About the Urinary Continence Service
Bladder problems are common and in most cases treatable, but a lot of people don't really understood them.
There are several departments involved in your care if you suffer with urinary incontinence including:
- Uro-gynaecology
- Pelvic Obstetrics and Gynaecology Physiotherapy (POGP)
- Urology
- Family Nursing and Home Care
Our specialist team understand the need for; assessment, and a personalised treatment plan, within a confidential service.
Causes and symptoms
Urinary incontinence and bladder problems can occur in people of all ages, and for a variety of reasons.
If you suffer with urinary incontinence, you may have one or more of the following symptoms:
| Type of urinary incontinence | Symptoms |
|---|
| Stress incontinence | Urinary leakage on movement or during exertion leakage with coughing, sneezing and activity which may include sexual intercourse |
| Functional incontinence | Unable or unwilling to go to the toilet |
| Overactive bladder or urge incontinence | Uncomfortable urgent desire to go to the toilet, usually with nocturia (night-time wakening) and urine frequency (going to the toilet too often) |
| Overflow incontinence | Characterised by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate |
| Enuresis | Involuntary urination during the night (bed-wetting) |
| Reflex incontinence or insensible leaking | Complete bladder emptying at regular intervals with no awareness of bladder emptying |
| End of life urinary incontinence | Urinary leakage at end of life |
There are various factors that affect the bladder or cause urinary incontinence, this is why an assessment is important.
Causes can include;
- urine or bladder infection
- constipation or faecal compaction
- enlarged prostate glands
- vaginal prolapse or weakness of pelvic floor
- oestrogen deficiency
- being obese (very overweight)
- pregnancy and childbirth
- drug therapy and medications
- endocrine disorders (diabetes)
- cardiac problems and leg oedema
- poor mobility, environment or psychological state
- neurological conditions or impairment of cognitive function
- weak bladder contraction
Who the service is for
The Urinary Continence Service is for adults of all ages registered in Jersey, who need help to manage bladder symptoms. We provide quality assessment, treatment and management of bladder problems that impact on the quality of everyday life.
Family Nursing and Home Care Nurses can review people at home if they are suffering with lack of control of their bladder and are housebound or in a residential home
Advice for children with bladder symptoms
The Urology and Continence Team is an adult service. If your child is suffering with bladder symptoms, the first point of contact would be their
School Nurse.
How to access the Urinary Continence Service
If you are a women suffering with urine incontinence (but dont have pelvic floor / prolapse issues) or for overflow incontinence, contact the Urology Department.
If you are a woman suffering with stress incontinence or mixed urine incontinence, contact the pelvic floor physiotherapy service. Email POGP@health.gov.je or call +44 (0) 1534 443051
Men suffering with urinary incontinence should contact the Urology Department.
Drinking for a healthier bladder
Don't cut back on your drinks When you're not drinking enough, the bladder gets used to holding smaller amounts of urine and can become oversensitive. You should consume 1.5 to 2 litres (6 - 10 average mug sizes) a day.
Certain drinks are more likely to irritate the bladder. These include drinks that contain caffeine and fizzy drinks – especially those labelled "light" or "diet" which have artificial sweeteners, such as aspartame or saccharine.
Alcoholic drinks, particularly spirits, can also irritate the bladder and for some, the acid in various fruit juices can make problems worse.
It often feels like cutting down on fluid intake will help relieve symptoms of overactive bladder, but this is not the case. A reduced intake will make your urine more concentrated and is likely to make your symptoms worse. For further information visit the Bladder and Bowel Community Website
Bladder training
The aim of bladder training is to teach you how to control your bladder, instead of your bladder controlling you.
Bladder training is the first-line treatment for urinary symptoms associated with an Overactive Bladder (OAB). It is a way of teaching your bladder to hold more urine and helps to reduce the number of times you need to pass urine. It can help to stop urine leaking if you experience urgency (the sudden, uncontrollable need to pass urine).
If you have OAB, you may feel like your bladder contracts before you are ready to go to the toilet. This can happen if you get into the habit of going "just in case", because the bladder learns to hold only a small amount of urine.
When you feel the urge to pass urine, do not go immediately. Try to distract yourself for five to 15 minutes from the time you get the first urge (using whatever method works best for you). If you can do this every time you get that sudden urge, you will find that this symptom begins to improve.
Over the next week, do the same thing but try to delay passing urine for an additional five to 15 minutes. Your bladder will learn to hold even more, and your symptoms will gradually improve.
It is helpful to keep a diary of how much urine you pass and how often while you are bladder training. It will help you see how you are progressing by showing fewer toilet visits with longer intervals between them.
Doing regular pelvic floor exercises together with the bladder training helps you identify and develop the muscles that prevent urinary leakage.
Keep trying even if you find it difficult. Your bladder is like any other muscle in the body. It may require a few months training to reach its full potential. Continue to practice the exercises regularly to maintain their benefit.
Pelvic floor exercises (women)
Up to a third of all women experience a problem with their pelvic floor muscles at some time during their life.
The most common problems are leaking with activity, sneezing or coughing (stress urinary incontinence) and pelvic organ prolapse (a feeling of something coming down in the vagina).
All bladder and bowel functions require good pelvic floor muscles.
The pelvic floor muscles lie across the base of your pelvis to help keep the pelvic organs - bladder, uterus and bowel - in the correct position.
The pelvic floor muscles work to help keep the bladder and bowel openings closed to prevent unwanted leakage (incontinence) and they relax to allow easy bladder and bowel emptying.
Not all women with symptoms have weak pelvic floor muscles, but sometimes they need to learn to use their pelvic floor muscles in the right way and at the right time. Pelvic floor muscles should be kept strong and active just like any other muscle in your body.
