Managing Urinary Incontinence, Nocturia, Urgency, Frequency, and Hesitancy

There are several forms of bladder dysfunction. They include:

• Urinary incontinence. This is a loss of bladder control. There are varying degrees of incontinence. The bladder may leak urine, or a person may have complete lack of control over the bladder.

• Nocturia. This is the term for frequent nighttime urination. People with this condition have an urgent and frequent need to urinate at night, even though they may be unable to go when they get to the bathroom. It disrupts sleep because the person often feels the urge to urinate several times in the night.

• Urgency. This refers to the urgent feeling of having to urinate.

• Frequency. This is the act of urinating more often than is usual, and the need occurs before the bladder is full.

• Hesitancy. This refers to the inability to start urination, even though the person feels the need to urinate.

People with urinary control problems may feel embarrassed or ashamed, or that they have lost control over their body. Fortunately, these conditions are often temporary. And there are ways to manage them. Anyone who has one of these problems, or who is worried about it, should talk with his or her doctor or nurse.

What Causes Urinary Problems

People can have urinary incontinence, nocturia, frequency, or hesitancy for many reasons. Simply growing older can cause these problems if the bladder stops functioning effectively. Both men and women can be affected. Incontinence can result from urinary tract infections and spinal cord injuries. The following conditions and situations may cause frequent urination at night, urinary frequency, and urinary hesitancy.

• Benign prostatic hyperplasia (BPH)

• Diabetes mellitus

• Chronic urinary tract infections

Cancer and its treatment can also cause these types of bladder dysfunction, too. Here are some cancer treatments that may cause problems.

• Surgery to remove the prostate gland, called prostatectomy

• Surgery to remove tumors in the bladder

• Chemotherapy or immunotherapy into the bladder for bladder cancer

• Radiation to the bladder, prostate, or pelvis

In most cases, urinary problems are temporary side effects of these cancer treatments. They may not happen at all. However, if they do occur, they commonly last for a few months after the cancer treatment ends, even without management of the symptoms. Sometimes, they are permanent.

Management of Stress Incontinence and Urge Incontinence

Symptoms of urinary incontinence vary, depending on how severe the problem is. For example, a person with stress incontinence may leak small amounts of urine when coughing or sneezing. Urge incontinence causes a person to leak urine following an urge to urinate, sometimes at unexpected times. The person may feel like he or she can never make it to the bathroom in time. Or a person can have a total lack of control of urination. The symptoms also vary in how bad they are and how often they happen.

According to Karen Maher, RN, MS, ANP, AOCN^® , a nurse practitioner with an expertise in kidney and bladder cancer, there is little a person can do to prevent incontinence. In addition, it’s rare that medications can completely cure it. That means a person must learn how to manage their incontinence and talk about it with their doctor.

Maher says, “It is important to define the cause and degree of urinary incontinence. You may have a total loss of continence, stress incontinence, urge incontinence, or a combination of symptoms.”

She suggests keeping a log of urinary symptoms. The log should include every time you urinate and every time you experience incontinence. Take your log with you when you see a doctor for a urologic evaluation. That evaluation can find out the degree of bladder muscle weakness and make sure there are no other complications causing the problem. Ask your doctor to refer you to a continence specialist.

These are the common methods of management.

• Bladder retraining.  This involves trying to urinate on a schedule. It trains the bladder to hold larger amounts of urine. For example, if a person urinates more than once an hour, he or she should try to urinate only once every hour. When the desire to urinate starts, the person contracts and then relaxes the pelvic muscles, which should help alleviate the urge. Different methods of relaxation, or even distraction, can be used to avoid urinating. When one goal has been reached, the person extends the time to urinate by 30 minutes. So in this example, the person would go to the bathroom once every 90 minutes.

• Catheters.  In some cases where the bladder cannot empty itself of urine due to weak muscles or a blockage, a catheter may be suitable. It’s a thin tube placed in the urethra to help drain urine. When these are used for a short time, the person may insert them. For longer periods, the catheter can be permanently inserted into the bladder. Permanent catheters empty into a bag worn under clothing.

• Conservative management.  This means avoiding or limiting things that make people urinate more. Maher recommends avoiding drinks that contain caffeine or alcohol and managing overall fluid intake. Conservative management also includes wearing disposable incontinence pads or underwear and losing weight if necessary.

• Electrical stimulation.  This therapy applies small amounts of electricity to stimulate the pelvic muscles. Small devices are placed in the rectum to deliver the electricity. The small current relaxes overactive muscles and helps weak muscles contract.

• Implanted devices. These   may be used to prevent leakage, mostly in men. They are made of material such as collagen (a fibrous tissue) and injected into the area surrounding the urethra to help close the urethral opening.

• Incontinence pads.  Used to collect urine in the undergarments, these vary in thickness to meet individual needs. They should be changed frequently to avoid skin irritation, odor, and infection.

• Pelvic muscle-strengthening exercises.  A doctor or nurse can teach Kegel exercises. These stimulate and strengthen the muscles of the pelvis and bladder. They are simple but effective exercises that improve bladder control. It is important to learn to do these exercises properly, as taught by a healthcare professional, because doing them incorrectly can make incontinence worse.

• Penile clamps.  Penile clamps compress the urethra to close it. The clamp must be repositioned at least every three hours to avoid skin problems. These are especially useful during exercise, when leaking is likely to occur.

• Surgery.  Although surgery may help ease urinary incontinence, it carries some risks. The incontinence may return, or a different type of incontinence can emerge. It’s used only when other, less invasive methods do not work. The method of surgery used depends on the type of incontinence. For example, an enlarged prostate that is obstructing the urethra in men can be removed or reduced in size.

If you are having problems with urinary incontinence, make sure you give your doctor a list of all the medications you are taking. These medications can cause bladder problems to get worse.

• Digoxin

• Diuretics

• Lithium

• Methoxyflurane

• Phenytoin

Your doctor may be able to change your prescription.

Management of Nocturia, Urgency, Frequency, and Hesitancy

Treatment for these conditions does not usually require surgery. Their treatment is similar to treatments used for urinary incontinence, including self-catheterization. Medications can help relax the bladder muscles and slow down contractions if that is what’s causing the problem. Other medications control leakage by tightening muscles of the bladder or urethra. Some medications, such as atropine and resiniferatoxin, are put directly into the bladder. Pills, such as tolerodine and oxybutinin, are effective but have side effects, including dry mouth, constipation, and blurred vision.

Continue to drink plenty of water to keep your urine diluted. This can help lessen the feeling of urgency. If you drink less and get dehydrated, the symptoms can become worse.

Coping Strategies

Urinary problems can disrupt a person’s life in many ways. People with these conditions may be afraid to go out in public or be worried about body odors. People with nocturia may suffer from lack of sleep, causing loss of concentration and fatigue during the day. Therefore, it is important to talk with a doctor or specialist and to begin managing it right away.

According to Maher, “Continence specialists help with the practical issues related to incontinence and symptoms, and offer management strategies for the psychosocial dimensions such as embarrassment, fear, and shame.”

To avoid skin irritation and odor, try to keep the skin around the genital area clean and dry. When incontinence occurs, change out of wet clothing or change wet bedding as soon as possible. Then wash with soap and water to remove any urine. A nurse or doctor can also recommend a moisturizer or skin barrier to protect the skin.