Urinating in bed for adults can be very embarrassing especially in an African context. The stigma that goes along with this condition is always detrimental to the victims. The majority of people tend to associate urinary incontinence with ignorance and immaturity. The social life of the victims tends to suffer most to an extent of some of them opting to embrace a complete introversion.

Let us reason out together guys. Do you think a twenty-five years lady can pee on herself while in a meeting because she is fagged out hence she chooses not to rush to the lavatory? What about a thirty years old man who wets his bed on a daily basis whether he is drunk or not. Do you think that he does this because he is reluctant to visit the toilet at night?  It’s high time we stop being moral adjudicators and instead we reach out to them and give them all the moral and medical support they need to overcome this problem. However, we need to understand this problem first before we embark on helping them. The diagram below illustrates the renal system which plays a very big role in excretion of waste materials.

 

Am going to use very simple terms so that we can understand fully the renal system and how it relates to incontinence. It is made up of two kidneys, Ureter, urinary bladder and various blood vessels. Kidney’s core function is to filter blood so that waste such as urea, drug metabolites, and excess water is removed. The combination of this waste matter is what forms urine and it is later channeled to urinary bladder via the ureters for storage. The urinary bladder is a very expansive organ. The desire to urinate is initiated when urine accumulates in the bladder to its capacity. Urethra communicates with the urinary bladder at the neck and is responsible for conveying urine out of the bladder during urination.

Why is it that adults are aware of urination and children are not? This has to do with the nervous system. When the urinary bladder is full, nerve endings that are sensitive to stretch are stimulated. In infants, this stimulation causes a spinal reflex action that leads to urination without the urge being sent to the upper brain to create awareness. It’s different in adults because they have a more developed nervous system. This stimulation of spinal reflexes sends sensory impulses to the brain and there is awareness of the need to urinate. Urethra has two leads (sphincter) both internal and external. The human being has the ability to control the opening and closure of the external sphincter which prevents dribbling of urine until one increases the pressure within the pelvic cavity. That is why one can control urination even when the urinary bladder is full.

There are so many factors that may compromise the performance of this composite system leading to urinary incontinence. This may include trauma, conditions such as Diabetes, Hypertension, Benign Prostate Hypertrophy and systemic infections such as cystitis.

Urinary incontinence tends to affect the elderly more because they have a reduced muscle tone. There are various forms of incontinence and we will discuss them briefly.

Have you ever sneezed or laughed only for you to pass some urine involuntarily? That is what we refer to Stress incontinence. It occurs when there is increased abdominal pressure. Surgical procedures such as prostatectomy and vaginal deliveries tend to aggravate this condition. Some drugs may also lead to this condition and they should be discontinued.

What about passing urine involuntarily just before you reach the toilet.

You feel the urge but you just can’t subdue it. That is what is known as Urge incontinence. It occurs due to neurologic dysfunction.

There is a situation whereby one loses urine involuntarily with a complete absence of voiding sensation. It occurs in patients who have a spinal injury which leads to loss of sensory awareness to micturate. This condition can only be repaired surgically.

There are some instances when one experiences urinary incontinence due to over distention of the bladder. This occurs when there is an incomplete emptying of the bladder leading to overflow of urine. Any physical obstruction of urine along the urethra and neurological abnormality may lead to this form of incontinence.

It’s important for anyone suffering from this condition to seek specialized medical care so that diagnostic and curative services can be accorded to him/her.

  • Behavioral therapy plays a very big role in treating this condition especially the stress incontinence. Sufferers should avoid food substances that tend to irritate the bladder. This may include carbonated drinks, caffeine, and much more.
  • It is recommended that you take at least eight glasses of water per day. You should not take excess fluids either. It is likely to cause overflow in the bladder and subsequent leakage of urine. One should avoid taking a lot of fluids during the night to prevent nocturia (Excessive urination at night). It is always encouraged for one to empty his/her bladder (urinate) before going to bed to minimize the chances of wetting the bed.
  • Kegel exercise is another treatment modality. It involves training your bladder to hold urine. This involves contracting and relaxing your pelvic muscles periodically. This nonpharmacologic method is recommended to both male and female patients. Most patients tend to give up in doing these exercises because they take time to give results depending on how regular and correctly one does them. One should consult a Doctor first to ensure that he/she is fit to do them. Click here to learn how to conduct kegel exercises.
  • Urinary Catheterization is done in the event the urine incontinence becomes uncontrollable to prevent complications especially if the patient is immobile. These complications may include bedsores, skin infections, urinary tract infections and a subsequent negative impact in your interpersonal life.

  • Surgical intervention is always the final resort when other forms of therapy fail.

 

I will urge the community to stop stigmatizing individuals who suffer from this condition. It’s important we support them in all aspects.  There is nothing funny with an adult wearing a diaper or a napkin.

Urinary Incontinence is a Curable Medical Condition that has nothing to do with Maturity or level of Intelligence Quotient. Retract your judging fingers and accord these patients all the necessary support.

Author: Eliud K Maina: Registered Nurse/ HTC Counselor

 

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