Throw us a bone

by director: Diane K. Newman, DNP, FAAN, BCB-PMD

Treatment for urinary incontinence is directed toward:

• Increasing bladder capacity
• Increasing awareness of signals from a full bladder.
• Increasing the ability to respond to a bladder contraction by using the outer sphincter muscle to withhold urine (pelvic exercises.)

Self-care or lifestyle practices such as adequate fluid management, elimination of dietary irritants, cessation of smoking, bowel regulation, and weight reduction are felt to be ways to prevent or reduce UI and overactive bladder. The following is a review of these methods and their impact on your symptoms.

Dietary changes to control urinary incontinence

Adequate Fluid Intake

Individuals with urinary symptoms often limit fluids so that they will not have to urinate as often. Individuals who have a high fluid intake (greater than 2,400 ccs/day) may show a reduction in incontinent episodes and voiding frequency by lowering their fluid intake. Incontinent persons with low fluid intakes (less than 1,500 ccs/day) may benefit from increasing their fluid intake. Reducing fluid intake after 6 pm (or 2- 3 hours before bedtime) and concentrating fluid intake during morning and afternoon hours may decrease nighttime incontinence episodes.

Elimination of Bladder Irritants

Dietary changes may help improve urinary incontinence. Eliminating alcohol, sweetener substitutes, and caffeine containing foods and drinks may be very helpful. This is especially true for persons who drink large amounts of coffee and/or tea and complain of urinary frequency with urge incontinence. Caffeine is found in milk chocolate, soft drinks, over-the-counter medications, and is used as a flavoring agent in many baked goods and processed foods (although you won't find it listed on the labels.) Taper caffeine intake slowly to avoid migraine-type headache.

The effect of other foods and beverages on the bladder is not understood but elimination of one or all of the items listed below may improve bladder control. It is recommended that eliminating these foods on a one-by-one trial basis may help reduce UI in some individuals. They are:

Maintain bowel regularity to control urinary incontinence

Other possible causes of UI, urgency and frequency are bowel constipation and impaction. I really recommend the use of whole unprocessed coarse wheat bran. This type of bran is not the same as the commercial bran cereals that are widely advertised. This form of bran can be purchased very inexpensively at health food stores or local grocery stores. It is advised to start using bran in small amounts, such as one tablespoon, and to gradually increase the amount over time. I suggest you start using this

"SPECIAL BRAN RECIPE"

Mix together: 1 cup applesauce 1 cup coarse unprocessed wheat bran 3/4 cup prune juice Mix to a pastry consistency. Refrigerate in a covered container between use.

Take 2 tablespoons of the mixture every day with a glass of water. Take the mixture in the evening for a morning bowel movement. Increase the bran mixture by two tablespoons each week until your bowel movements are regular. Always drink a large glass of water with the mixture. Your goal should be to achieve one soft, well-formed bowel movement daily.

If you don't want to use this special recipe then just add unprocessed wheat bran to your diet. Start by using 1 to 2 tablespoons every day. If necessary for regulation, increase bran slowly over several weeks to approximately 6 tablespoons every day. Mix the bran in foods like applesauce, cereals, sauces, gravies, or puddings. Sprinkle bran on ice cream, vegetable and fruit salads, or cottage cheese. Add to baked muffins, breads, and cookies when baking.

Bran will not harm you but a normal reaction to bran is stomach bloating and increased gas. These symptoms usually last for only the first week. If symptoms last longer, contact your nurse or doctor, immediately. If you follow this you will avoid side effects such as flatulence (gas), stomach bloating, and cramps. If these side effects do occur, they usually disappear within weeks. Whole unprocessed bran is natural to the body and a person cannot take too much of it. If you have fecal impaction, you must take care of the impaction before starting bran.

In addition to bran, drink at least six to eight glasses of caffeine-free fluids per day and attempt to exercise.

Stopping smoking as a treatment for urinary incontinence

Nicotine is irritating to the detrusor muscle causing bladder contractions and urgency. A smoker's repeated and chronic coughing may cause urinary leakage. Smoking cessation may help to decrease urine leakage.

Maintaining optimal weight can help control incontinence symptoms

Weight reduction programs for moderately and morbidly obese women may help reduce urinary symptoms such as urgency, frequency incontinence because of less pressure on the bladder.

[Adapted with permission from Newman, DK. (2002) Managing and Treating Urinary Incontinence, Baltimore: Health Professions Press]

Certain voiding techniques can improve bladder emptying if you have a neurogenic bladder or a bladder that does not completely empty. One technique to help stimulate complete bladder emptying is trigger voiding. Find a "trigger" to initiate a bladder contraction. One common method is called "suprapubic tapping" which involves drumming the abdomen overlying the bladder. The application of rhythmic tapping is thought to produce a summation effect on the tension receptors in the bladder wall and activation of the reflex arc via the afferent discharges produced.

The best suprapubic triggering technique is to tap the suprapubic area (area over you pelvic bone in the front rapidly seven or eight times, stop three seconds, and repeat. Other trigger mechanisms include pulling pubic hairs, stroking the abdomen or inner thigh, digital anal stimulation, and dilation. If you have a complete spinal cord injury you may find these techniques difficult to perform. Quadriplegic clients may have a difficult time performing these maneuvers due to decreased hand dexterity.

A Crede method can help to facilitate voiding. Crede method is a means of direct compression to empty an atonic or flaccid bladder. You press firmly with one hand (or both hands) directly into the abdomen over the bladder. Because intravesical pressure is markedly increased, the bladder neck opens and emptying continues as long as the bladder is being compressed.

A program of double voiding may be helpful in completely emptying the bladder. You must void twice during each trip to the bathroom to reduce urine left in the bladder. First void, remain on the toilet, and void again after a resting for several minutes.

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Posted December 2003
Last updated July 2009