Managing urinary incontinence.

Urinary incontinence is not a disease but a symptom of an underlying problem, the cause of which is sometimes unknown. More than 600,000 New Zealand adults have experienced the problem at some time and should be referred to a health professional with expertise in urinary incontinence.

* Urinary incontinence is more common in women than men, with a ratio of 4:1.

* 40,000 women experience some degree of bladder leakage on a daily basis.

* One in three women who have had a baby will wet themselves.

* Only one third seek professional help; most think nothing can be done.

* 70-80 percent can become dry again or significantly improved.

* Bladder problems can seriously limit people's social life. Some won't go out for fear of an embarrassing episode.

The most common type of incontinence is called stress incontinence, experienced by women following childbirth. It is characterised by small amounts of urine leakage, usually associated with physical exercise or laughing, coughing or sneezing. In later life, with a decrease in female hormone production, the problem can occur again, or for the first time. In these cases, the muscles of the pelvic floor are weakened and treatment revolves around exercises to strengthen them.

Another type of incontinence is over-active bladder or urge incontinence, so named because of the strong desire to urinate which can occur many times a day, leading to frequency. Treatment is based on bladder retraining using biofeedback techniques and may include dietary modification and/or medication.

Overflow incontinence is more commonly experienced by men and is usually caused by enlargement of the prostate gland with resulting obstruction. Treatment in many cases requires surgery.

Continence nurse specialists working throughout all district health boards have special expertise in managing bladder and bowel control problems for men, women and children. The nurse will complete a full assessment, including a post void residual ultrasound and ensure an appropriate programme of conservative management is completed. This involves pelvic floor muscle training exercises, bladder retraining, fluid intake modification, management of constipation, dietary advice, caffeine reduction, weight toss and smoking cessation. Research has shown that 70 percent of people will become much improved or dry. The remainder can be given advice on a product to help them manage their bladder control problem and improve their quality of life.

For free, confidential help and information, phone the continence association on 0800 650 659, or visit the website www.continence.org.nz. Conference to investigate incontinence A conference hosted by the New Zealand Continence Association in Hamilton in September--Investigating incontinence: humanity and technology--will be a very effective toot in educating health professionals in areas of continence assessment, management and care.

Keynote speaker is Australian Winsome St John, who has 25 years' experience as a clinician, educator and researcher. Her keynote address is entitled "Urinary incontinence in community dwelling populations': A wide range of topics include conservative management techniques, diet, rest-home care management, use of technology, physiotherapy advances, childhood constipation, sexual issues, politics, and the cost of bladder dysfunction.

For more information and a full programme, email [e-mail]. Continence Awareness Week will be held in the first week in September.

Report by Continence Association executive officer Jan Zander