Do you feel a strong urge to urinate on a trigger? Do you have symptoms like involuntary urinary discharge? Are you undergoing annoying voiding symptoms? Have you considered keeping a voiding diary for it? If not, then now is the time to maintain one. Nearly 40% of the women and over 15% of males globally experience symptoms of uncontrollable voiding. The data suggests that the numbers might be unrecorded as the patients may feel shame addressing the issue. In this blog, we will elaborate on voiding incontinence. In addition to this, we will look into maintaining a proper voiding diary using CareClinic App. Let us get started without further ado.
What do we mean by involuntary voiding?
Involuntary or uncontrollable voiding means an automatic urinal discharge that cannot be controlled by the individual. It may be accompanied by annoying as well as an intense urge to micturate upon the trigger. Each individual has a different set of symptoms. Some may feel an irritative impulse to pass urine while others do not even realize it. However, occasionally, normal individuals may find themselves with a similar feeling to urinate. It is when the bladder is full and it cannot accommodate any more fluid.
Such incontinences are classified into certain types based upon the presence or absence of symptoms
- Stress incontinence- It is when there is the presence of raised internal abdominal pressure. Abdominal pressure can increase due to several reasons. The reasons could be either normal or pathogenic.
- Normally, intraabdominal pressure can rise during vigorous physical activity. This may include playing sports, high-intensity workouts, sneezing, standing, and so on.
- Pathogenic increase in intra-abdominal pressure occurs due to long-term cough or any other chronic respiratory disorders.
Suddenly changing positions from seated or supine to standing could also possibly stimulate the bladder.
- Urge incontinence- It is a type of involuntary leakage followed by a spontaneous, strong desire to urinate. This happens due to the overactivity of the urinary bladder. Moreover, the bladder could be oversensitive. Such a type of condition is greatly influenced by trigger factors. Neuropathogenic disorders are one of the underlying as well as co-existing conditions that may be the reason for the impulsive urge to react to a trigger. Sensory triggers may include cold temperature, hearing the sound of running water and many more.
- Mixed- Some patients may even have the urge as well as stress incontinence combined. Such kinds are classified into mixed types.
- Overflow- this is when the bladder retention capacity is reached to the maximum. Patients do not necessarily feel an urge but there is a loss of retention beyond sensory control.
- Functional- It occurs due to impaired motor controls. In other words, functional loss of urinary retention is when a person is unable to perform physical functions. This may or may not be due to mental disorders such as cerebral palsy, parkinsonism, dementia and so on.
What are the causes behind enuresis?
It is important to note that there is always an associated etiology behind any pathologic condition. The same is true for the inability to retain urine. There might be direct or indirect causative agents for the voiding dysfunction.
- Comorbidity- comorbid condition means the simultaneous presence of two or more than two illnesses that may or may not be inter-causative. For example, chronic cardiac conditions and incontinence frequently occur together. In many cases, they are interdependent.
- Physical causes- this may include excessive pressure on the abdomen during childbirth, weakening of urethral tissues due to C-section or prostate surgery or labor. Not just that, other lower limb surgeries or invasive urologic interventions may also be the etiologic factor.
- Medicinal- long-term intake of few medicines such as cholinergic, diuretics or drugs prescribed to increase fluid secretion in the visceral tissues. The above-mentioned classes of drugs are also the ones that could be used to treat certain heart conditions.
- Aging- loss of sense of control due to age and age-related diseases can also lead to poor sense of micturition. The prevalence of this condition increases with age. Most cases are reported for individuals above 50 years of age.
- Mental health disorders- several mental illnesses could hamper sensory control. As a result, this may interrupt the neural control over the detrusor muscle. To illustrate, some conditions such as brain stroke, parkinsonism and a few more can be etiologic factors.
- Urinary tract infections- Infectious diseases pertaining to the renal system like Cystitis, bacteriuria, Vaginitis or other bladder infections may cause irritation. Such triggers could lead to urine leakage.
- Diabetes– hyperglycemia can lead to an overflow type of incontinence. This is because the frequency of urination is raised in individuals with diabetes mellitus. Subsequently, it might lead to bladder distention when the frequency of urination is prolonged.
The conditions that coexist simultaneously with void incontinence might also trigger it.
