Urology and Incontinence: Seeking Treatment
Some 20 million Americans are incontinent. The 28-year-old new mother is as likely to be affected as the 82-year-old grandfather just home from the hospital following prostate surgery. People of all ages who live with a range of conditions or just cranky bladders cope with incontinence as a matter of course.
Some 60 percent of people with incontinence do not get medical help, usually because of discomfort discussing the problem, or because they assume it's a normal part of getting older. Doctors say that incontinence is not unavoidable and need not be an inevitable part of aging. Instead of getting effective treatment, which resolves the difficulty in about 90 percent of the cases where people seek medical assistance, patients often change the way they live, from limiting their outings to giving up activities they enjoy.
The good news is that advanced materials science and other sophisticated technologies make it easier than ever to manage urinary incontinence.
You are in a position not only to equip people with the products that will minimize the life disruptions that continence issues can cause, but also to ease patients' anxieties. By being familiar with the causes of incontinence, as well as with the latest urinary incontinence products and the kinds of incontinence they are best suited to manage, you can help your clients keep the problem in perspective and enable them to continue living full, active lives.
First, a review of some basics. Incontinence is not a disease, but a consequence of another condition. It occurs when people lose some or all control over the release of urine from the bladder. Recall that the kidneys filter toxins from the blood and remove excess fluids from the body. The ureters carry this liquid waste to the bladder, where it's held pending evacuation via the urethra.
Except, as in all of life, when something doesn't quite work right. Various medical conditions, and even medications, can interfere with patients' awareness that their bladder is full, leading to premature urination. In other cases, patients experience sudden, uncontrollable urinary urgency. In still others, there is dysfunction in the muscles proximate to the urethra (the sphincter and pubococcygeus) that normally control the flow of urine. In men, prostate enlargement is the most common cause of incontinence, and, in women, the culprit is often diminishing estrogen levels. Some 80 percent of incontinent patients are female.
Mild to advanced incontinence, transient or permanent, is the result.
Incontinence can be treated with medications, bladder training, and pelvic-muscle rehabilitation. Less often, surgery is necessary.
When it can't be cured, though, incontinence can be managed. That's where you and today's selection of continence-management products enter the picture. Although the variety of products is remarkable, virtually all of them do one of two things with leaky urine: They absorb it and wick it away from sensitive skin, or they capture and transport it away from the body. There also are products for male patients that use compression to compensate for glitchy sphincters.
The most important medical aspect of incontinence management is avoiding the damage that urine can cause to patients' skin. Highly acidic urine that remains in contact with skin for an extended period can lead to tissue breakdown and serious dermatological complications, including infection. So, the main requirements for the first category of incontinence products is absorbency and wicking. Absorbency measures how efficiently a material attracts and holds liquid; wicking measures how effectively a material transports absorbed liquid away from skin-surface contact.
Selecting the best disposable urine-collection products for a patient requires that several variables be taken into account: degree of incontinence (how much urine is lost), the pattern of incontinence (when urine is lost: only at night, only with laughter or coughing), ease of product use, cost, a product's capacity to control odor, durability, and comfort. A product appropriate for an otherwise healthy 65-year-old woman who experiences minor leakage only at night will not be appropriate for an 80-year-old woman with Alzheimer's and high-flow incontinence throughout the day.
Clients with mild incontinence may ask you whether they can't simply use inserts and pads usually used by women to manage menstruation. Designed for another purpose, these products handle urine poorly. A better choice would be washable cloth liners secured by a liquid-impermeable garment. There are, however, a range of more satisfactory solutions.
The most common is adult underwear. Available in sizes small to extra large, these can be disposable or reusable. Again, the most important features for avoiding complications are absorbency and wicking. Because many brands now incorporate advanced gel technology that is remarkably absorbent, disposable undergarments are often preferred. They also control odor well.
Despite disposables' convenience, reusable garments are worth considering because they cost less and are friendlier to the environment. Odor can be controlled by frequent changing and washing. The reusable/washable option generally includes cloth diapers worn inside a plastic cover.
On the disposables side, patients and caregivers can choose from pull-up varieties that resemble normal underwear, while others use side closures and are especially convenient for bed-bound patients. For these products to perform well, they must be the right size -- patients shouldn't try to make do with medium-size garments if they actually need a smaller size -- and they should have elasticized leg openings, which allow for a snugger fit and better liquid containment.
