused by similar things such as tea, coffee, and alcohol which make the kidneys produce more urine. The bladder is also very sensitive to our emotional state and frequency and urgency commonly occur when we are anxious or depressed. Constipation can also be a cause as the distended bowel can press on the bladder and irritate it.

LEAKAGE

This occurs when a small amount of urine leaks from the bladder, before or after a visit to the toilet, or on exertion. This is often due to weakness of the pelvic floor muscles or a change in the position of the bladder and urethra (such as occurs in pregnancy, childbirth, or after surgery). Another kind of leakage is 'overflow' incontinence, which occurs when the bladder is full, but unable to release urine. Amongst other things, this can be caused by an enlarged prostate in men, a prolapse in women, or by some medication.

Incidence

Figures vary according to the definitions used but it is estimated that between 3 and 3.5 million people (adults and children) are affected in the United Kingdom. More than half of the sufferers are over 65, and the majority of them are women. The NHS spends approximately £80 million a year coping with incontinence, and it is estimated that this is spent on treating only a minority of sufferers as the majority will not seek help due to the embarrassing nature of the problem.

Current Treatment

SELF HELP

There are several things that can be done to try to reduce irritation to the bladder. ·

. Observe the colour of your urine. Is it is too concentrated, orange in colour and strongly smelling, you may not be drinking enough liquid.

· Notice what you are drinking. Tea, coffee and alcohol can increase the amount of urine that is produced.

· Avoid constipation and try to keep your bowel habits regular by eating plenty of high fibre foods and avoiding rich sugary foods

· Try to 'retrain' your bladder to hold greater amounts of urine. If you take advantage of every opportunity to empty your bladder, it will only be trained to hold a small amount of urine before sending the message that it needs emptying. This capacity can be increased if you try to "hold on" a little longer each day (try to distract yourself by phoning a friend or watching a T. V. programme), until the intervals between emptying your bladder become more manageable.

· If your problem is sensory - ie. your bladder does not communicate to you that it needs emptying then get into the habit of going to the toilet regularly (every two to three hours) and help yourself to remember either by using an alarm or by always going after certain events e.g. getting up, after breakfast, after your favourite radio programme etc.

· If you suffer from leakage, the muscles around your urethra may be weak and as these muscles are under our voluntary control, they can be retrained by exercise. Start by identifying the muscles by trying to stop the flow when you are emptying your bladder. Once they have been found, they can be 'exercised' by tightening and relaxing them slowly at every opportunity.

MEDICAL HELP

Obviously incontinence cannot always be cured by self help. It is often necessary to refer to a doctor or a specialist, and after the above options of self help are explored other measures may be necessary.

·Surgery can correct some problems such as prolapse or an enlarged prostate.

·Medication can be prescribed to treat infections and some other disorders.

·Physiotherapy can help not only with improving muscle strength in the pelvic floor, but also with general mobility if getting to the toilet is part of the problem.

If your incontinence cannot be cured, then it can almost certainly be managed. With careful planning and appropriate equipment, incontinence need not rule your life. Some methods of management are:

Urinary catheters, where a tube is inserted into the urethra to allow for the passage of urine which is then collected an external bag.

Pants & pads which absorb the urine and keep the patient dry.

External collection devices (for men only). The devices are fitted to the penis and the urine is collected in a bag which is strapped to the body under the clothes.

Who can help?

A doctor - your family doctor · a nurse - a district nurse, practice nurse, school nurse or health visitor · a continence adviser - who is a nurse or physiotherapist specialising in incontinence. Ask your doctor how to contact the continence adviser · a physiotherapist - who can teach you exercises to strengthen your muscles · a confidential telephone service -The Continence Foundation Helpline: Telephone 0191 213 0050 (open Mon-Fri 9am-6pm).

What will you be asked?

You may be embarrassed to approach your doctor - but try not to be. Talk it over with him or her. These are the sort of questions you may be asked: ·When did the problem start? How often do you pass water? When do you wet yourself? How many drinks do you take each day? Do you have to get up at night to pass water? Do you sometimes wet the bed? Do you have difficulty opening your bowels (i.e. are you sometimes constipated)? Do you open your bowels very frequently (diarrhoea)? Do you find that you have insufficient warning to get to the toilet on time?

Don't just put up with problems - ask for professional advice now!

What can be done?

Treatment might include: · exercises for the pelvic floor muscles which control the bladder and bowel · training the bladder or bowel to "hang on" · medicine may be prescribed · equipment to make use of the toilet easier if you have difficulty getting on or off · an operation may be suggested in some cases. Often incontinence can be cured. If not, there are lots of different products (special pads, pants or appliances) which can help you to lead a normal life.

If you think you may be incontinent, or know someone who may have a problem, consult a nurse or doctor, or ring The Continence Foundation Helpline: