This post discusses how our body controls peeing and how one can lose it when a stroke occurs.

How peeing is controlled?

First, let us look at the anatomy of the structures that produce and store urine. Urine is a waste product that is filtered and passed out of the kidneys to the store-room (bladder) via two tubes (ureters).

Figure 1 below shows the tubes (ureters) that transport out urine from our kidneys and the inside view of our storage facility (bladder). As you can appreciate that the storage facility’s wall is thick. It is made up of a strong muscle called “detrusor” and stretchable to accommodate about 450-500 ml of urine.

When our bladder fills up to this much of urine, we get to know it. How?

We will receive messages continuously until we decide to empty the bladder through a web of nerve endings that cover the whole outer layer of the bladder wall. These nerve endings relay their situation to the nearest transit center which is stationed at a place of the lower part of the spinal cord. This center again relays this message to the master control center placed at the brain and awaits a signal of approval to open the gates.

Control gates

Go through Figure 1 again; find out the two control gates. We have two gates: the inner gate (named inner urethral sphincter) and the outer gate (named outer urethral sphincter). These are situated in the tapering lower part of the storage facility (bladder). No sooner the transit center at the spinal cord receives the approval from the brain center, it sends to messages to the gates to open and the bladder wall to contract.

What happens in a stroke?

A stroke can attack the brain’s regulatory center and as a result, may lose the ability to control the transit center. Therefore, as soon as the bladder is getting filled, urine may go through the gates.

This does not happen among all those who face a stroke, but only among those whose a large part of the brain is attacked.

Therefore, we can consider that the presence of incontinence after stroke as a marker of stroke severity and the best single predictor of survival and recovery at the end of three months.

However, brain damage is not the only reason for the incontinence after stroke; it can happen due to a myriad of other factors: inability to communicate to the caregiver for assistance; delay in reaching the disposing container; delay in transferring to the commode, and some medications such as urine pill (diuretics).

Would you like to add more to this post? You can. Add your inputs into the comments section.

A variety of urine absorbent products for men exist in the market. Some products – pull-ups and diapers – wear both men and women. I wrote about those in one of my earlier posts.

This post is about urine absorbent products for men.

Inserts

Men wear inserts, as its name by itself implies, are placed inside the diaper or brief. For men, some products exist in the market to contain urine as it comes out of the penis. One such product is the pouch (leaf).

Leafs or Pouches: Inserts for men who dribble urine

The pouches or leafs are for men who dribble urine in very little amounts. As its name implies it covers only the penis so that urine does not spread around the scrotum and groin area. It holds about 1-2 ml of urine.

Baby diapers

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Baby diapers (size 1) are creative alternatives some people use particularly during day time. You can wrap it around the penis. Obviously, it is not suitable for men whose penis is now retracted. These products can hold little more urine than pouches. The main advantage of this over pads is that you can remove it if it is wet and can insert a new one during the day easily.

Pads (also called liners, leaves, sheaths, shields or guards)

Unlike pouches and baby diapers, pads (sheaths or guards) cover the groin allowing urine to spread around the area. Not only men who dribble but those who leak a lot of urine also wear these. Pads have an adhesive strip on the outer layer to paste it on to either brief or adult diaper with tabs with the aim of keeping it in place.

These pads are available in small and large sizes. While small ones are used by men who dribble urine large sizes are used by those who leak moderate – large amounts of urine.

Small disposable pads

The following is an example of small incontinence pads with its outer and inner views.

large incontinence pads

HOW TO USE A PAD

The following video clip published by continence product advisor.org shows you the step-by-step about wearing a pad.

Key points

• The incontinence pads for adults include diapers, briefs, and inserts.
• These are structured into three layers: inner, middle, and outer.
• The inner layer lies in contact with the skin, permeates urine and body fluids into the middle absorbent layer.
• The outer layer does not allow to leaking of urine out of the diaper.

Stroke carers cannot evade the problem of urine /fecal incontinence which is one of the most challenging. It drains out all the energy, innumerable number of hours, and money.

Stroke carers need to have a very good understanding of incontinence pads in order to manage the urine incontinence satisfactorily. The knowledge definitely saves not only the carer’s money but improves the quality of life of the carer as well as the person living with a stroke too.

My aim of this post is to broaden the readers’ knowledge about adult diapers and briefs; however, I invite caregivers to share your knowledge, experience, and new information that this post does not include. It will definitely be an immense help for those who are facing the difficulties I spell out here.

Before going any further, I invite you to read one of my earlier posts about the anatomy of the bladder. because you will have an understanding of various forms of urine incontinence that occur such as “stress incontinence” and “urge incontinence”.

Adult diapers or briefs?

First of all, a word of caution: the word, “diaper” may carry a certain degree of stigma for an adult because it is a thing for babies – the adult version of a nappy; hence adults may prefer the word, “brief” to “diaper”. I believe this is crucial in protecting the affected’s dignity. However, even the government of Canada website uses the term “adult diapers”.

When to use?

Adult diapers and briefs are intended for those who experience “moderate to heavy” urine incontinence. This is what the book says. But determining the “moderate-heavy” incontinence is challenging. Experts agree that those who pass more than 100 ml urine within 24 hours are having “moderate-heavy incontinence”. And, those who pass less than 100ml are experiencing a “light” degree of incontinence.

How do you decide that?

I will deal with that problem later. You need to be able to estimate the leaking volume because this is one of the criteria manufacturers adhere to when producing incontinence products.

First of all, I will describe here the main parts of a diaper or a brief.

Anatomy of adult diapers and briefs

A standard diaper consists of three layers: the inner layer, the middle pad, and the outer layer. The following is the basic structure of an adult incontinence brief.

The inner layer (top sheet) – the inner layer

The inner layer lies in direct contact with the user’s skin; the fabric here is non-woven material to enable urine and other body fluids permeating down into the middle absorbent pad.

The middle absorbent pad – the middle layer

The absorbent pad – the most important section – consists of super absorbent polymer – of course, a synthetic type – which can absorb water as much as 20 times more than its weight. Some products contain fluff pulp too.

The outer layer (back sheet) – the outer layer

Unlike the inner layer, this one is made up of woven fabric designed not to allow trapped body fluids seeping through onto clothes or bed linen.

Elasticated wraps and self-adhesive tabs

Since a diaper is an adult version of a nappy, it holds itself with its elasticated wraps around the thighs and self-adhesive resealable tabs around the waist.

What are the adult diapers and briefs?

Broadly speaking, adult urine absorbent types exist in two forms: pull-ups and diapers with tabs (tape-attachment diapers). Most of these products are disposable; few varieties exist as reusable too.

Briefs (Pull-ups)

Briefs are also called “pull-ups” which are like shorts – you can call it as a type of underwear too – to which the absorbent materials are built into it. Those are ideal for those who are not bed-bound it does not hinder walking and other body movements. However, sometimes those who cannot sit or stand, wear this type too.

Pull-ups come in various sizes: small or medium, large or extra-large, and XXX large. The government of Canada website publishes item numbers and prices per each size for provinces and territories.

Diaper with tabs

This type is ideal for bed-bound clients. It also comes in different sizes like pull-ups. The advantage of this type is that we can adjust with the tab to make it snug fit properly. Companies sold these under the term “adult briefs (tape-on)”. According to the Cochrane research database, this type is the most cost-effective one for men with moderate-heavy urine incontinence.

What do we know about urine incontinence?

Key points

• Pelvic floor exercises prevent and reduce urine incontinence.
• The available evidence for effective interventions to reduce the toll of urine incontinence among stroke survivors is inadequate.

I am a fan of Cochrane reviews. Just in case, if you are not aware of Cochrane reviews, it is a global repository of high-quality reviews of research published across the globe on specific health problems people face. They do not entertain commercial or any other sort of conflicted funding. Most countries own their own Cochrane review centres.

On behalf of the 2019 world continence week which falls between June 17 – 23, Cochrane published a summary of reviews they published about the effectiveness of interventions on urine incontinence. This post is about that.

Following are their summaries;

1. Do pelvic floor exercises prevent/reduce incontinence?

For those who are not familiar with pelvic floor exercises, you can read about this through this post link. This is a common dilemma among front line healthcare providers. Cochrane reviewers reached the following conclusions after reviewing 31 studies involving 1817 women from 14 countries.

The authors of this study concluded that when compared to no treatment, women with stress incontinence if they practice these type of exercises are eight times more likely to report continence! This is a pretty amazing result, right?

Those who are interested in the complete report can read through this link:https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005654.pub4/full

2. Treating incontinence after a stroke in adults

This is again a very important and critical study; unlike in the previous case, the authors of this study concluded that the existing evidence was inadequate. If you are a caregiver, you may be dealing with your loved one’s incontinence problem with adult briefs (diapers) and pull-ups most of the time; sometimes with catheters too. They reached this conclusion and highlighted its evidence gap after reviewing 20 studies which involved as many as 1338 adults with urinary incontinence one month after a stroke event.

Those who are interested in reading their full paper can access the paper through this link: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004462.pub4/full

In one of my previous posts, I highlighted that urine incontinence is the leading cause to seek residential care in Canada and the US. In spite of its prime significance, you can see how little we know about its management.

According to a Canadian Continence Foundation report, published in December 2014, urinary incontinence leads among other reasons to seek a bed in residential care both in the US and in Canada. The report further claims that as many as 3.5 million Canadians experience some form of incontinence – either urinary, fecal or both.

Keep in mind that not all people acknowledge the existence of this problem due to the embarrassment of divulging that sort of information to a researcher – an outsider.  

Because those with incontinence spend more time in clinics and hospitals, family caregivers spend innumerable numbers of their productive hours in clinics.   

And, we know that due to the ageing of the population – an unavoidable phenomenon – this the negative impact of the problem grows exponentially.

So, what can we do?   

Learn a little bit more about how urge urine incontinence occurs among those who face a stroke by clicking this link: https://www.strokecarer.com/peeing-problem-in-a-stroke/

Do you have similar experience and what actions you take to address this problem? Would you like to share for the benefit of others? 

You can reach the Canadian report that I referred to in this post via this link: http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf