Urinary Incontinence and Social Isolation

• Beverly Phelps

Abstract

Urinary incontinence is loss of bladder control, that one in every 25 million Americans deal with on a daily basis, and it can mean anything from a slight leak to complete inability to maintain control. (Chris Lliades, 2009)

Discuss the social concerns associated with incontinence. What nursing interventions would be appropriate to assist a patient who is experiencing social isolation as a result of incontinence? Include community resources, as appropriate.

Many women, at one stage of life or another, experience that annoying leakage of urine when their bladder is too full, and/or when laughing, running, jumping, or sneezing. For some it occurs after childbirth when all of those muscles down in the pelvic region are stretched out and recovering. For others, it occurs later in life with the change of hormones and loss of estrogen. There are three most common types of incontinence. Stress incontinence occurs when you put stress or pressure on your bladder with coughing, sneezing, or running. Urge incontinence happens when you have the immediate “urge” to urinate and can’t seem to hold it. Mixed is a combination of both. Urine is specifically kept in the bladder until you are ready to use the bathroom, however if the detrusor muscle and urethra aren’t behaving like they should, you leak. Improved My Health Changed My Life Saved My Life Research “suggests that 30 to 40 percent of women 60 years and older deal with incontinence.” Risk factors include: pregnancy, multiple births, menopause, obesity, diabetes, certain autoimmune conditions, prolapse, abdominal surgery, diuretics, anxiety, and nerve damage to the mid-low back, bladder infections, overactive bladder, inability to urinate regularly when needed, and stimulants such as coffee/soda/chocolate. Evaluation by your health care provider, or a specialist called an Urogynecologic, often involves a full intake surrounding the situations in which you are incontinent, your history, medications, and pregnancy history. A vaginal physical exam is important to assess for proper anatomy and then testing may be needed such as a hormone testing, urinalysis (to look for infection), a bladder stress test, an ultrasound of your kidneys/bladder/ureters, or cystoscopy (a scope inside your bladder). Treatment depends on what they find. It may be something like pelvic floor physical therapy where you learn how to do a proper Kegel exercise and recruit all of your muscles, not just the strong ones. It may require bladder retraining, hormone evaluation, weight loss coaching, or surgery in some cases (Jones, 2011)

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Psycho-Social Issues of Adult Incontinence

Incontinence is not a disease but symptom of an underlying problems. Urinary incontinence is viewed as a hidden condition that is secreted by many and often feared due to loss of independence and quality of life. Often underreported Incontinence is associated with a social stigma. The stigma tends to be negative rather than positive. Many individuals are embarrassed to talk about the problem In North America incontinence is the major reason for nursing home placement. -Approximately 45-70% of residents in nursing home have incontinence. Urinary incontinence affects 15-30% in the community setting and affects up to 50% in long-term care. Only 25% of the population will discuss this problem with a provider. 60% of this individuals will avoid physical activity One study cited 2-64% had sexual dysfunction, and 28% will not seek treatment (Sue Reif, 2012)

Easing the Emotional Effects of Urinary Incontinence

Loss of bladder control can leave an individual constantly worried about embarrassing accidents. Managing urinary incontinence symptoms can help boost your confidence. (3) Urinary incontinence can have a major impact on your personal, social, and professional lives, especially when a loss of bladder control results in an embarrassing accident. “There can be significant social issues with urinary incontinence,” says Roger Dmochowski, MD, professor of urology at Vanderbilt University in Nashville, Tenn. “There’s fear of embarrassment and hygiene issues, and there can be withdrawal from normal social behavior. Some people can’t work because of this disruption. “Urinary incontinence emotional effects Doctors point out that the emotional effects of urinary incontinence can be as significant and far-reaching as those of any chronic condition. “Urinary incontinence has been shown to have a severe impact on quality of life, similar to other chronic diseases, such as Alzheimer’s disease, stroke, and emphysema,” says Leslie Rickey, MD, an urologist at the University of Maryland Medical Center in Baltimore. However, there are ways to manage urinary incontinence and boost confidence so that you can enjoy social activities again without worrying about embarrassing accidents. Urinary Incontinence: The Emotional Effects Worrying about loss of bladder control and embarrassing accidents causes many people with urinary incontinence to stop participating in everyday activities. “Many individuals, especially older people with urge incontinence, stop exercising or going out with friends and stay at home,” says Dr. Rickey. “Younger women may stop jogging, and women may stop gardening because squatting can be a problem. People stop traveling and swimming, and even start avoiding intercourse. “For many people with incontinence, engaging in certain activities involves a couple of obstacles. First, it’s a logistical challenge to manage the symptoms of urinary incontinence when you’re on the go, away from bathrooms, or doing an activity that puts pressure on your bladder. “Say it’s an older person who relies on a bus or a van and has no other way to get places,” says Rickey. For these people, not being able to get off the bus and to a bathroom can be a problem. Then there are the emotional concerns. The loss of bladder control can cause stress, anxiety, and embarrassment. (Sue Reif, 2012)

