A sensitive subject

Bladder weakness affects one in three women and one in four men, but despite its prevalence, people may feel too embarrassed to ask for help. So what support can the pharmacy offer?

Bladder weakness affects more than nine million people in the UK, yet many don’t seek medical advice. It’s a growing pharmacy category, especially as the population ages. However, it’s not only older people who experience problems with bladder control.

Bladder weakness can affect people of all ages, and may be associated with some long-term medical conditions, such as neurological problems and prostate trouble in men. It can also be associated with lifestyle factors such as diet, fluid intake and medication. So what should the pharmacy team know about bladder weakness and which products should they stock?

Diagnosing bladder weakness

When advising customers on bladder weakness, it helps to be aware that there are various types, with the two main types being urge incontinence and stress incontinence.

  • Urge incontinence is when urine leaks out and there is a sudden need to urinate (sometimes triggered by a change in position or the sound of running water). It is often caused by overactive bladder muscles and develops either out of the blue, due to a blockage or because of poor fluid intake
  • Stress incontinence causes urine leakage at times of pressure, such as when sneezing, coughing or lifting. It is often caused by weak pelvic floor muscles due to the menopause or surgery
  • Mixed urinary incontinence is a combination of stress incontinence and urge incontinence
  • Overflow incontinence, or chronic urinary retention, is when someone is unable to fully empty their bladder, which causes leakage. This may be caused by an obstruction or blockage, such as an enlarged prostate, constipation or bladder stones
  • Total incontinence is when the bladder can’t store any urine at all, causing frequent leakage. This is usually caused by a problem with the bladder from birth, a spinal injury or a bladder fistula (a small, tunnel-like hole between the bladder and a nearby area, such as the vagina)
  • Urinary incontinence may be associated with the menopause because of changes in the pelvic floor. It can also be a side effect of certain medicines, such as antidepressants, diuretics, hormone replacement therapy (HRT) and sedatives. It may be associated with a lower urinary tract infection, so customers should see their GP if they have any pain or other urinary symptoms
    Customers should keep a diary recording how much they drink each day and how much and how often they urinate. The sooner their symptoms are diagnosed, the better, as urinary incontinence can worsen over time.

Self care tips

Certain lifestyle factors can exacerbate or even cause bladder weakness, but there are a range of ways in which people can manage or prevent symptoms:

  • Lose weight: being overweight can put extra pressure on the pelvic floor and bladder, causing leakage
  • Drink water: six to eight glasses a day is best. Many people with urinary incontinenece limit their fluid intake, but this can make the problem worse as it reduces the bladder's capacity.
  • Concentrated urine can irritate the bladder and cause over-activity
  • Avoid caffiene, or at least limit tea, coffee, energy drinks, chocolate and other caffeinated drinks, as caffiene can irritate the bladder
  • Eat healthily, but avoid spicy curries or acidic foods such as citrus fruits as these can irritate the bladder
    Cut down on alcohol: it is a diuretic, so it makes people urinate more often 
  • Treat constipation: straining to empty the bowels puts more pressure on the pelvic floor muscles and makes urine leakage worse, so customers should eat plenty of high fibre foods, drink sufficient water and take regular exercise
  • Stop smoking: coughing puts extra pressure on pelvic floor muscles
  • Do daily pelvic floor exercises: it’s important to do these properly and for at least three months to see the benefits.
It's important to drink six to eight glasses of
water a day

Product choice

Customers with bladder weakness will want to make sure they stay dry at all times and are prepared for leakage. Many women use sanitary pads rather than specialist bladder weakness products because they’re cheaper and more familiar, but these stay damp and can make the skin sore.

Thorrun Govind, community pharmacist at Sykes Chemist in Bolton, says the bladder weakness fixture can be very confusing, which is why people often use sanitary towels instead. “Pharmacists and pharmacy staff should discuss whether customers are using the right products,” she says. “It’s important to advise that specific incontinence products are much more absorbent and feel more secure. These lock in the odour and moisture, which is why they need to be recommended over sanitary protection.”

One of the most popular products are pads and liners, which are worn inside underwear. There are various absorbencies, shapes and sizes, with separate products aimed at men and women. Liners and thin pads are ideal for minor leakage, whereas more absorbent pads and pants, which are worn instead of underwear, are more suitable for significant wetness, offering security while remaining discreet. These products use the same technology as nappies, with a ‘hydrophobic’ layer that draws urine away from the skin, and are available for both men and women. 

Customers may need to change their product choice according to their activity, using higher absorbency pads when they are doing sports and exercise. For more severe urine loss, customers can use sheaths and drainage systems for men and urinals (urine collection devices) for men and women.

For customers who experience problems at night, you can recommend washable bed pads, which sit on top of a mattress to soak up any urine. Clothing and swimwear brands for people with bladder weakness are available online, and pharmacy staff may wish to direct customers to suitable companies.

If customers experience bladder weakness, they can develop sore skin – just as babies can develop nappy rash. Products formulated for nappy rash should relieve the symptoms, but customers may prefer to use adult-specific brands and pharmacy staff are ideally placed to offer advice on suitable products, such as barrier creams and moisturisers.

Pelvic floor training

Pelvic floor muscles control the flow of urine. If they are weak or damaged, for example during pregnancy or childbirth or after prostate surgery, this can cause urine leakage.

Dr Ruth Maher, physiotherapist, pelvic floor expert and co-inventor of Innovo, comments: “Crucially, it is important that women understand that there is no such thing as a ‘weak bladder’. What we really mean is a ‘weak pelvic floor’. There are common misconceptions surrounding bladder weakness, and these make it more difficult for women to understand the issue and therefore find an effective solution.”

Pelvic floor exercises can help strengthen the pelvic floor and reduce incontinence episodes. These exercises involve contracting the pelvic floor muscles at least three times a day, for at least three months. Ideally, customers should visit a specialist continence physiotherapist to make sure they’re doing the exercises properly.

Pelvic floor strengthening aids may help men and women if bladder weakness is caused by a weak pelvic floor. Some devices provide a visual way for customers to see if they’re doing the exercises properly. Weighted vaginal cones provide resistance, like weighted tampons, but aren’t suitable for women after a significant prolapse. It’s important to speak to a specialist continence physiotherapist before stocking these types of products, as even those available on prescription may not be effective or may not work for everyone.

The bladder weakness fixture can be very confusing, which is why people often use sanitary towels instead

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