How to check if you are contracting your pelvic floor muscles correctly
- using a mirror, check the area between your vagina and back passage (perineum), it should move up and inwards away from the mirror when you contract your pelvic floor muscles. If you see any bulging, STOP, you may make your pelvic floor muscle problem worse.
- feel inside your vagina with your thumb or index finger. Tighten your pelvic floor muscles. You should feel the muscles tightening around your thumb or finger
- if you are sexually active, you could try to squeeze your muscles during sex. Ask if your partner can feel the squeeze
If you experience pain when exercising the pelvic floor muscles, or if you have abdominal or pelvic pain after doing the exercises consult your GP or seek advice from the Pelvic Floor Physiotherapy Team.
Improving your pelvic floor muscles
Pelvic floor muscle exercises (sometimes called Kegels) should include long, held squeezes as well as short, quick squeezes; ensuring that you let the muscle 'go' or 'relax' after each squeeze. Work the muscles until they tire and do the exercises regularly to help the muscles become stronger and more effective.
Long squeezes
- tighten your pelvic floor muscles, hold them tight, then release and let them fully relax. See how long you can hold the squeeze for
- repeat the squeeze and hold until the pelvic floor muscles tire. See how many times you can repeat the squeezes
Short squeezes
Aim to do 10 long squeezes, holding each squeeze for 10 seconds, followed by 10 short squeezes.
You may need to start with 'little and often' if you find that you can only hold the squeeze for a short time, or only do a few before the muscles tire.
You should do your pelvic floor muscle exercises at least 3 times each day. You may find it easier to start your programme when you are sitting or lying down.
Build up your exercise routine gradually over the weeks and months. You should notice an improvement in 3 - 5 months then, keep practising your pelvic floor muscle exercises once a day to maintain the improvement.
As your muscles improve, aim to do your exercises in other positions such as standing up. Eventually you can practise using these muscles whilst doing activities such as walking and bending.
Pelvic floor exercises (men)
Your pelvic floor muscles are important for bladder and bowel control. These muscles help to keep the bladder and bowel openings closed to prevent leakage of urine, faeces or wind. They also relax to allow the passage of urine and faeces out of the body.
How to check if you are contracting your pelvic floor muscles correctly
It is important that you get the right muscles working in the right way.
- sit comfortably with your thighs, buttocks and tummy relaxed
- squeeze and lift from the front by either imagining you are trying to stop yourself from passing urine, or trying to shorten / draw your penis up and inwards
- now try lifting the muscles from the back as if stopping the escape of wind
- when you feel you have the hang of it, try lifting the front and back together
This is a pelvic floor muscle contraction, don't worry if you find it too difficult. After some practice you will find the method that is easiest and most comfortable for you.
How to check that your pelvic floor muscles are working correctly
- place your fingers on your perineum (the area between the testicles and the anus). You should feel the perineum lift upwards as you contract your muscles
- stand in front of a mirror; when you do a pelvic floor muscle contraction you should see the base of your penis draw inwards and your testicles / scrotum lift
Try not to hold your breath while you contract your pelvic floor. You are more likely to breathe easily if you lift your pelvic floor on your out-breath. Do not actively clench your buttocks, but don't be concerned if you feel a tightening in your buttocks and / or lower abdomen at the same time. This is normal. If you are unable to feel a definite tightening in the pelvic floor muscles, you should consider seeking professional advice.
Remembering to exercise
It is easy to forget to do your pelvic floor muscle exercises, particularly when your symptoms start to improve. Try to make them part of a daily routine, doing them at the same time as another activity you already do regularly e.g. brushing your teeth.
Try the following suggestions:
- put a reminder on your phone
- try one of the pelvic floor exerciser apps available
- after emptying your bladder, whilst sitting on the toilet (but don't practise by
- stopping your urine flow)
- take a moment to do them when you go to the gym
- during a regular journey in the car, bus or train
Ideally you will be able to improve your pelvic floor muscles with these exercises. Some people like to use gadgets to help them remember. There are many available to buy, but they don't always suit everyone.
Ask your GP to be referred to the pelvic floor physiotherapist if you are finding it difficult to do these exercises due to health problems, or if your symptoms are not improving.
Other ways to help your symptoms
Lifting
Always try to avoid unnecessary strain on your pelvic floor muscles. If you have to lift in your job or daily routine, get advice about safe lifting and equipment to help
Intra-abdominal pressure
Tighten your pelvic floor muscles before any activity which involves a rise in intra-abdominal pressure:
- coughing
- sneezing
- lifting
- carrying
- bending
- hard laughing
Constipation
get help from your doctor if you tend to strain on the toilet. Make sure that your diet has enough fibre, and that you drink at least 1.5 litres of fluid per day
Going to the toilet
Using a step or stool under your feet while on the toilet helps create a squatting position which will reduce pressure into your rectum when passing a stool. This reduces pressure on the ligaments and muscles in this area.
It is also important to sit and relax on the toilet and not hover This does not allow your pelvic floor to relax completely while you empty your bladder
Relaxation
Relaxing your pelvic floor muscles is just as important as exercising them. Increased stress can cause changes to your posture and breathing and this can put more tension in all our muscles, our pelvic floor included. Practising mindfulness techniques can help improve your breathing as well as relax your muscles
Weightloss
If you are overweight, try to lose weight. Even quite small changes in weight can help with your symptoms. Seek help from your doctor if you have tried but not succeeded with weight loss.
Exercising
If you find that you have stress urinary incontinence during exercise, try a low impact activity such as pilates, walking and swimming. You might need to avoid very high impact exercises which involve jumping, heavy weights or prolonged increases in intra-abdominal pressure e.g. double leg lifts
Smoking
If you smoker, try to give up. Your doctor might be able to refer you to a smoking cessation group.
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