- Surgery – surgical intervention of a part of a central nervous system could have interfered and induced sensory incompetence. Furthermore, urologic or lower intestinal surgical procedures might be the causative factor.
- Urinary tract infections– infections have the potential to lead to transient or chronic incontinence. Severe or chronic infections impair the ability to retain the urine and might lead to dribbling.
- Neurological muscular dysfunction- neuropathologies can lead to musculoskeletal impairments. As a result, bladder muscles can possibly paralyze. Conditions like palsy, severe autistic disorder or paralysis of lower limbs.
- Chronic respiratory conditions- Illnesses like chronic obstructive pulmonary disease, asthma or a chronic cough from Tuberculosis have the potential to precursor stress type of urinary incontinence. This is because these are the contributing factors for raising intraabdominal pressure.
- Nerve compression- loss of control over the bladder could also be triggered by pressure on the sensory nerve due to a benign or metastatic tumor. The hypogastric nerve is the one that supplies nerve fibers to the detrusor muscles. Occasionally, a blood clot can also impinge the nerve. Consequently, nerve damage interferes with the smooth transmission of signals that helps regulate micturition.
How is the incontinency determined?
It could be hard to differentiate incontinence from the other comorbid conditions. Few comorbidities can mimic the renal incontinency. Few examples include central nervous system injuries, hemiplegia or Quadriplegia. There are certain tests that are to be performed to rule out the diagnosis. A combination of cough test, void diary and positive stress incontinence history can confirm the diagnosis. However, History taking and maintaining a voiding log is of utmost importance to correlate and confirm the etiologic factors.
Voiding diary is a record of a patient’s micturating activity on a daily basis. The patients are usually asked to keep track of the frequency of urination, amount of liquid consumed, and the voiding proportions. It is generally suggested to keep a 3-day voiding diary to produce a reliable resource. Also, it helps in tracking residual volume after voiding. It is known as Postvoid residual volume or PVR. Measuring and tracking PVR is one of the diagnostic tests to reach the final diagnosis for bladder incontinence.
What are the treatment procedures for enuresis?
The management of incontinence depends upon the type to a major extent. In other words, different classes of incontinence are to be managed differently for most cases. Treating and preventing comorbidities can lessen the episodes of involuntary voiding. This applies to voiding incontinence because of underlying comorbid conditions. Let us get into the details of incontinence management:
- Medical therapy- medication is considered the first-line treatment in mild to moderate cases. Medicinal management is adapted for symptom prevention. Such symptoms include the intense desire to void, loss of control over the bladder, and a few other similar indications. Pharmacologic intervention for this particular condition cannot treat the underlying cause. Hence, it must be viewed as a preventative measure and not a curative step. The medicinal approach is always adopted with another procedure for better outcomes.
- Class of drugs used for the treatment:
- Antimuscarinics- These drugs decrease the overall bodily fluid secretion. Consequently, the urinary production by the body is decreased. As a result, the frequency of voiding is decreased.
- Antispasmodics- these pharmacologic agents are used to regulate muscular spasms. As a consequence, the muscles such as the detrusor are relaxed and do not immediately produce stress response/ stretch response to the brain.
There are a few other classes of pharmacologic agents that help by decreasing the frequency of urination. They are often used in a combination with the drugs of choice. A medication tracker feature in the CareClinic app aids in keeping records of your medicines. It also allows you to share the medical history with your Caregiver.
Tips for Managing Incontinence
There is always an attempt to deal with disorders or conditions conservatively in medical science. Invasive procedures are performed either only in severe cases or when other treatment methods fail.
- Stress reduction- consumption of stress-inducing agents can lead to intense desire or urgency to void. Such agents include caffeine, tea, alcohol, tobacco and other abusive substances. Helping the patient reduce the intake of these substances and behavioral modification therapy greatly produces a good prognosis in urge incontinence.
- Physical therapy- the pelvic floor rehabilitation exercises are proven to be effective in leaks caused by stress incontinence. In addition to this, it helps in regaining lost control over muscle involuntariness.
- Bypassing through catheters- catheterization is a minimally invasive method that can help patients with severe voiding problems. It is offered as both transient or long-term management.
- Pads- absorptive paddings are utilized as one of the non-invasive management. However, it is not a preventative or treatment measure. However, these are of great convenience for chronic or severe incontinence cases.