Ways to Boost Confidence

You can boost confidence about your condition by finding effective ways to manage the symptoms. “Techniques like timed voiding, not drinking too much fluid at once, doing pelvic floor muscle contractions — these can all help,” says Rickey. “You can also carry around a change of clothes and wear light pads. “Getting symptoms under control can help you carry on with your life with confidence. “Some individuals may have dramatic improvements and can re-embark on many activities,” says Dr. Dmochowski. These tips can help you manage the fears and anxieties of urinary incontinence: Don’t accept incontinence as inevitable. Many people think that urinary incontinence is a normal part of aging or childbearing, so they don’t bother getting treatment for it. However, even though urinary incontinence is common, it is not normal, says Rickey. Don’t view your urinary incontinence as unchangeable. “There’s almost an acceptance of the condition, a fatal resignation,” says Dmochowski. “Instead of acceptance, consider aggressive management flip the negativity and create a positive-looking approach.” Changing your way of thinking will do even more than boost confidence, says Dmochowski. It will also help you better manage your urinary incontinence symptoms. Talk openly about your urinary incontinence with your doctor. Some people may simply feel too embarrassed about their loss of bladder control to discuss it with their doctor. It might be because they incorrectly believe that it can’t be treated. “People think that nothing can be done, or it can only be treated with intensive surgery,” says Rickey. “I reassure people that there are treatments.” It’s important to talk about your symptoms, especially with your health care provider. Don’t give up. Managing the loss of bladder control and learning how to handle embarrassing accidents is an ongoing process. Urinary incontinence is a chronic condition not something that is cured after a few days of medication but there are many options available to you. “If one thing doesn’t work, keep trying different approaches,” advises Dmochowski. “We are continually finding new treatments, new types of drugs. 1.”Seek support. Talk about your urinary incontinence with your family and friends both to get support and to know you are not alone. Since an estimated 30 percent of women report an incidence of urine leakage at some point, it’s likely that someone you know has also experienced the problem, says Rickey. “It may not be what you talk about at the dinner table with the kids, but you must feel comfortable talking about it. 2.”Get the facts. “Go online and look up how common it is,” says Rickey. 3. “Do a little research.” Sites such as the American Urogynecologic Society’s Mypelvichealth.org are reliable sources of information. “You can gain confidence and get motivation to seek out help,” says Rickey. 4. “Don’t be embarrassed. “View your urinary incontinence as what it is, a chronic medical condition.” “It’s not something to be embarrassed about, any more than someone who has high blood pressure would be embarrassed,” Rickey says. No longer a taboo topic, urinary incontinence can and should be discussed openly, at least with your doctor, so that you can find the medical treatments that will help you better manage the condition and its emotional effects. (Lee, 2010)

Bibliography

Chris Lliades, M. (2009, August 31). Urinary Incontinence Resources. Retrieved from everyday health: http://www.everydayhealth.com/urinary-incontinence/incontinence-resources.aspx

Jones, D. C. (2011, June 03). Experiencing Incontinence? Retrieved from Empow Her: http://www.empowher.com/urinary-incontinence/content/experiencing-incontinence

Lee, K. (2010, August 03). Easing the Emotional Effects of Urinary Incontinence. Retrieved from http://www.everydayhealth.com/health-report/urinary-incontinence/emotional-effects-of-urinary-incontinence.aspx

Sue Reif, M. C. (2012). Psycho-Social Issues of Adult Incontinence. Retrieved from Center for Connected Care: http://my.clevelandclinic.org/ccf/media/files/Digestive_Disease/woc-spring-symposium-2013/psycho-social-issues-related-to-incontinence.pdf