Next week is Arthritis Week presenting an opportunity to highlight the connection between arthritis and continence issues.
While arthritis doesn’t directly affect bladder or bowel function, incontinence associated with arthritis is common, and the problems often start with reduced mobility and joint stiffness, says the Continence Foundation of Australia (CFA).
The CFA highlights the following issues which pharmacists may be able to assist with. For example:
Not getting to the toilet in time
Limited mobility can result in people with arthritis arriving at the toilet too late. Some common compensatory measures taken to avoid accidents can actually exacerbate incontinence. For example, going to the toilet before feeling the urge may work for the short term, but can lead to the bladder losing its capacity over time, resulting in its emptying more often in increasingly smaller amounts.
Another compensatory measure is to reduce fluid intake in the hope of reducing the number of trips to the toilet. While this appears logical, the reverse is true; insufficient fluid causes the urine to become concentrated, which can irritate the bladder, causing to it empty more often, resulting in frequency and urge incontinence.
Stiffness, particularly in the hands and wrists, can make removing underwear and outer clothing difficult. Again, trying to compensate by going to the toilet before feeling the urge, or reducing fluid intake, can all risk frequency and/or urge incontinence.
As people get older, the bladder muscle can become overactive, resulting in more frequent bladder contractions and more trips to the toilet. The two main symptoms of overactive bladder – frequency and urge incontinence – can worsen over time to the point where leakage occurs even before reaching the toilet.
People with arthritis are more prone to constipation, either because they are not as active as they used to be, or because they are limiting their fluid intake to manage their bladder.
Constipation is one of the main causes of urinary incontinence, particularly in older people. This is because an overfull bowel pushes on the bladder and restricts its capacity to hold urine, which can lead to frequency and urge incontinence. In addition, straining on the toilet because of constipation can stretch and weaken the pelvic floor muscles, which can lead to stress incontinence.
According to the CFA of Australia, there is much that can be done to help people with continence issues, as not only is it common, people need to understand that they can be helped if they seek help.
In fact, the CFA says 1-in-4 adults have some form of continence issues; and it has a far reaching impact on quality of life, and sadly, can lead to depression, particularly in women.
“Incontinence is not normal, and should never be ignored. Fortunately, in the majority of cases, there is much that can be done to prevent or better manage incontinence,” says the CFA..
The CFA recommends some basic steps for people with arthritis, such as wearing clothes that are easily removed, and using toilet aids that their occupational therapist can best advise on.
The Foundation also recommends these 5 steps for good bladder and bowel control for everyone:
- Eat a balanced diet that includes at least 30g of fibre daily.
- Consume about 1.5 -2 litres of fluid daily, limiting caffeine and fizzy drinks.
- Exercise regularly.
- Keep the pelvic floor toned.
- Practise good toilet habits.
Pharmacy staff seeking advice on managing their patients’ incontinence can speak to a continence nurse advisor on the free, confidential National Continence Helpline (1800 33 00 66). The Helpline is also available to consumers, who can phone for advice and information about arthritis-specific or any other incontinence.
An extensive range of free resources, videos, educational opportunities and information is available for pharmacy and consumers by clicking here