In recent membership surveys, the National Association for Continence (NAFC) was distressed to learn that, on average, people were waiting seven years before seeking treatment for their bladder or bowel control problem. After finally receiving treatment, more people rated their incontinence as "unchanged" or "worse" after treatment than "improved" or "cured."
NAFC has prepared this web tool to help you explain your condition to a healthcare professional and to enable you to get the best and most economical results from your care.
You should seek treatment for incontinence when you are not able to control your bladder or bowel as you once did. Loss of bladder or bowel control could be the first symptom of something more serious; usually it is not. Many people change their lifestyle when their bladder or bowel habits begin to control their lifestyle. They may stop visiting friends, going to church, doing aerobics, having sexual intercourse, or traveling to see their children. You should seek treatment whenever changes in your bowel or bladder habits keep you from going and doing what you want to do.
Ten Warning Signs of Bladder Control Problems:
- Leakage of urine which impacts your activities
- Leakage of urine causing embarrassment
- Leakage of urine after an operation, such as a hysterectomy, Caesarean section, or prostate surgery
- An urgent need to rush to the bathroom and/or loss of urine if you do not arrive in time
- Frequent bladder infections
- Urinating more frequently than usual without a bladder infection
- Pain related to filling the bladder and/or during urination in the absence of a bladder infection
- Inability to urinate, also known as urinary retention
- Progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying
- Changes in urination related to a neurological condition such as stroke, spinal cord injury, or multiple sclerosis
If you experience any of these conditions, you should consult a healthcare provider.
You should seek treatment for incontinence, because it is a symptom with many causes. Some causes are: infection, weakened pelvic floor muscles, low levels of female hormones, constipation, diabetes, prostate enlargement, multiple sclerosis, Parkinson's disease, and the effects of surgery. Other medical conditions or the effects of certain medications could also be the reason for your incontinence. When your incontinence is diagnosed and treated, often bladder and bowel control is greatly improved or completely restored. You should seek treatment to enjoy the happiest, healthiest, and most satisfying life possible.
Facts You Should Know
- Incontinence is the loss of bowel or bladder control.
- Incontinence - urinary and bowel - is believed to affect more than 25 million Americans.
- Incontinence affects people of all ages - young and old - both sexes, and people of all races.
- Incontinence is not a disease; it is not part of being a woman; and it is not just what happens as you get older.
- Incontinence is a symptom with many causes, so it is important to seek treatment to find out what is causing it and what can be done about it.
Your family physician is the best place to start. If your family physician does not have special interest in diagnosing and treating incontinence, ask to be referred to a specialist.
- A urologist is a surgeon who specializes in the urinary conditions of men and women. Many urologists have advanced training in the surgical correction and medical treatments for incontinence; but not as many have experience with nonsurgical treatments such as Kegel (pelvic muscle) exercises, bladder training, biofeedback, electrical stimulation, and the use of pelvic support devices or urethral inserts. However, interest and expertise in this area is increasing due to the growing number of urologists that are specializing in female urology.
- A gynecologist is a doctor specializing in the reproductive health of women. Some have special interest in the diagnosis and treatment of urinary incontinence and prolapse. If they have advanced training in this area, they may become urogynecologists.
- A geriatrician is a doctor who specializes in treating older people. Some geriatricians have advanced training in the treatment and management of incontinence.
- A gastroenterologist is a doctor who specializes in problems of the intestinal system. If you have diarrhea, constipation, or bowel incontinence, you may be referred to a gastroenterologist.
- Some nurse specialists, psychologists, physical and occupational therapists, and behavioral scientists have training that qualifies them to offer nonsurgical treatments for incontinence.
There are several ways to find the right specialist. Begin by asking your family doctor for a referral to an incontinence specialist. In addition, you may access our online search engine of the specialists in your area who have qualified for affiliation in NAFC's growing If we do not list a healthcare professional within driving distance of your home, you may want to look in your yellow pages where physicians are listed. Call your local hospital, and ask if the hospital has a continence clinic. Confide in a friend. Often friends will tell you where they had their treatment and if they were satisfied.
When you are looking for a qualified specialist for yourself or someone you care for, ask the following questions before you make an appointment. Unless the receptionist answers "yes" to at least eight of the ten questions, you should call another specialist.
- Does the specialist have a particular interest and training in the diagnosis and management of incontinence problems?
- Does the specialist have the ability to do special office testing of bladder function to help determine the cause of incontinence?
- Do other health professionals refer incontinent patients to this specialist?
- Does the specialist have experience in the treatment of patients who have had previous unsuccessful attempts at correcting their incontinence?
- Is the specialist experienced with nonsurgical forms of treatment for incontinence, such as pelvic muscle exercises, behavioral therapy, intermittent self-catheterization, etc.?
- Does the specialist teach other health professionals about the diagnosis and treatment of incontinence?
- Is the specialist experienced in the evaluation of patients for the implantation of the artificial urinary sphincter?
- Is the specialist experienced in the evaluation and treatment of incontinence related to birth defects, such as spina bifida, and accidents that cause spinal injury or bladder damage?
- If my incontinence cannot be cured, can the specialist or someone in the office tell me about printed information, support groups, and/or management alternatives that will make life with this condition more comfortable?
- Does the specialist know about the Agency for Health Care Policy and Research Clinical Practice Guideline for the Treatment of Urinary Incontinence in Adults and about the National Association For Continence (NAFC), formerly Help for Incontinent People (HIP)?
#1 - Be ready to answer these and many other questions that will be asked of you.
