Department of Health and Ageing

Live Better

with urinary incontinence


Contents



Introduction

Urinary incontinence affects 3.84 million Australians – men, women, older people and younger people alike. People are affected by urinary incontinence in different ways. Some people leak a little when they cough or sneeze. Others have to rush to the toilet and don’t make it, while others cannot store any urine in their bladder and leak almost all the time.

Managing urinary incontinence in everyday life can be very difficult, but if you or someone you know leaks urine or has a weak bladder, you’re not alone. You’ll find lots of useful information and strategies in this booklet that will help manage the condition in a way that fits into your lifestyle.

the information in this booklet has been provided by nurses who have been working with urinary incontinence and researching this area for many years. They understand your problem and help people like you on a daily basis. The information has also been gathered from more than 300 adult men and women living with urinary incontinence who have shared their ideas with us on how they manage their condition. Interestingly, many of them used the same strategies.

Please take a little time looking over the material – you may find you have more choices than you think. For example, you can try out our tips for travelling, for visiting friends, for playing sport and for shopping – all the areas of your life where urinary incontinence may be a problem.

If you’re reading this booklet you may be waiting for surgery or for other medical treatment to cure your incontinence, or you may have only just started thinking about how you can better manage your condition. Either way, it’s important to work with a health professional for advice and support. In the the resources section of this booklet you’ll find a list of contact details for people who can advise you on treatments and therapies that will help you live better and experience the daily activities you enjoy with confidence.

LIVE BETTER
WORKING OUT WHAT IS BEST FOR YOU

None of us ever wants to have to deal with a problem like a weak bladder, but day-to-day life can be much better if urinary incontinence is managed through:

PLANNING

People who deal with urinary incontinence every day said it’s much better if they make plans that take into account their condition.

For planning to work well you need to work out:

With this kind of self-assessment you’ll be able to try things out and see if they work for you.

Think about the following questions:

Use the bladder diary and the planning guide to help you plan your activities.

Circle “yes” or “no” for each question.

THE IMPORTANCE OF PLANNING

Managing a weak bladder is an individual thing. Your physical and social activities at home or work will be different from others, so you have to have routines that suit you. Having theses routines will help you reduce the chance of having an accident and will help you be prepared if you do have one. Being prepared is the key.

You’ll probably need different routines in different circumstances, so make sure you plan for:

Sometimes you’ll have set routines, things that you usually do. But life’s not always like that, so it’s good to think about what it’ll take to be able to do things on the spur of the moment. Here are some tips for things to do when you are out socially and you cannot predict everything that will happen.

Tips

STRATEGIES FOR DAILY LIVING

Remember the key to living with urinary incontinence is:

For each area covered in this section we’ll explain: how to self-assess and plan; what you might need to practice; strategies for prevention; and how to problem-solve if accidents happen.

TOILETING

To prevent accidents and to reduce leaking, people use a number of strategies that involve the use of toilets and the timing of toileting. As with all strategies there may be some you use when you’re out and others you use at home. The important thing is to find what works for you and plan to use what you need in different situations.

Self-assessment

It’s important to be able to get to the toilet in time, wherever you are, to avoid having an accident. When you’re at home, holding on for as long as you can will increase the capacity of your bladder. Why not take the time to practice how often you need to go to the toilet and what things help you to hang on for longer?

Planning

You may discover that certain situations make you go to the toilet more often or less often when you’re out. Knowing where the toilet is and going to the toilet as soon as you get the urge are habits that many people with bladder problems practice, especially when they’re away from home.

'When I go to a show I always try to get a seat outside near the toilets, not in the middle, ’cause you have to crawl in front of all the people' – Alanah

Strategies

When you get an urge to go to the toilet, practice putting it off by thinking about something else, sitting down, talking to someone or creating a distraction. Some people find tightening the pelvic floor muscles helpful.

Many people find it useful to identify where toilets are and the best way to get to them. This is especially important if you don’t have much time to spare once you get the urge to go. You can find public toilets on the National Public Toilet Map (see the resources section). It’s also important to know which places have clean toilets and use them where possible. You could try a popular takeaway restaurant, for example.

