NAFC GLOSSARY OF INCONTINENCE-RELATED TERMS
Learn the definitions behind the many different incontinence-related terms.
Pads and garments, either disposable or reusable, worn to contain urine. Absorbent products include shields, guards, undergarment pads, combination pad-pant systems, diaper like garments, and bed pads.
Angiotensin converting enzyme (ACE) inhibitors can be used for lowering blood pressure. Categorized among antihypertensives.
Activities of Daily Living (ADL)
Tasks that people can do on their own without assistance. ADL tasks include such everyday activities as dressing, bathing, cooking, and shopping and are used as a formal measure to determine the extent to which someone requires institutional or assisted care.
Agency for Health Care Policy and Research (AHCPR)
A division of the United States Public Health Service. The agency has developed care guidelines for conditions, diseases, and diagnoses considered of highest priority, including incontinence. It has also developed surveys for measuring consumer satisfaction, health status, and outcome ratings for people who use both public and private healthcare systems as well as managed care organizations and traditional commercial insurance health plans. The agency has been renamed under the Clinton Administration to Agency for Healthcare Research and Quality (AHRQ) because it is not a policy-setting body.
Drugs that can cause or contribute to chronic retention of urine by causing urinary retention and increased sphincter resistance. They are typically present in over-the-counter medications used as appetite suppressants as well as in formulations marketed for the relief of cold symptoms. However, alpha-adrenergic agonist drugs are often recommended for women with stress urinary incontinence who have no contraindications for their use. Since side effects may include agitation, respiratory difficulty, headache, hypertension, and cardiac arrhythmias, they are often contraindicated in many geriatric residents.
Drugs that affect the smooth muscles that receive signals through the peripheral nervous system and thus can cause or contribute to stress urinary incontinence by causing urethral relaxation through decreased sphincter resistance. They are often prescribed to lower blood pressure by dilating arterioles and veins.
Drugs that can cause or contribute to incontinence by inducing constipation and thus impaction of stool with chronic retention of urine. An example of anticholinergic medication is a muscle relaxant. Anticholinergic agents may also cause urinary retention, contributing to chronic retention of urine. Other anticholinergic effects include dry mouth and blurred vision. However, these agents (e.g., oxybutynin, propantheline, tolterodine) are recommended often as pharmacological therapy for individuals with detrusor instability associated with urge incontinence. They can also be useful for mixed incontinence; urge/stress incontinence.
Drugs that can trigger reversible urinary incontinence by causing anticholinergic action or sedation. Tricyclic antidepressants (TCAs) represent first-generation antidepressants introduced more than 40 years ago. Imipramine is a member of the class of TCA drugs. The most common adverse effects that limit therapeutic usefulness are anticholinergic effects (see anticholinergic agents), sedation, weight gain, sexual dysfunction, and hypotension. Fluoxetine (i.e., Prozac) represents an example of a subsequent generation of antidepressant drugs with fewer effects on the nervous system and thus less toxicity.
Drugs that block dopamine receptors in the region of the brain that controls emotions and behavior. They are used to treat major psychiatric disorders such as schizophrenia, mania, and bipolar manic-depressive disorders. They can trigger reversible urinary incontinence by causing anticholinergic action, sedation, rigidity, and immobility.
Inflammation of the vagina and vaginal dryness as a result of low estrogen levels after menopause. This is a condition corrected by taking postmenopausal estrogen. With aging, capillaries in the vaginal walls shrink, or atrophy, reducing blood flow and nutrients to these tissues. The outer folds of the vagina shrink, causing the skin to sag and become dry. The vagina is thus susceptible to irritation and infection. For a full diagnosis, the acid-base balance (pH balance) of the vagina is determined, and a sample of vaginal cell types is analyzed for their maturation index.
Damage pertaining to the myelin sheath. In the peripheral nervous system, the larger axons are surrounded by a myelin sheath formed by circular layers of plasma membrane.
Specific interventions designed to alter the relationship between the patient's symptoms and his/her behavior and/or environment for the treatment of maladaptive urinary voiding patterns. This may be achieved by modification of the behavior and/or environment of the patient. Behavioral modifications include biofeedback, bladder retraining, electrical stimulation, habit training, pelvic floor muscle exercises, and prompted voiding.
A means of bladder retraining using equipment specifically for incontinence that requires either a sensor placed in the vagina of the female or the anus of a male. The sensor is connected to a computer or home therapy unit that can show how the muscles of the pelvic floor are contracting and relaxing. This is helpful behavioral therapy because it enables the person to focus attention on contracting the correct muscles of the pelvic floor.
