Myths associated with urinary incontinence

Urinary incontinence only affects women.

WRONG. Despite the fact that a higher incidence is reported in women, men can also suffer from urinary incontinence. In cystic fibrosis, several studies have shown that the incidence in adult women is between 30 and 68% versus between 2 and 16% in men. In the general population, this ratio is 25 to 45% for women and 4 to 32% for men. On the other hand, in children, we notice that this phenomenon can occur frequently. In fact, 8 to 47% of girls who participated in the studies noted symptoms of urinary incontinence compared to 2 to 14% of boys. In the general population, this ratio is 3 to 9% among children of all genders.

Constipation causes urine to be lost.

TRUE. There are several other risk factors for urinary incontinence besides coughing. A constipated person needs to increase the amount of force used to be able to have a bowel movement. This force causes the pelvic floor to stretch and, over time, the pelvic floor muscles relax, preventing it from functioning normally.
Also, the chronic inflammation known in patients with cystic fibrosis can have consequences on muscle contractility, and therefore on the pelvic floor.
A few other risk factors have been studied and explained, such as the quantity and quality of muscles as well as the control of the autonomic nervous system.

People with CF have smaller bladders, so the pressure gets too much more quickly, leading to urinary incontinence.

WRONG. The size of the bladder differs from one individual to another and so there is no connection with the disease. There are 3 types of urinary incontinence: stress incontinence, emergency incontinence, and a combination of these first two types. Stress incontinence is the involuntary loss of urine during sneezing, coughing, or physical exertion. Emergency incontinence is caused by the sudden desire to urinate followed by the loss of urine. In cystic fibrosis, patients, as you might have guessed, mostly suffer from stress incontinence. The normal urination cycle results in the filling of the bladder which causes the first sensations of urination followed by the emptying of urine. Some of the important physiological components to consider are the muscles of the bladder and pelvic cavity. The bladder has a muscle called the detrusor. This muscle allows the bladder to contract when full, causing urine to flow. The urethra is the duct that allows urine to come out. This leaves the bladder and becomes the urinary meatus. The urethra is supported by several muscles that together are called the pelvic floor. When it is contracted, it prevents the flow of urine because it envelops and serves the urethra. The pelvic floor also protects the rectum and uterus in women. Among other things, urine loss can be caused by a problem with the pelvic floor muscles.

The intervention of a physiotherapist is relevant to prevent and treat urinary incontinence.

TRUE. There are physiotherapists who specialize in urinary and faecal incontinence. They are trained to assess and treat problems with urine and stool loss. There are several ways to treat incontinence, including exercises and other specialized procedures. The pelvic floor is a muscle that requires training and rehabilitation.
Urinary incontinence is a subject that is still unknown and that is not discussed enough in cystic fibrosis. It is important to discuss this issue with your treatment team if it occurs. There is a connection between urinary incontinence and the disease. There are several alternatives to deal with this problem and help the patient improve their quality of life.
We hope that this teaching capsule will enlighten you and help you. Do not hesitate to communicate with your resource persons.

Coughing causes urinary incontinence.

TRUE. Cough is the primary risk factor for urinary incontinence in cystic fibrosis. The pelvic floor, previously mentioned, is also intended to support the organs of the abdominal (liver, pancreas, stomach, intestines) and pelvic cavities (uterus, bladder, rectum) cavities. When a person coughs, a variety of muscles contract, including the abs and some back muscles. The contraction of these muscles when coughing causes an increase in pressure on the pelvic floor, which in turn causes it to stretch and, over time, to cause a loss of muscle strength. So, the pelvic floor does not fulfill one of its functions, which is to retain urine by constricting the urethra.
A hypothesis has been put forward that could otherwise explain the urinary incontinence associated with cough in patients with cystic fibrosis. The abdominal muscles become so strong from coughing that it causes an imbalance of pressure in the abdominal and pelvic cavities. Because of the imbalance, the pelvic floor would be unable to function normally and would have difficulty contracting. Therefore, there may be a consequence of urine loss.

There are significant consequences for the quality of life of patients with urinary incontinence.

TRUE. To avoid urinary loss, a person can prevent themselves from coughing, doing respiratory physiotherapy, and limiting physical exercise. It is obvious that these behaviors can have consequences on lung health such as increasing the quantity of secretions and therefore increasing the risk of pulmonary superinfection. Also, patients may tend to isolate themselves, less willing to go out, especially in places where the toilets are not nearby, which can interfere with their social life. Some patients said they needed to wear panty liners to avoid getting their panties wet. In addition, some patients say they tend to drink less, which is not recommended in cystic fibrosis. It is important to stay hydrated for a variety of reasons, such as to compensate for the loss of salt through the pores of the skin that leads to dehydration and to avoid constipation.

Virginie Letendre

Clinical nurse at the CHUM cystic fibrosis clinic
Montreal (Quebec)
Canada

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