- How often do you urinate (pass your water) each day? *
- How much liquid do you drink each day? With meals; between meals? *
- Do you leak urine when you cough or exercise?
- Do you feel an urge when you have to urinate? *
- Do you have to rush to the toilet?
- Do you sometimes not make it?
- Do you have trouble starting your urine stream?
- Is your urine stream like it always has been, or does it seem "slow" or "weak"?
- Do you feel like you empty your bladder?
- Do you have to strain or push?
- Do you dribble or leak urine after you think you have finished urinating?
- How many times do you get up at night to use the toilet? *
- Does it ever hurt or burn when you urinate?
- Does your urine have a bad odor or appear dark yellow or "strong"?
- Do you ever see blood in your urine?
- When did this problem of leakage start?
- How often do you wet your clothing? *
- How many pads do you wear each day? Are they wet when you change them?
- Are there a few drops in the pad, or a bladder full? *
- How often do you have a bowel movement?
- Are your stools soft, soft and formed, hard, easy to pass, difficult to pass?
The questions marked with an * will be answered if you keep a bladder diary (Uro-Log) for four days before your appointment. On this diary, record each time you urinate, how much urine you pass, what you drink and eat each day, when and how much leakage you have, and what you were doing when the leakage occurred.
#2 - Take a list of all your doctors and medical conditions, such as diabetes, high blood pressure, etc. to your appointment.
#3 - Take a list of any operations you have had and when you had them. Women should list the number of pregnancies, number of deliveries, weight of their babies and whether they were delivered through the vagina or by Caesarean section.
#4 - Show the doctor all your medicines. We suggest you get three food-storage size bags. In one, put all the prescription medicines you are taking that have been prescribed or refilled during the last 30 days. In the second bag, put all the prescriptions that you keep in the house but that you don't take regularly. In the third, put all the over-the-counter medicines, vitamins, and cold remedies that you take.
#5 - Be prepared to describe how incontinence affects your daily life. Make a list of the most bothersome problems related to your incontinence.
#6 - On the day of your appointment, expect to be asked for a urine specimen. Talk with the doctor's receptionist when you make the appointment and when you arrive, to see if there are tests or preparations for tests that you should know about.
Expect the health professional to be concerned about your complaint and to be attentive to the information you bring. Be ready to give a complete history, which will include the questions we have listed for you and probably many more. Expect to have a complete physical examination. You will be asked to give a urine specimen, and you should be tested within 15 minutes after that to see if there is still urine in the bladder. Sometimes this is done by passing a small thin tube (catheter) into your bladder. Other times it is done with a small sensor that is rubbed over your lower abdomen. This is called an ultrasound. A sample of your blood may also be taken.
The doctor may begin treatment immediately or do some other tests called urodynamics [yer-o-die-NAM-icks]. These tests show how your bladder acts when it is filling and emptying. The reason for all tests should be explained, and you should know when, how, and where you will get the results.
Once the specialist has made a diagnosis of your bladder or bowel problem, you should expect to have the treatment choices explained to you with the risks and benefits and estimated cost of each.
And finally, expect to participate in your care to get the best results. Your treatment will be most successful when you help choose the solution and when you do all that you need to do in the way of record-keeping, going to the toilet regularly, drinking the recommended amount and type of fluids, and performing exercises if you are told to do so. Of course, you should report any side-effects of medicines or treatments and discuss any concerns you have about your treatment with your healthcare professional.
- Why do I need this medication?
- Are there any side effects?
- How soon should my symptoms improve?
- Are there any special instructions?
- What will this test show you?
- How accurate is it?
- How will it affect my treatment?
- Are there any risks or side effects?
- Do I need to do anything special before or after the test?
- How much will it cost?
About treatment and surgery
What are the benefits and risks? How soon will it improve my condition? Are other treatments available? Can you refer me to another physician for a second opinion? If surgery is needed, how long will I be hospitalized and what will it cost? What is the average recovery time?
Q. What treatments will help my condition?
A. Behavioral therapies, medicine, surgery, and absorbent products and devices are options recommended by the Clinical Practice Guideline for Urinary Incontinence in Adults. This Guideline, released in 1992 and updated in 1996 by the Agency for Health Care Policy and Research of the U.S. Public Health Service, was developed by a panel of experts invited by the government to study the problems of incontinence and to make recommendations for treatment. Some types of incontinence have more than one treatment option. Discuss the options for your type of incontinence with your physician and your family, and choose the one that is best for your lifestyle.
Q. What should I expect to happen after I receive treatment?
A. You probably should not expect your incontinence to go away in a day or two if you have had it for a long time. Have your healthcare specialist explain the results you should aim for. You should know whether to expect your condition to improve in a matter of days, weeks, or months. Be watchful to changes and improvements, however small.
Q. Should I expect to be cured?
A. In many cases, yes. In most cases incontinence can be improved. If you have a condition, such as multiple sclerosis or spinal cord injury, you may not be able to change your incontinence; but you should be able to manage it comfortably without the embarrassment of leakage or odor.
Q. What about incontinence and skin care products?
A. They are very important for your comfort and confidence. Use of the proper products will protect your skin from irritation and will protect you and your home from embarrassing odor. Along with the Quality Care quarterly newsletter and access to the Find An Expert Database, NAFC Subscribers receive a complimentary copy of the Resource Guide - A Comprehensive Directory of Products and Services for Bladder and Bowel Control ($25 annually). All incontinence products are illustrated, described, and cross-referenced to their manufacturers. Click here to become an NAFC Subscriber.