Bladder retraining is an education program that teaches the person to restore a normal pattern of voiding by setting scheduled voidings to achieve longer time intervals between voiding. Teaching methods include learning to resist or inhibit the urge sensation. Improving the ability to suppress the urge sensation and eventually diminish urgency will enable the person to adopt a more normal voiding pattern. Two strategies used to inhibit the urge sensation is the use of slow, deep breathing to relax and reduce or eliminate the urge and performing 5 or 6 rapid, intense pelvic floor muscle contractions (Kegel exercises).
Calcium Channel Blockers
A major class of drugs often used in the treatment of angina and hypertension. By decreasing bladder contractility, they can induce urinary retention and cause chronic retention of urine.
An acute inflammation of the deep subcutaneous skin tissues and occasionally muscle. It is usually caused by infection from various bacteria. It is characterized by edema, or swelling, warmth, and tenderness.
Chronic Obstructive Pulmonary Disease (COPD)
A chronic disease of the airways including either emphysema, chronic bronchitis, or both. It results in destruction of the air sacs, a non-reversible destructive process that is usually the result of cigarette smoking.
The ability to exercise voluntary control over the urge to urinate until an appropriate time and place can be found. The ability to control involuntary leakage of urine or fecal matter.
Coronary Heart Failure (CHF)
A condition in which the heart cannot pump enough blood to meet the requirements of the body's other organs. The most common signs of CHF include swollen legs or ankles, difficulty breathing, or weight gain due to fluid retention.
A condition associated with inflammation of the bladder wall and the development of ulcers in the lining of the bladder, leading to decreased bladder capacity and hypersensitivity of the bladder. It is often accompanied by abdominal pain as the bladder fills, a need to urinate frequently, and relief of pain after urinating, with no signs of infection.
Protrusion of the urinary bladder through the vaginal wall which can make it difficult to empty the bladder completely. The residual pool of urine in the bladder can form a breeding ground for bacteria. Common in older women, it is also called a cystic hernia. Chronic retention of urine may be caused either by an obstruction of the urethra, an underactive detrusor muscle, or both. Obstruction may occur as a result of a cystocele, impacted feces, a narrowing of the urethra, or a pelvic tumor.
A radiographic demonstration of the bladder filled with a contrast medium.
A general term for any part of the body that pushes downward. In the urinary tract system, the detrusor muscle is actually a network of muscles that lie within the bladder wall and that contract and relax to allow for the storage and elimination of urine. When the detrusor muscle contracts, the bladder neck opens, releasing urine from the bladder into the upper part of the urethra, or the canal that conveys urine from the bladder to the exterior of the body. Relaxation of the detrusor muscle allows the bladder to refill. Instability or overactivity of the detrusor muscle can lead to urge incontinence, or overactive bladder. It is represented by involuntary detrusor contraction in the absence of associated neurological disorders.
Increased excretion of urine.
An agent that promotes the excretion of urine. Diuretics are often prescribed for treatment of coronary heart failure, renal disease or in the treatment of hypertension alone ,or in combination with other drugs. Hydrochlorothiazide is one of many thiazide diuretics used in hypertension therapy. Diuretics decrease blood volume by enhancing salt and water excretion by the kidney and lowering the resistance of blood vessels, thereby lowering blood pressure. Diuretics can cause reversible UI by increasing frequency and urgency of urination.
Abnormal discomfort or pain and a burning or smarting sensation accompanying voiding.
Pelvic Floor Stimulation
Pelvic floor stimulation is the use of electrical current that causes the pelvic muscle to contract. Through the use of internal probes or skin sensors, an electrical current is sent to the pelvic muscle causing a muscle contraction. This can be useful in that the stimulation provides a passive contraction with increased awareness of pelvic muscle contractions.
The recording and study of the intrinsic electrical properties of skeletal muscle by means of surface or needle electrodes to determine whether the muscle is contracting or not, or by inserting a needle electrode into the muscle and observing, by cathode-ray oscilloscope and loud-speaker, the action potentials present in a muscle or induced by voluntary contractions.
The involuntary loss of urine during sleep. This term is most often applied to nighttime bed-wetting in children, or nocturnal enuresis.
