Voluntary incontinence of urine

As the bladder fills with urine a stage is reached when we realize that we could pass urine if we wanted to and if it was appropriate, but at this stage it is not urgent – we can suppress this sensation, for example, when sitting in the cinema or on a bus. Some time later, however, another sensation tells us that we have to go soon. Gradually the feeling gets more urgent and painful. If stuck in a lift or tied to a chair, all of us would inevitably have to pass urine, i.e. be voluntarily incontinent. We would know what was happening, but force of circumstance would cause the incontinence.

A person with Alzheimer’s disease in a strange environment will suffer this latter fate; they know that they need to go but often cannot communicate this or else can’t find the toilet. The person is then either incontinent or they pass urine in an unacceptable place (sink, waste bin, etc.). Carers and others often know when the toilet is needed because the sufferer gets a little more agitated, begins to get up and wander and may clutch their private parts. Guiding them to a toilet quickly often saves the day. The environment is thus extremely important, not only for the mentally confused but also the other main group that are prone to voluntary incontinence, the immobile. A person with a physical handicap (such as a stroke) will find the stairs up to or down to a public toilet as daunting as you or I would find climbing Everest. A poorly designed environment can mean misery to the disabled and a lot of bladder discomfort.

Drugs (especially diuretics/water tablets) can cause sudden incontinence. The strong acting ones begin to work within minutes and fill the bladder so quickly that the incontinence starts before the person is really aware of it, especially if they are a little confused and perhaps slightly immobile. Some people sit on the toilet for a good few hours after taking their tablets, until the danger of incontinence has worn off. It is simpler and better to see one’s doctor and change the medication.

We should perhaps remember that for millions of people passing urine when and where they like is a fact of life and as culturally accepted as our use of toilets with all mod cons.

Voluntary incontinence of faeces

This is much less common, but the same basic principles as above apply. It is easy enough to ignore the desire to have one’s bowels open, and eventually the urge can go away (the motions move back up the large bowel). However if this is done frequently then the motions dam up and get passed involuntarily.

Confusion is again one of the main causes of voluntary incontinence of faeces, and being able to find a toilet the best way of treating it. Thus the environment and immobility also play an important role. Again, cultural differences spring to mind, for in some countries faeces form the basis of manure in the fields and are passed accordingly.

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Among new lens wearers, soft contacts are favored two to one over hard contact lenses. Still, hard contacts do provide superior visual correction and are the only type corneal surface. They are less expensive, more durable, require minimal care – daily removal and simple cleaning -may be polished to remove scratches, and reground to adjust to small changes in the eyes. But hard contacts require a protracted break-in period. They are difficult to get used to and must gradually be worn for hours at first and then only up to eighteen hours at a time. If you stop wearing them for a few days, you must repeat the gradual breaking-in process. Rushing the adjustment can lead to painful eye inflammations.

Hard contact lenses let you change the color of your eyes. They can be tinted purple for cosmetic uniqueness, made into bifocals, and do correct a wide range of deficiencies. They may be adapted in any number of other ways limited only by one’s imagination.

Made of a special hard plastic, as well, the gas-permeable contact lens is more expensive than the standard polymethyl methacrylate hard contact. It lets through oxygen and carbon   dioxide,   enabling the cornea   to “breathe.” The gas-permeable lens seems more comfortable to most people. They adapt to it faster than the regular hard lens. If you need the visual correction offered by a hard lens but cannot tolerate the conventional type, the gas-permeable one is probably preferable.

The American Association of Ophthalmology warns that there are certain conditions which make the wearing of contact lenses inadvisable. Examples are chronic inflammation, infection, or allergy affecting the eyes. Some persons suffer from chronic dryness of the eyes due to a deficiency of tears; this may make it impossible for them to tolerate contact lenses. A person who cannot manipulate small objects with ease because of arthritis or tumor affecting the hands is also not a proper candidate for contact lenses. There may be some transient discomfort during the initial period of adjusting oneself to contacts. You may experience discomfort if a bit of foreign matter gets into your eye and lodges behind the lens.

At the beginning of this subsection on contacts we suggested that loss of a contact lens could stop traffic. In fact, if your lens should become dislodged or lost while you are driving, a serious hazard would result. Persons who wear contacts and do a lot of driving are advised to carry a spare set of lenses.

If you have an illness which might cause you to lose consciousness at times, as with diabetes or epilepsy, you should wear a medical information bracelet which, along with other vital information, records the fact that you are wearing contact lenses. In an emergency, the person providing medical care would be alerted to remove the lenses. Hard contacts should never be worn during sleep. The natural blink reflex keeps fluid circulating under the lens; this is necessary to the metabolism of the cornea. Normal fluid circulation ceases when the patient sleeps with his contact lenses in place.

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