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Arthritis and bladder and bowel control

Photo: Arthritis and bladder and bowel control
It’s Arthritis Awareness Week May 29 – June 4.  Arthritis is the major cause of disability and chronic pain in Australia, with 3.85million Australians affected each year.*

While arthritis doesn’t affect the function of the bladder or bowel directly, functional incontinence associated with arthritis is common, with reduced mobility and joint stiffness often where the problems start.

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.

Joint stiffness
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.

Overactive bladder
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.

Constipation
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.

Preventing and managing incontinence
4.8 million (one in four) Australian adults have some form of incontinence. It has far-reaching impacts on quality of life and is associated with 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.

The Continence Foundation of Australia 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 five steps for good bladder and bowel control for everyone:
1. Eat a balanced diet that includes at least 30 g of fibre daily.
2.   Consume about 1.5 -2 litres of fluid daily, limiting caffeine and fizzy drinks.
3.   Exercise regularly.
3. Keep the pelvic floor toned.
4. Practise good toilet habits.

For more information go to continence.org.au/pages/prevention.html

Health professionals 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.

* Painful realities: The economic impact of arthritis in Australia 2007 (Report by Access Economics, Pty Ltd for Arthritis Australia. 2007

This article is supplied by the Continence Foundation of Australia, the peak national organisation working to improve the quality of life of all Australians affected by incontinence. For more information go to continence.org.au

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