While both men and women can use waterproof undergarments, men have some additional options. Although no longer acceptable as conversations starters at holiday parties, drip collectors have their devotees. These are simple pockets of absorbent padding secured by tight underwear.
Condom-catheter devices may bring back fond memories for some of your male clients. The product, similar to a conventional condom, fits over the penis and urine is carried to a leg-worn collection bag via a small tube. The advantage: it is easy to use, flow rates don't matter, odor is well controlled, and skin irritation is minimal. The downside: some men have difficulty keeping the condom in place, a problem they perhaps thought was exclusive to their youth.
Because accidents happen and the best-engineered products aren't foolproof, complementary products are available that protect patients' beds and chairs. Reusable and disposable absorbent pads of various sizes do an excellent job of containing flow when undergarments don't quite do the job. Like adult undergarments, disposable-pad products are available that both absorb and wick, continuing the regimen of keeping skin dry and out of contact with acidic urine.
Less well known are newer products cleverly engineered for male incontinence. One is called Afex and is a system that includes a penis-covering receptacle and specially designed cotton briefs that secure the receptacle and collection bag. It's an attempt to solve the problems associated with external catheters: the latex receptacle covers the penis but doesn't rely on friction to remain in place. It also incorporates back-flow prevention and ventilation features that reduce the chance of infection and skin irritation. The collection bag's design (a one-touch drain port, for example) makes it easy to empty and clean, plus it's double-thick and doesn't use straps, tubes, or adhesives, so patients report both comfort and minimal odor-control issues.
Afex and similar products can be cost effective for your male clients, as they greatly reduce or eliminate the need for disposable undergarments and protective pads.
Another category of male-incontinence products attempt to compensate for the muscles that normally withhold urine by compressing the urethra. These padded clamps may be effective and just right for your clients who need minimal leakage protection, but they have to be removed at least every couple of hours to allow for urination. Under some circumstances, clamps pose a danger of tissue damage, penile stricture, infection, and skin irritation.
A variation on the penile clamp is the disposable ActiCuf Compression Pouch, designed for mild to moderate incontinence. Shaped like a bowler hat without the brim, the absorbent cuff gently compresses the urethra and can be worn up to four hours. It can't be worn at night, and patients must watch for skin irritation.
Another product category is the internal catheter, a soft tube inserted into the bladder via the urethra to drain urine in patients dealing with incontinence and urinary retention. Catheters can be used intermittently or permanently, in which case they're called indwelling catheters. In certain cases, catheters are surgically introduced into the bladder through the abdominal wall.
In addition to removing unvoided residual urine to avoid infection and damage to the bladder and kidneys, intermittent catheters are routine in the care of patients with spinal-cord injuries.
With training, intermittent catheters can be inserted, removed, and otherwise cared for at home by patients, family or other non-professional caregivers, although medical professionals are essential for long-term management of indwelling catheters.
Indwelling, or foley, catheters are necessary in patients with obstructed urethras, unresolvable urinary retention, and in terminal patients for whom moving is difficult, painful, or impossible. Foleys are also indicated for patients whose skin has become severely irritated by their other incontinence-management methods or who have incontinence-caused stage 3 or 4 pressure ulcers.
No one likes the idea of being incontinent, but it's remarkable how much symbolic significance is attached to the involuntary flow of this liquid that is 95 percent water. Continence is associated with independence, good health, and youth. We assume that continence is the normal state, and, when that state is lost, people are often overwhelmed by anxiety. They may fear that they've lost their youth, that their health has become seriously compromised and may not be regained, that they may become socially isolated because of odor or even accidents in public.
You can help patients enormously by becoming their ally in coping with incontinence, by sharing your technical expertise and helping match their incontinence with the best products.
But, you can give them something even more valuable, the assurance that, regardless of the severity of their incontinence, it is something that affects young and old, can often be regained, and can always be managed, from odor to moisture containment to comfort. You can equip them with the very best products, but the best thing you can help give them is the confidence to go on with the lives.
This article originally appeared in the June 2007 issue of HME Business.