- Dietary changes- maintaining a non-diuretic diet prevents water retention. As a result, it can improve incontinence-related symptoms.
- Invasive procedures- surgical approach is the treatment of choice in unmanageable cases. Male and female surgeries vary due to differences in anatomy. Surgeries also vary on the basis of type of void incontinence.
How does the CareClinic app help keep a voiding diary?
CareClinic app is one of the best self-care tools available online. It can be the perfect tool for void incontinence patients to keep their medical data in one place. Let us walk you through all the features of the CareClinic app.
- Void diary- CareClinic app has a built-in feature of a diary. This will help you keep track of voiding. Doctors suggest keeping a 3-day voiding log for reliable results. One can even keep records for as long as they want to maintain their medical history of voiding symptoms. The diary feature can even be useful for urge incontinence patients taking behavioral therapy. They can track their behaviors on a regular basis, their trigger points, and even record the improvement in irritable symptoms. The diary can also be shared with the caregiver or a doctor to help them in measuring improvements. CareClinic’s void diary feature could be a great tool to supplement creating a treatment plan.
- Key points to be noted in a void journal are-
- Amount of void
- Type of liquid intake
- presence/absence of urge
- Other symptoms
- Triggering activity that might have triggered voiding
How to open the bladder diary in the CareClinic app?
- Open the CareClinic app
- Go to the ‘check-in’ feature
- Go to ‘Diary Entry’
- Symptom tracker- It is inevitable for an incontinence patient to record their urgency triggers. CareClinic app’s Symptom tracking feature helps such individuals to map their symptoms and trigger points. It is such an effective way to keep a record of all triggers and their frequencies of repetition in one place. The symptom tracking feature can be found in the ‘check-in’ option of the CareClinic app. They can check-in daily with the symptoms and even share them with the caregiver. It is a great way to keep the doctor updated. Furthermore, this will allow the caregiver to set the action plan for the patient.
- Nutrition check-in – voiding incontinence patients have to regulate their fluid intake. This helps them lessen the void frequency and the urge to urinate. In addition, dietary tracking can help them monitor foods that might work as a voiding stimulant. CareClinic’s nutrition check-in helps individuals to enter the food they have. This could be a useful tool for patients involuntarily passing urine due to stimulating foods like caffeine, tea, cocoa and many more. In addition, there are readily available nutrition plans by CareClinic to further ensure optimum nutrition.
- Medication tracking- patients could be even helped with recording their medication intake. How does it work? Individuals can set daily reminders to take medicines on time. Moreover, a supplement tracker is a great way to maintain the pharmacological records.
Other features to help manage urinary incontinence
There are other great features that urinary incontinence patients could benefit from such as factor tracker. Patients can add factors that affect their symptoms. For example, they can add daily weather since a cold atmosphere worsens the symptoms. Furthermore, women with incontinence can monitor their menstruation and premenstrual period to note if the cycle affects their micturition. Moreover, one can manage appointments and schedule them through the app. It can be tough to remember multiple appointments if the patient suffers from chronic conditions and sees multiple specialists. One can set reminders for the appointments. One can also add the pre-existing condition in ‘My conditions’ and link it to the Care plan.
It is tough to cope with chronic conditions. This can take a toll on mental health as well. CareClinc app has Care plans particularly designed for mental health care. One can keep check on stress symptoms as well with a symptom tracker.
How can caregivers benefit from the CareClinic app?
Caregivers such as doctors or a healthcare team can create care plans with the app and share it with the patient. They could even track patients’ improvements or degradations through the reports feature of the app. Reports allow one to see the whole picture. The charts and logs in the reports section can help correlate various data the patient entered in the form of journal entry, medication, symptoms and so on. It means that the caregiver or the caretaker can take action based on the fluctuations in patients’ reports. Doctors can work with specialists from different fields for a patient with multiple conditions. This makes it easier to generate plans when an interdisciplinary approach is required.
Caretakers can suggest a diet plan and monitor the improvements as well as the changes through the app. It also helps doctors to communicate with the healthcare team regarding particular cases. In other words, it becomes simple to share the information among various healthcare professionals working on it. The app is designed to accommodate the needs of both a patient and a caregiver.
The CareClinic iOS and Android application has made taking care of your loved one simpler and executable. You can install the app from the app store or a play store for Android using the button below or to the right. The first step to start taking care of your closed one has just got easier.