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Incontinence: The Caregiver's Role
By Kevin McShane

Incontinence in children is called "training". In adults, it's often called embarrassing. Without understanding the problem, people may jump to the conclusion that their loved one is suddenly getting too lazy or simply doesn't care. This is so rare, that it should be the very last consideration when seeking a cause. Although incontinence is usually not an emergency, problems with incontinence should be reported to the doctor. The gynecologist and the urologist are the specialists who are most familiar with incontinence and can evaluate the causes and recommend several treatment approaches.

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There are a number of reasons your loved one may be experiencing incontinence, thus, while it may not seem like a medical emergency, it is wise to inform the doctor when problems are noticed. The specialists more familiar with incontinence are gynecologists and urologists. Depending on the cause of the incontinence, there are several recommended treatments. These should be discussed in detail with the doctor. The following possible causes are not arranged in order of likelihood of occurrence. Such predictions are based on the individual and aggravating or contributing factors.

    Dementia, mental confusion or psychological factors
    Restricted mobility
    Urinary tract or prostate enlargement or infection
    Side effects of medications
    Impaired nervous system
    Pelvic muscle weakness
    Nerve or muscle damage after pelvic radiation
    Developmental problems of the bladder
    Pelvic, prostate, or rectal surgery
    Bladder spasms

When you do speak with the doctor, give the doctor the most appropriate and applicable information. Here is a checklist of things the care recipient should share with the doctor.

    Describe your problem
    When does this occur?
    How long has incontinence been a problem?
    How much of a problem has this condition become?
    How many times does this happen each day?
    Are you aware of the need to urinate before you leak?
    Are you immediately aware that you have passed urine?
    Are you wet most of the day?
    Do you wear diapers in case of accidents? Occasionally? All the time?
    Do you avoid social situations in case of accidents?

History and factors

    Do you have a urinary tract infection now? In the past?
    Is it more difficult to control your urine when you cough, sneeze, strain, laugh, run, jump or walk?
    Is the incontinence worse when sitting up or standing?
    Do you suffer from constipation?
    Is there anything you can do to reduce or prevent accidents?
    Have you ever been treated for this condition before? Did it help?
    Have you tried pelvic floor exercises (Kegel)? Did it help?
    What surgeries have you had?
    What injuries have you had?
    What medications do you take?
    Do you drink coffee? How much?
    Do you drink alcohol? How much? How often?
    Do you smoke? How much each day?

Expect and prepare your loved one for the likelihood of a physical exam. For both men and women, expect an abdominal, rectal and neurological exam. Additionally, men are given a genital exam and women a pelvic exam. The doctor will also run a number of diagnostic tests, which will include urinalysis, cystoscopy (checking the bladder) and procedures to check urinary functioning.

You should encourage your loved ones and/or clients to avoid items that irritate the urethra or bladder. Check with your doctor for more specific information. Some of these items include liquids that tend to increase urination (coffee, alcohol), diuretics (water pills), some anti-spasmodic medications, antidepressants and antihistamines, cough/cold medications (they should also avoid coughing, so this may be a tricky one), ventolin (albuterol) or other beta agonists.

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