To prevent having an accident when you’re out, go to the toilet at regular times, for example before going to bed, every few hours or after sitting for some time. Holding on too long can lead to an accident.

When you’re planning to go out, go to the toilet:

Emergency strategies

When there is risk of an accident, as soon as you get the urge:

‘Never be afraid to go even into a man’s toilet, just go ... a toilet is a toilet’ – Betty

Strategies for men

‘I carry an old hospital bottle in the boot of the car in case I get stuck somewhere’ – Arthur

Tips

FLUIDS AND DIET

Did you know that your diet and weight can affect urinary incontinence and that being overweight can make the condition worse in women? Also, what you drink can affect how much urine you pass and some fluids can irritate the bladder, so it’s important to plan your diet and fluids to know what works for you.

Self-assessment

Completing what’s called a ‘bladder diary’ is a great way of understanding your own patterns. In a bladder diary you record all the times you drink fluids and pass urine either in the toilet or when you leak. By looking at this diary you’ll be able to see if there are times of the day when you leak more and whether this is related to activities or when and what you drink.

You’ll also need to be aware of what you eat, and if you’re overweight you may need to see your doctor or dietitian. Your health professional will be able to use the diary to provide you with tailored advice.

There’s a copy of a bladder diary for your convenience at the end of this booklet. Keep this diary for at least three days (up to a week if you can manage it).

It’s a good idea to observe the colour and concentration of your urine. Dark urine can be a sign that you may be getting dehydrated and need to drink more fluid. Also what does your urine smell like? If there’s an unpleasant odour you may have an infection. A simple test by your doctor will be able to determine if this is the case.

Planning

Depending on your self-assessment, you may need to increase or decrease your fluid intake. The usual advice is that a healthy fluid intake is about 1500 to 2000 mls a day, which includes all the food and fluids you have in a day. You may discover that it’s best for you to plan your fluid intake over a 24-hour period.

There are some people who need to decrease their fluid intake for other health-related reasons. For example, people with heart problems and kidney problems are usually told to drink less fluid. In all cases follow the advice of your doctor and if you’re receiving conflicting advice discuss this with your health professional.

There are some fluids that can cause problems for people with urinary incontinence, either because they irritate the bladder or because they make you pass more urine. These fluids include:

These fluids affect people in different ways. You may find that they affect you, or have no effect at all. To test if a particular type of drink makes you leak more, try the following:

Develop a timetable for eating and drinking that suits your lifestyle, tastes and desires.

Strategies

You can test the effects of certain food and drink in your own time at home – always worthwhile if you have problems with urgency (needing to go to the toilet in a hurry) or incontinence at night. But only restrict fluids if there’s a major problem with leaking. See a continence specialist for extra help on fine-tuning your strategy.

‘If I stop drinking at about seven o’clock at night it’s much better for me’ – Joan
‘I like to have a cup of tea in the morning, but if I’m taking my daughter to school and then going somewhere else, I won’t have a cup of tea, because I know I’ll need to go to the loo before I get there’ – Kristy

Tips

Amount

If there is a need to increase fluids

When out socially

Type of fluids

BODY CARE AND HYGIENE

Most people with bladder problems want to keep their condition private, so personal hygiene strategies are important. For some people, if an accident happens, this will mean clearing up immediately or changing slightly soiled underwear. For others with a more severe incontinence problem it’ll mean taking care of skin and seeking to reduce odour.

Self-assessment

In your self-assessment make sure you look at your skin to make sure you’re not excessively red or swollen. (You may need a mirror.) If you are, you’ll need to consult your doctor.

If you have a history of allergies, skin conditions, or haemorrhoids (piles) or a prolapse you may need to be especially careful. Again, consult your doctor if you’re worried.

Planning

Plan your daily hygiene routine. If leaking unexpectedly is a problem, make sure you take additional pads, underwear and cleaning cloths when you go out (baby wipes are good).

Strategies

Clothing should be washable, easy to launder and not require dry cleaning or hand washing. Why not try selecting clothes that are manageable, easy to remove and simple to pull up and down? you’ll also want clothes that make it easy to reach between your legs.

