Our friend Cynthia Randall, RN, BSN with over 30 years of experience in kidney transplant, urology and oncology is answering some common questions about incontinence.
How does the bladder communicate with the brain?
The bladder is an actual muscle. It is a muscle that has sensory receptors around it. Then you have your brain, it is basically the motherboard of everything. And through the spinal cord going down there are fibers of sensory nerves that control sensations and motor nerves which control movements. Toward the end of it that is where your bladder and your bowel are. Everything in your body goes up and down through the spine.
So when we drink something, soon our bladder starts sending us signals, that it is filling and later that it is full. What happens when things are abnormal? Sometimes you don’t get a sensation that your bladder is filling. Someone might be walking around not knowing that their bladder is full. Sometimes it has to do with neurological issues. Sometimes it is diabetes. As they get older and diabetes progresses, they lose that sensation.
Urodynamic studies tell us what the capacity of the bladder is. For people who don’t get sensation or ignore that message, the bladder becomes like a balloon and stretches and gets bigger. But bigger sometimes doesn’t mean better. It loses the elasticity it needs to actually contract.
Types of incontinence
So we have three types of incontinence:
Urgency incontinence or overactive bladder
When your bladder is filling, it sends the message up to the brain. What usually happens, it waits for the brain to send the command back to relax. With an overactive bladder it starts contracting without command from the brain. By the time you acknowledged that it is time to go, your bladder is already going. This condition is treated by urologists with medications, sometimes with Botox injections.
This type of incontinence happens when you put pressure on the bladder, for example during exercises or running, and you experience a little bit of leaking. In this case it indicates that the pelvic floor muscles are weak. Sometimes it is treated by surgical procedures.
This type of incontinence is the most common for people with neurological issues like Spina Bifida. It often affects the bowel and bladder at the same time. Bladder can have limited capacity or limited sensation. In some cases you don’t get sensation, but you remember to empty the bladder and the bladder has enough capacity. But sometime when you don’t get sensation the bladder is filled with urine and when it overflows, it starts to leak out. With overflow incontinence the bladder usually is not emptied completely. If you are not catheterizing and keeping that reservoir full, old urine stays there and causes recurring bladder infections. Urodynamic tests are very helpful to determine the reasons and treatment.
How kids with urological problems can adjust to everyday life
Kids don’t really like to take a lot of medicines. One of the things we always focus on with them is their everyday routine. When you wake up in the morning you go and pee, at launch time you pee, when you come back from school you go and pee, before you go to bed you use the bathroom. But you need a little help to empty the bladder completely by catheterizing yourself. So we explain to them that everything they do is normal, they do everything the same as their friends, they just use a little tool to help them empty their bladder completely and avoid infections. We make sure to also teach them to wash their hands and keep the area and catheter clean. But by doing that it makes them feel normal.
When using My Private Pocket Underwear kids with incontinence can have all their supplies and extra pair of undies within reach! The inside pocket is the perfect size to discreetly carry a little catheter and wipes. And if they did have an accident the soiled underwear can be folded into a waterproof pocket and stored. It helps a lot with social aspects at school, when kids don’t want everybody to know about their condition.