On our previous article we mentioned a study that found out that a diet low in saturated fats can reduce the occurrence of incontinence episodes. That said, we decided to dig deeper on the subject to provide our readers with more information about these fats.
According to the American Heart Association:
“Saturated fat is the main dietary cause of high blood cholesterol. Saturated fat is found mostly in foods from animals and some plants. Foods from animals include beef, beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheese and other dairy products made from whole and 2%milk. All of these foods also contain dietary cholesterol. Foods from plants that contain saturated fat include coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter.”
The American Heart Association’s Nutrition Committee strongly advises these fat guidelines for those trying to live a healthy life:
* Limit total fat intake to less than 25–35 percent of your total calories each day;
* Limit saturated fat intake to less than 7 percent of total daily calories;
* Limit trans fat intake to less than 1 percent of total daily calories;
* The remaining fat should come from sources of monounsaturated and polyunsaturated fats such as nuts, seeds, fish and vegetable oils; and
* Limit cholesterol intake to less than 300 mg per day, for most people. If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day.
For example, a sedentary female who is 31–50 years old needs about 2,000 calories each day. Therefore, she should consume less than 16 g saturated fat, less than 2 g trans fat and between 50 and 70 grams of total fat each day (with most fats coming from sources of polyunsaturated and monounsaturated fats, such as fish, nuts, seeds and vegetable oils).
There are many studies that show the correlation between incontinence and obesity as well as studies that proved that certain foods can help or worsen incontinence episodes. But up until recently no one had studied the effects of saturated fat on incontinence.
A recent study conducted by the Department of Epidemiology at the New England Research Institute and published by the American Journal of Epidemiology examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002–2005).
Research concluded that incontinence in women is improved by weight loss and dietary modification such as reducing the amount of saturated fats in the diet. For detailed information we copied the study’s abstract for you to read it:
Weight loss involving diet modification improves urinary incontinence (UI) in women, but little is known about dietary correlates of UI. The authors examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002–2005). Data were collected from in-person home interviews and food frequency questionnaires. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the presence of moderate-to-severe UI; a severity index was analyzed in secondary analysis of 597 women with urine leakage. Greater total energy intake was associated with UI (Ptrend = 0.0001; highest quintile vs. lowest: adjusted odds ratio = 2.86, 95% confidence interval: 1.56, 5.23) and increased severity. No associations were observed with intake of carbohydrates, protein, or total fat. However, the ratio of saturated fat intake to polyunsaturated fat intake was positively associated with UI (highest quintile vs. lowest: adjusted odds ratio = 2.48, 95% confidence interval: 1.22, 5.06) and was strongly associated with severity (Ptrend < 0.0001). Results suggest that dietary changes, particularly decreasing saturated fat relative to polyunsaturated fat and decreasing total calories, could independently account for some of the benefits of weight loss in women with UI.
As we say regularly, it’s important that Incontinence is talked about more often by TV and celebrities to help break down the taboo’s around that exist around incontinence despite the fact that the condition is so common.
Therefore we were really pleased that Coleen Nolan chose to cover the topic in her new nolan’s online series.
You can also find the programme within our Incontinence Help and Advice section.
History taking in women with urinary incontinence (UI) allow doctors to guide the investigation and management by evaluating symptoms, their progression and the impact of symptoms on lifestyle. A good clinical history will include enquiries about impact of the disease on quality of life by asking how the symptoms affect aspects of daily life and social, personal and sexual relationships.
When obtaining the woman’s history, the aim should be to explore possible aetiological factors and to enquire about neurological disease, past obstetric trauma and gynaecological and urological surgery. When polyuria is present doctors must ensure that this is not secondary to a pathology, such as diabetes mellitus, diabetes insipidus or hypercalcaemia.
But, most of these women will prove to have primary polydipsia and simple advice on fluid restriction should be sufficient to resolve any problem of urinary frequency. To reach a clinical diagnosis, doctors should take a urinary history to determine storage and voiding patterns and symptoms. Common symptoms are:
• Storage symptoms – frequency (daytime), nocturia, urgency, urge UI, stress UI, constant leakage (which may rarely indicate fistula).
• Voiding symptoms – hesitancy, straining to void, poor or intermittent urinary stream.
• Post-micturition symptoms – sensation of incomplete emptying, post-micturition dribbling.
In addition to these symptoms, it is important to enquire about colorectal symptoms and genitourinary prolapse. Accompanying symptoms that may indicate a more serious diagnosis and which require referral – haematuria, persisting bladder or urethral pain, or recurrent urinary tract infection (UTI) – can also be identified when taking a urinary history.
In current practice women with urinary incontinence are categorised, according to their symptoms, into those with stress, mixed or urge urinary incontinence. Around one half of all incontinent women complain of pure stress incontinence and 30-40 per cent have mixed symptoms of stress and urge incontinence.
Women with mixed UI, defined as an involuntary leakage associated with urgency and also with exertion, are treated according to the symptom they report to be the most troublesome. First treatment should commence on this basis. In mixed urinary incontinence, the treatment should be directed towards the predominant symptom.
If you have a question about the contents of this article don’t hesitate to ask them via our comments section or if you prefer a little more discretion you can ask our nurse specialist Shona here.
It is not part of our work philosophy to scrap articles from other websites, we are always looking to provide our readers with unique and informative content about all types of incontinence and incontinence products. But while researching for a new article I came across a very interesting article on Nursing Times where a patient shared its experience of living with urinary incontinence for 12 years, so I decided to share it with our readers.
“I have been suffering with Bowel Incontinence since December 1998 when I started having MS related spasms (although I did not know at this time that I had MS and what the spasms were!). I remember having one of these horrific spasms in the kitchen during the Xmas break and sensing the urgency to get to the toilet!
Over the months from being diagnosed in March 1999 with MS I started having bowel accidents! They are a complete evacuation of my bowel, which is very distressing, embarrassing, disgusting and I worried about leaving the house every day for 11 years in case I have an ‘accident’.
I moved house in 1999 and registered with a new Doctor’s practice. I explained about my bowel incontinence and the following year I was referred to see another gastroenterologist. He did a colonoscopy and took a biopsy but found nothing wrong. He decided to refer me to see a professor of anal physiology who carried out all sorts of tests and the diagnosis was that I have nerve damage in my rectum from the MS, and a tear in my sphincter muscle from childbirth.
My incontinence has got worse over the years. I was diagnosed with diabetes in December 2003 and was put on metformin. These tablets worked fine for quite a while but then in the summer of 2005 I started having the most horrendous bowel accidents. So my tablets were changed and everything was back to ‘normal’. Normal for me meant that I would have a bowel accident at least once a month or more frequently! My tablets were changed to gliclazide and everything settled down again.
I have had contact with a continence nurse since 1999 (in fact she is the one who first diagnosed me with diabetes following a urine sample I asked her to check! She sorted out my bladder incontinence for me by introducing me to intermittent catheters which I have been using since about 2003 and are absolutely brilliant! I also take solifenacin succinate to stop the urgency problems I have with my bladder. She has tried to help me with my bowel problems and asked me to try an anal plug! Well, I did try this one day as I was going to a meeting some distance away and inserted it at 10.00am. At 5.00pm I went to the toilet and something shot out. I felt very sore and uncomfortable and phoned the doctor’s surgery for an urgent appointment.
I explained to the doctor what had happened and took him a sample of a plug. He examined me and fortunately it had come out! I was very relieved! It took a few days for the soreness to disappear and I will never use them again!
My continence nurse then introduced me to transanal irrigation in January 1998. This was difficult to do initially but once I got the hang of it I think the longest I went without a bowel accident was 19 weeks! It was brilliant because my confidence increased and I could relax because I was confident I wouldn’t have a bowel accident. Unfortunately over the months things changed again with my bowels.
I began to have a problem that every time I went to the toilet to pass urine I check myself and found I had leakage from my bowel. I went to see my GP who gave me Picolax and I took the first sachet at 8.00am and four hours after taking it I had a bowel movement which was ok. I was supposed to take another sachet four hours later but decided against it as I felt ‘comfortable’. At 4.00pm I was cooking the tea when I had a huge bowel action and it went everywhere including my shoes!
I didn’t have any kind of bowel movement for eleven days after that! Since then I went back to having bowel leakage every time I go to the toilet to pass urine. I went to see my GP and he told me he had read my notes and should not have given me oral laxatives!
In mid October 2009 I had to visit my GP and he said he had seen a consultant from the Maelor Hospital, Wrexham who had really impressed him with what he does to help people with bowel problems and that he had mentioned me to him. My GP asked me if I wanted to be referred to him so of course I said yes!
I went to see my new consultant and he examined me and realised that I have no muscle control in my rectum at all and he said he would preform a colostomy.
I saw a stoma nurse and she explained to me what will happen if I choose to have a colostomy, what it looks like how I would have to look after it, what I can and can’t do (physically and eat and drink to start with). She gave me lots of information and samples of ‘the bags’ I would use. I asked her lots of questions which she answered and so I was able to make a fully informed decision there and then.
Since surgery I feel really well and wish it had been offered to me a long time ago because it is life changing for me! I no longer have to worry whether I will have an accident either at home or more importantly when I leave the house!”
Source: Nursing Times
Do pelvic floor exercises help, and should they be done during pregnancy and not just afterwards? Do some women have tougher collagen than others in their pelvic floor?
The answers to these questions you will find below, so keep reading.
Preventive measures and conservative treatment for UI can be initiated in primary care. Lifestyle adjustment, in particular encouraging the cessation of smoking, a trial of caffeine reduction, treating chronic cough conditions, providing advice on weight reduction and rectifying exacerbating conditions such as constipation, can often help to reduce the severity of symptoms. Advice should be given on modifying the level of fluid intake for UI or overactive bladder (OAB); the optimum is around 1-2 litres per day. Women with UI or OAB who have a BMI greater than 30 should be advised to lose weight.
Pelvic floor muscle training (PFMT) is an appropriate preventive measure and first-line treatment for most women. The aim is to promote the woman’s awareness of her pelvic floor muscles and to improve their contractility and co-ordination.
Women performing pelvic floor exercise were more likely to be dry or mildly incontinent (61 per cent) than those receiving no treatment (3 per cent). A trial of supervised PFMT of at least three months’ duration should be offered as first line to women with stress or mixed UI. A PFMT programme should comprise at least eight contractions three times per day and needs to be continued on a long term basis to prevent recurrence of symptoms.
PFMT should be offered to women in their first pregnancy as a preventive strategy for UI. There is evidence that PFMT used during a first pregnancy reduces the prevalence of UI at three months following delivery, but effects in the long term are inconsistent and the impact of subsequent pregnancies unknown. The prevalence of urodynamic stress incontinence is thought to be higher in Caucasians, whereas detrusor overactivity is more common among African-Americans.