‘If I’m going to be far away from home, I’ll take an extra pair of pants with me’ – Kim

Strategies related to outer garments

Strategies related to undergarments

Tips

PHYSICAL ACTIVITY AND EXERCISE

Some people are more likely to leak if they’re exercising or physically active. This depends on what type of incontinence they have, how much and how often they leak, their age and gender, and how quickly they can get to a toilet. As part of your self-assessment why not see if you can work out which kinds of activities cause you problems?

For women, physical activity such as jumping or running can cause urine leakage, especially for those who leak when they cough or sneeze. For men, greater physical activity at work such as lifting and heavy manual labour may mean more leaks or more frequent or urgent trips to the toilet.

Continence aside, it’s vital to maintain activity for general fitness, for balance (to prevent falls in later life) and to control your weight. Recent research has shown that some people who leak urine actually stop exercising as a result. Yet for some people with urinary incontinence, gait and strength training may help make urine leakage more manageable.

Self-assessment

Wearing a pad in the privacy of your home, try out exercises like walking, climbing stairs, running, running up stairs, jumping on the spot or lifting a moderately heavy suitcase (less than 15 kg).

Which activities make your leaking and urgency worse? How much of an activity can you do before your leaking and urgency gets worse?

Planning

It’s important to think ahead and work out how to get help with activities like lifting. You may be able to modify an activity or swap an activity that causes leakage with one that won’t.

Strategies

Exercise is important for overall health, so even if it makes you leak, don’t stop exercising altogether. Replace jogging with walking. Try stopping or limiting exercise that increases leakage (such as lifting, strenuous sports like jogging or swimming or even standing for too long.)

Or why not try passing urine before physical activity or wearing a more absorbent continence pad during exercise?

For women: If you only leak with exercise, coughing or sneezing, you may find using a tampon helpful during exercise as it will support the front wall of the vagina.

And for physical exercise such as sex, urinating beforehand and changing positions are both common ways to reduce leakage.

Tips

Amount

I play croquet and I make sure that I don’t have a big drink before I go, because I don’t want to have to pull out of the game and have to go to the loo’ – Lorna

STRATEGIES FOR SOCIAL OCCASIONS

Urinary incontinence doesn’t have to dominate your life. All it takes is a little understanding of your situation and you can enjoy most social activities to the full if you plan ahead. In this section you’ll learn more about what we call ‘social continence’. It’s all about living a life that’s as normal and as sociable as possible, using toileting strategies, pads and other aids to help increase your confidence.

Self-assessment

‘The worst thing that can affect me is when I finish dinner and go to the sink to rinse the dishes.As soon as the water starts,pssht,that’s it, I’ve got to go’ – John

Planning

Everyone prefers to prevent accidents, but if one does occur, it’s always best to be prepared with spares and supplies. It also helps if there’s someone you can confide in – a relative or close friend who can help. Here are some other tips that can help make socialising easier:

‘When we’re travelling we always stop at McDonalds, because the toilets are clean and they are right on the highway’ – Mary

Strategies

Take back-up supplies such as:

Tips

PADS AND OTHRT AIDS

There are many different aids available that help manage incontinence, with disposable or washable pads being the most popular product choice. Other aids include ‘over’ toilet seats that help you get on and off the toilet, bed pads to put on the bed at night, pads to help protect the furniture, and waterproof covers on mattresses, doonas and pillows. For men there are also sheaths or catheters and for women there are devices that act as ‘stoppers’. Good sources of information about these products are the local continence nurse, community health nurse, or the National Continence helpline (see the resources section).

Self-assessment

Why not familiarise yourself with some of these products and test them out for yourself? Shop around and you’ll have first-hand experience of what works best for you. Try different types of pads to identify the best kind for your problem and work out how often you need to change them to prevent leakages when you’re out and about. You can also try to work out if you need different pads for day and night. You’ll find that pads come in a range of sizes, all with different absorption abilities. There are washable pads that can be inserted into underwear and there are reusable pants with built-in pads. These are very effective for people with light incontinence but less effective for people with severe urinary incontinence or faecal incontinence. Once you’ve tried out a variety of products you may decide that there are other types of aids apart from pads that are better for your specific condition.

Disposable pads fall into three main groups:

  1. Shaped pads that either stick into your underwear with adhesive strips or with special stretch pants
  2. Pull-up pads/pants
  3. All-in-one pads that wrap around the body and do up with adhesive tabs

These pads are available in many supermarkets in a limited range of brands and types. Most of the pads sold in supermarkets are for mild to moderate incontinence. Some local pharmacies stock a wider range of brands and products, but can be more expensive. If you wish to try out a variety of pads, some companies will provide samples free of charge.

You may also be interested to know that there are government subsidy schemes available in some states to assist with the supply of pads and aids. To check your eligibility for these subsidies, contact your nearest community health centre or Continence Foundation of Australia branch (see the resources section).

Planning

Once you’ve identified which pads or aids are best for you, work out when and how to use them by:

Strategies

‘I always make sure I’ve got a pad on, because I can’t just drop everything and go to the toilet. I try to, but it’s not always convenient’ – Julieanne

Tips

WHERE TO FIND OUT MORE

This booklet has provided you with useful information on managing incontinence. Health professionals will be able to help you further with treatments and therapies. Generally health professionals recommend the following strategies to people with urinary incontinence:

We hope that this booklet has provided you with useful information on managing incontinence. Other health professionals will be able to help you further. If you haven’t already gone to a doctor or continence nurse for an assessment, why not book an appointment today?

Health professionals and how they can help with urinary incontinence

When you’re looking for professional help with your incontinence a general practitioner may well be the first person you contact – someone who is well placed to offer you advice and refer you to a continence specialist if necessary.

You’ll probably also come across nurses who are involved with the management of incontinence in all settings and across all clinical areas. There are also continence nurse specialists in public and private health care organisations who have specialist knowledge about managing incontinence. Continence nurse advisors can do a comprehensive assessment of your continence problem, and provide advice about treatment, daily - living management and other sources of help.

Other professionals include physiotherapists, who have long played a central role in the management of urine leakage. Specialist physiotherapists have been trained to assess urinary incontinence and to teach people behavioural techniques to improve continence. These techniques include pelvic floor muscle exercises, bladder retraining, electrical stimulation and biofeedback, most of which have been shown to be effective in reducing incontinence. You can access physiotherapists directly without referral by a doctor (see the resources section below).

For better assessment, diagnosis and treatment of urinary incontinence, research suggests that health care provided in a specialist clinic is best. Some areas have clinics where doctors, nurses and physiotherapists work together to help people with urinary incontinence. To see if such a service is in your area, contact your local hospital or community nursing service and ask if there are specialist nurses or specialist clinics for urinary incontinence. Resources

Other places that provide information about continence or assistance include:

Telephone helpline
Internet sites and other resources
Assistance with purchasing pads and aids

Advice about funding schemes is available from the National Continence Helpline on 1800 33 00 66. They will give advice about:

Federal funding schemes

PLANNING GUIDE

How does incontinence affect my life?

Life impact0
Not at all
1
Slightly
2
Moderately
3
Severely
Everyday tasks
Work
Shopping
Social activities
Physical activities (e.g. sport, leisure)
Travel for more than 30 minutes
Going away on trips
Sexual activity
Feelings about myself
Other (specify)


What have I stopped doing because of my leaky bladder?

When am I most likely to have an accident?

What bothers me the most about the impact of my leaky bladder?

What strategies do I currently use to manage my leaky bladder and how well do they work?

What do I find most difficult to manage?

What daily living activity would I most like to improve? (E.g. travel, exercise, work, special events)

What are the things that get in the way of improving these activities?

MY PLAN

What are my aims? (E.g. a special occasion, holiday, activity)

 

Resources I can access

 

Strategies

 

Short term

 

Medium and long term

 

Planning, preparation or changes I need to make

 

Strategies to try out at home

 

Outcome of trials or dummy runs

 

Backup plans

 

Emergency strategies

 

Equipment and supplies

 

Things I need to discuss with my health professional

 

BLADDER DIARY (EXAMPLE PAGE)

Date: 23/7/06

>
IntakeOutput in toilet
TimeAmount of fluid (mls)
Use a measure
Type of fluidTime
When did you go to the toilet?
Amount of urine passed in toilet
Circle either the SM, MED or LGE symbol
Was the urge present?
(Yes or No)
7:30 am200 mlsTea7:00 amLarge amountYes
8:00 am50 mlsMilk on cereal8:15 amSmall amountYes
9:45 am150 mlsWater10:00 amSmall amountNo
12:00 noon400 mlsWater1:30 pmLarge amountYes
3:00 pm200 mlsWater3:00 pmSmall amountYes
4:00 pm100 mlsWater5:15 pmMedium amountYes
5:00 pm150 mlsTea7:30 pmMedium amountYes
7:00 pm100 mlsWhisky9:00 pmSmall amountNo
8:45 pm50 mlsWater3:00 amLarge amountYes
Total1400 mls423
Accidental leaks
Approximately when did you leak urine?How much urine did you leak?
1 = A few drops
2 = A medium amount
3 = A large amount
Type of pad brand
and weighting
(E.g. panty-liner/mini, standard, maxi, or specific incontinence product)
Was the pad changed?
(Yes or No)
6:15 am2 (medium)No pad
 Mini padNo
9:50 am1 (few drops)No
10:30 am1 (few drops)Yes
 No
5:00 pm3 (large amount)Yes
7:25 pm2 (medium amount)Yes
10:15 pm1 (few drops)No
 
 

What things seem to contribute to or be associated with your leaking?

When I put the key in the door; coughing or stand up after sitting down for some time.

BLADDER DIARY

Date:

IntakeOutput in toilet
TimeAmount of fluid (mls)
Use a measure
Type of fluidTime
When did you go to the toilet?
Amount of urine passed in toilet
Circle either the SM, MED or LGE symbol
Was the urge present?
(Yes or No)
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
 Small, medium and large symbols
Total
Accidental leaks
Approximately when did you leak urine?How much urine did you leak?
1 = A few drops
2 = A medium amount
3 = A large amount
Type of pad brand
and weighting
(E.g. panty-liner/mini, standard, maxi, or specific incontinence product)
Was the pad changed?
(Yes or No)
 
 
 
 
 
 
 
 
 
 

What things seem to contribute to or be associated with your leaking?

 



Living better with urinary incontinence

Print ISBN: 978 1 921291 30 2

Online ISBN: 978 1 921291 32 6

Published by Australian Government Department of Health and Ageing

Copyright © 2007 Research Centre for Clinical and Community Practice Innovation, Griffith University, Gold Coast campus, Griffith University, Queensland, Australia, 4222 Parklands Drive, SoUthport, Queensland, Australia 4215

While care has been taken to ensure that the information in this booklet is based on available research and expert consensus, any loss, damage, cost, expense or liability suffered or incurred as a result of this information (whether arising in contract, negligence or otherwise) is, to the extent permitted by law, excluded.

About the authors

Associate Professor Winsome St John
School of Nursing and Midwifery, Griffith University
Research Centre for Clinical and Community practice Innovation, Griffith University

Professor Marianne Wallis
Chair, Clinical Nursing research, a joint appointment between Griffith University and the Gold Coast Health Service District
Research Centre for Clinical and Community practice Innovation, Griffith University

Ms Shona McKenzie
Nurse Practitioner - Continence, Royal Brisbane Hospital

Ms Susan Griffiths
Research Centre for Clinical and Community practice Innovation, Griffith University

Acknowledgments

This project was funded by a grant from the Australian Government Department of Health and Ageing, National Continence Management Strategy.

Thanks are due to continence nurses belonging to Australian Nurses For Continence (ANFC), who provided information about advice they give their clients; the reference panel, who provided their expertise (Dianne Neilson, Heather Miller, Audrey Burgin, Christine Leech, Janie Thompson, Rosemary Mahomad, Carolyn Ehrlich, Charmaine Bryant and Jenny Nucifora); and people living with urinary incontinence who gener- ously shared their experiences and ideas.