External (condom) systems are devices made from latex rubber, polyvinyl, or silicone and used primarily in men. The catheters are secured by a double-sided adhesive, latex, or foam strap that encircles the penis and are connected to urinary collecting bags by a tube. These catheters are disposable and can be applied and removed by the person using them. A new catheter is used every 2 days.
An abnormally frequent desire to void, often of only small quantities (e.g., less than 200 mL).
A physician who specializes in problems of the intestinal system. Problems with chronic diarrhea, constipation, or bowel incontinence may be referred to a gastroenterologist.
A physician who specializes in diagnosing and treating the health disorders of older people. Some have advanced training in treating and managing incontinence. Of the approximate 60,000 physicians in the United States, only 8,000 are board-certified geriatricians.
A physician who specializes in the reproductive health of women. Some have special interest in diagnosing and treating urinary incontinence and prolapse. Those with advanced training and certification in this area may be urogynecologists.
Blood in the urine. Renal hematuria refers to blood that comes from the kidney. Urethral hematuria refers to blood that comes from the urethra. Vesical hematuria refers to blood that comes from the bladder itself.
Difficulty starting the urine stream. Represented by an increase in the length of time between initiation of urination by relaxation of the urethral sphincter and when the urine stream actually begins.
Abnormally increased content of sugar in the blood.
Any exaggeration of reflexes. In urinary incontinence, it represents an involuntary detrusor contraction resulting from a neurological disorder.
The regular insertion of a clean, straight catheter into the bladder to allow the urine to drain freely. Once the bladder is emptied, the catheter is removed. Catheters are cleaned and reused for at least 10 days. This may be necessary in people who do not empty the bladder completely (urinary retention). Self-catheterization can be done safely by the individual person.
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
A national organization that accredits healthcare organizations and agencies.
Kegel (see Pelvic Muscle Rehabilitation)
Measurement of the pressure or tension of liquids or gases using an instrument known as a manometer.
The passage of urine, or urination.
The supply of energy or stimulation to a nerve or supply of nerves to a part of the body.
An atonic, or unstable, bladder associated with a neurological condition such as diabetes, stroke, or spinal cord injury. May be referred to in literature as reflex urinary incontinence.
Excessive urination at night. Awakening at night by the need to void.
Nonsteroidal anti-inflammatory drugs including a broad classification of non-opioid analgesics such as aspirin, ibuprofen, acetaminophen, and naproxen widely used to reduce both inflammation and the pain associated with various forms of arthritis. Gastric irritation tends to limit their long-term usefulness.
A nurse with advanced nursing training, certification, and education usually including a masters degree in nursing. Some have special interest in the and treatment of urinary incontinence related problems.
Low blood pressure when standing erect.
Refers collectively to classic urge incontinence, as defined in the literature, in combination with frequency and urgency.
A slowly progressive disease usually occurring in late life characterized by mask-like facial expression, a characteristic tremor of resting muscles, a slowing of voluntary movements, a shuffling gait, peculiar posture, and weakness of the muscles. There may be excessive sweating and feelings of heat. Pathologically, there is degeneration within the nuclear masses of the extrapyramidal system. Also called shaking palsy.
The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the foot or feet, characterized by visual swelling.
Pelvic Floor Muscles
A sling of muscles extending from the inside of the pubic bone to the anus and woven around the vagina, urethra, and rectum help indirectly to control the contractions of the detrusor muscle and the urethral pressures. The pelvic floor muscles relax to allow urination and tighten to stop the stream of urine. Pelvic floor muscle exercises can be taught to strengthen the sphincter muscles. Contraction of the pelvic floor muscles closes the lower urethra, squeezing any remaining urine back up into the bladder.
Pelvic Muscle Rehabilitation
A rehabilitation program that involves strengthening the pelvic floor muscle. Additional tools such as biofeedback, electrical stimulation and neuromodulation may be used to assist the person in identification and coordination of these muscles. Pelvic muscle exercises (PMEs) often called Kegel exercises, consist of repeated, contractions of the pelvic floor muscle. Persons must become aware of the function of the pelvic floor muscle and taught to contract the muscle in a planned exercise program. At least 30 to 50 exercises per day can increase support to the bladder and urethra.
A pelvic organ support device that is placed in a woman's vagina to support the bladder and/or compress the urethra. Pessaries come in various shapes and are selected and fitted by gynecologists and some nurse specialists. Pessaries are particularly helpful for women who are not healthy enough to be candidates for surgery or do not wish to have surgery for a cystocele.
The passage of a large amount of urine in a given period, a characteristic of diabetes.
A localized area of dead tissue that commonly develops over bony prominences when muscle, fat, and skin layers of tissue are compressed for a prolonged period of time and deprived of oxygen and nutrients. Other common causes of pressure ulcers are friction, the dragging of skin across a surface, and excessive moisture from incontinence. Urinary incontinence can cause the skin to become softened, or macerated, by the continual presence of unabsorbed urine. Continence status is thus a risk factor for developing pressure ulcers.
The abnormal increase in the number of normal cells in a normal arrangement in the prostate gland in males that surrounds the neck of the bladder and the urethra. When enlarged, it can compress or obstruct the urethra, reducing the force of the urinary stream, causing hesitancy in initiating voiding, as well as inability to terminate micturition abruptly (with post-voiding dribbling), a sensation of incomplete bladder emptying, and urinary retention.
Percutaneous Tibial Nerve Stimulation (PTNS)
Percutaneous tibial nerve stimulation (PTNS) is an in-office procedure for the treatment of overactive bladder and/or urge incontinence. It involves the delivery of electrical stimulation to the sacral nerve via the tibial nerve, accessed at the ankle. The principle behind this treatment is that stimulating the nerves of the pelvic floor through gentle electrical impulses (i.e., neuromodulation) can alter the activity of the bladder. Each treatment lasts approximately 30 minutes, in an initial series of 12 treatments, typically scheduled a week apart.
Pulsed Magnetic Treatment
A deep penetrating therapy that rehabilitates the nerves and muscles that control continence by building strength and endurance in these muscles. Therapeutic success is independent of a patient's ability to do pelvic floor muscle exercises. Patients need to only sit in the therapy chair and be properly positioned to receive the benefits this treatment.
Supportive device for the area posterior to the pubic bone.
Sacral Nerve Stimulation
A therapy for people with urinary urge incontinence, symptoms of urgency/frequency, and urinary retention who have not responded to more conservative therapies such as medication and behavioral modifications. It uses a surgically placed system under the skin that uses mild electric pulses to stimulate a sacral nerve in the lower back. This nerve influences the bladder and surrounding muscles that control urinary function.
Programs that are either staff-dependent or self-toileting that is voiding on a scheduled time basis. The premise of these programs is that if a person is taught to void frequently in toileting receptacles, incontinence will not occur. The most appropriate are persons that may have mobility or cognitive impairment but are able to cooperate with toileting, have normal bladder capacity, and have continent voids during the day. There are two types of toileting programs: Timed toileting on a fixed schedule basis can prevent urinary incontinence episodes. Research has shown that 82% of an individual's voiding episodes occur during the same hourly blocks of time. Prompted voiding includes a toileting schedule, verbal feedback, and positive reinforcement of the successful toileting. Prompted voiding is dependent on staff involving himself or herself in the person's voiding process as it stresses active communication.
A ring-like band of muscle fibers that closes a natural opening. Tightening the urethral sphincter controls the urge to urinate. Tightening can also prevent loss of urine and can serve as a reflex mechanism to calm the bladder and relax the detrusor muscle. Both the anus and the urethra have sphincters, whose muscle tone is key to preventing leakage and maintaining fecal and urinary continence, respectively.
Hand-held, reusable containers and devices that can be used by both men and women to catch or collect urine. The use of these products can promote independence and self-toileting.
The membranous canal conveying urine from the bladder to the exterior of the body.
Urethral Bulking Agents
A periurethral injection of collagen protein or carbon coated beads suspended in a gel that may be administered for women with moderate-to-severe leakage from stress urinary incontinence who have not improved with pelvic floor muscle exercise. In this minimally invasive procedure, collagen is injected under the lining of the urethra to add bulk, allowing the urethral sphincter muscle to close at the appropriate time to prevent urine leakage. More than one injection may be required. Another implantable, non-bulking material is a tension-free vaginal tape system that offers a viable option for the treatment of stress urinary incontinence. No sutures or anchors are necessary as with more invasive surgical procedures. The mesh tape is designed to support the bladder neck and urethra.
An intense desire to void immediately. It often accompanies frequency.
A surgeon who specializes in the urinary conditions of men and women. Not all urologists, however, have advanced training in non-surgical behavioral treatment for incontinence. Some urologists specialize in female urology.
Protrusion of the cervix, or neck of the uterus, midway down the vagina, to or beyond the vulva because the ligaments and muscles supporting the uterus are weakened and need to be shortened.