Reflex incontinence is under-researched and less well known than other types of incontinence. However, it can have a life-changing impact on sufferers.
According to the North American Nursing Diagnosis Association, reflex incontinence is an “involuntary loss of urine at somewhat predictable intervals, whenever a specific bladder volume is reached”. It is often compared to urge incontinence, in that both conditions cause leakage when the bladder is not completely full.
Just like urge incontinence, reflex incontinence is caused by detrusor dysfunction. This is a dysfunction in the muscle of your bladder called the detrusor muscle. Even if your bladder is not full, this muscle contracts and squeezes. This signals your body to urinate immediately. Whereas urge incontinence causes a sudden urge to urinate, however, reflex incontinence causes no urgent sensation. Accidents may be due to hyperactivity or hypersensitivity of the bladder. Supraspinal reflex incontinence is when brain performance is impaired, whereas spinal reflex incontinence is a occurs when the connection from the brain to the spinal cord is interrupted.
Conditions Causing Reflex Incontinence
Spinal Reflex incontinence is caused by a disease or injury to the spinal cord. The brain and the spinal cord are the central chains of command that transmit signals and messages to and from the bladder. Below the end of the lumbar spine is the sacral spine region. The nerves in this region stimulate bladder sensation and function. When these become damaged, organ dysfunction results and incontinence can occur. Causes of this can include bruising of the spinal cord or inadequate blood flow. Cauda Equina Syndrome can also cause spinal reflex incontinence. This occurs when the spinal nerve roots are compressed due to conditions such as disc herniation, spinal fracture or a lumbar tumour. Individuals with this condition have no control over the function of the bladder or sphincters.
In supraspinal reflex incontinence, brain performance is impaired by diseases such as Alzheimer’s, Parkinson’s, Dementia or a stroke. Researchers Nygaard and Lemke found an association between Parkinson’s disease and urinary incontinence, as did Brown et al. The brain and the bladder consequently do not communicate effectively. Voluntarily bladder control by the brain is not possible. The causes and treatment methods of each type of incontinence differ, so it is important to understand which type you are suffering from. Ensure you go to your Doctor and ask for some tests to determine whether you have reflex incontinence. A Doctor may conduct a cough test to ensure you are not experiencing stress incontinence. You will also be given a urine test to detect a urinary test infection. A blood test, cystoscopy and post-void residual urine assessment will also be required. In preparation, you can keep a bladder diary prior to this so the Doctor can establish links between certain foods/fluids and leakages. To keep a bladder diary, simply keep track of any accidents and the foods and fluids you consumed that day. You should be prepared for a full physical examination so the Doctor has a better knowledge of your medical history.
Ageing: The Huge Risk factor
As a person ages, the immune system weakens, organs begin to deteriorate and the body becomes more susceptible to diseases. Ageing is the main risk factor for prevalent diseases of developing countries, such as cancer, cardiovascular disease, and Alzheimer’s. Many of these diseases are common causes of reflex incontinence. Cerebrovascular diseases, common in elderly individuals, may damage the neurologic pathways which maintain continence. Furthermore, degenerative changes in the central nervous system increase with age. As researcher Magnus Fall asserts, “age-related degenerative and illness-related changes within the cerebrum predispose to bladder dysfunction”. It is not a surprise therefore that epidemiology studies have found a positive association between age and reflex incontinence.
How is Reflex Incontinence Treated?
Most patients with reflex incontinence can be treated successfully by conservative means. This means many individuals with the condition are able to avoid aggressive, surgical treatment. The following are popular treatment methods:
At home behavioural treatment is a non-surgical treatment method for individuals with reflex incontinence. This can include bladder training, which uses distraction or deep breathing techniques to help you suppress leakages. Doctors and experts often recommend scheduled bathroom breaks, in which you avoid the bathroom unless scheduled. This treatment aims to extend the length of time you wait before visiting the toilet.
Interested in bladder training? Read more about it in our bladder training information blog.
Pelvic floor muscle exercises are also recommended as a healthy, non-invasive way to strengthen the muscles in your bladder. Your Doctor can talk to you about the different ways of doing these.
Medication should be considered as a second option if at home behavioural treatment does not work. You can ask your doctor to prescribe medications designed to relax the muscles of your bladder. This medication will gradually reduce bladder spasms. Tricyclic antidepressants often used to treat depression, are often used as an effective muscle relaxant. Spasmolytic drugs are the basis of treatment for hyperactivity or hypersensitivity of the detrusor. Conjugated estrogen is an effective drug for women. You can insert this into the vagina, helping to increase the tone of the urethra muscle. Conjugated estrogen enhances the strength of the pelvic floor muscles. Anticholinergics and antimuscarinics are medications that are designed to relax the muscles of your bladder and reduce bladder spasms.
More drastic surgical interventions are sometimes necessary when other methods have been unsuccessful. This should be considered as a last resort method.
Sling Procedures: Sling procedures are designed to cradle the bladder neck and urethra for support. Some sling procedures can lift up the bladder neck take the pressure off your bladder.
Artificial Sphincter: When men have a problem with sphincter malfunction, an artificial sphincter is recommended.
Cystectomy: For uncontrollable hypersensitivity of the detrusor, cystectomy and bladder substitution should be performed as a last resort.
Electrostimulation: This is an alternative method of treatment, involving stimulation of the afferents of the pudendal nerve, via the pelvic floor.
The method of surgery ideal for you depends on your health and the severity of your incontinence. Your Doctor will talk to you about the best option for your situation.
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