Posted - December 2011 in Living with HSP - Management & Treatment News
HSPers can have trouble with urinary function, but this is not easily or often talked about. It’s a huge topic and we’ll just begin the conversation here. This is the first of a two-part series – the second part will appear in the Autumn 2012 edition in early March.
Problems can include:
- increased urgency – when you have difficulty getting to the toilet quickly enough
- frequency problems – having to urinate unusually often
- incontinence – the inability to hold urine in
- stress incontinence – urine leaks when one sneezes or coughs
- difficulty voiding – not being able to empty the bladder
- hesitancy in starting urination
- frequent nighttime urination (also known as nocturia)
Non-HSPers also suffer these incontinence issues in large numbers for reasons including: inadequate activity or exercise or immobility, inadequate water intake, inadequate fibre in diet, increased body weight, stress, medicines, depression… all of which also apply to HSPers. Too, current research is showing that low serotonin levels, which are associated with depression, can also cause urinary incontinence. For the HSPer, an additional, specific cause of incontinence is malfunctioning nerve signals leading to lower extremity weakness and spastic muscles.
There are lifestyle options that might help to improve control of urinary function. These include eating more fruits, vegetables and fibre, drinking more (not less!) water and getting some exercise. Physiotherapy and biofeedback can also be helpful. Both men and women can benefit from exercises to tone pelvic muscles and retrain the bladder.
Setting up a daily schedule for when to urinate has been shown to be helpful. For example, urinate when you get up in the morning and then at spaced set times during the day – rather than running to the bathroom every time you think of it.
There are numerous incontinence products available now including disposable liners, pads or pants to keep one clean and dry, mattress pads, swim wear and more. Catheterisation (inserting a thin tube into the bladder to remove urine) is helpful for some HSPers (who say it’s not as horrible as it sounds!).
If lifestyle modification alone isn’t enough, there are numerous drugs and patches available, with various side effects and at differing costs. Of course you would need to talk with your doctor or neurologist about specifics and options but these are a few of the drugs your doctor might prescribe.
For an overactive muscle and also a sphincter which fails to open or close appropriately:
- Propantheline bromide
For those who have a problem with retention, these drugs can allow the sphincter to relax to facilitate emptying:
Also found to help with urinary incontinence:
- antidepressant drugs
There are more newly available options including:
- Botox injections – Botox is injected into the bladder, resulting in relaxation of the bladder.
- Sacral Nerve Stimulator Implants – One way the brain controls our body’s muscles and movements is through electrical messages. These electrical impulses are carried by nerves. Sensations such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes. Sacral neuromodulation can help correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.
There is a test phase before implantation of the device. If successful, the device, about the size of a stopwatch, would be surgically implanted in the buttocks to send mild electrical pulses to the sacral nerves. Stimulating the sacral nerves helps the brain and nerves communicate.
We have only just touched on the issue of urinary incontinence here but the important thing is you are not alone and there are treatments available. Unfortunately lots of HSPers and people everywhere have these annoying, embarrassing problems. There are lifestyle issues that might be helpful for you and medical options too, and there are lots of resources for you to explore further.
Continence Nurses and Physiotherapists all can be located either through the CFA helpline or through your Area Health Service. You can ring the National Continence Helpline on 1 800 330 066. The following websites offer a wealth of useful information:
South Australian Government website (http://www.sa.gov.au/government/entity/1646/About+us+-+Disability+Services/News%2C+events+and+resources/A-Z+of+disability+information+sheets+and+publications). Click on the letter C for Continence and scroll down to “Continence: key points” and “Continence Resource Center” to learn about free services provided including a phone number for enquiries and appointments with the Registered Nurse at the Continence Resource Centre.
Continence Foundation of Australia: http://www.continence.org.au/
Offers a national helpline phone number 1 800 33 00 66 and much more.
Bladder and Bowel Website, Australian Government Department of Health and Ageing: http://www.bladderbowel.gov.au/
Better Health Channel, Victorian Government Department of Health: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Incontinence_management?open
MS Australia – Bladder Dysfunction: http://www.msaustralia.org.au/symptoms-bladder.asp
Spastic Paraplegia Foundation (USA): http://www.sp-foundation.org/treatment.html
National MS Society (USA): http://www.nationalmssociety.org/living-with-multiple-sclerosis/you-can/control-bladder/index.aspx
This video http://www.pelvicexercises.com.au/bladder-control-training/ is ideal for women (and men too) who experience urinary urgency (i.e. intense bladder spasm and overwhelming urge to empty their bladder). It provides simple, effective and practical strategies and bladder control exercises to overcome bladder urgency, retrain the bladder and stay dry.
Descriptions of sacral nerve treatment: