Incontinence is a condition that affects millions of Brits each year. There are many forms of incontinence, and they can greatly affect one’s quality of life and become a cause of anxiety and embarrassment in private and public situations. Thankfully, there are a variety of healthy lifestyle choices, treatments, and products that can help cure and improve incontinence symptoms.
What Is Incontinence?
Incontinence is a condition characterised by an inability to control urination or prevent a bowel movement. Without the ability to control one’s bodily excretions, a person affected by the condition would be prone to urinating or defecating even when they are not in a restroom. This can cause a lot of worry and anxiety, making sufferers afraid to leave their homes in fear of being unable to reach a toilet or have an accident in public.
Incontinence is not only a condition that affects the elderly. The condition affects millions of people in the UK and usually depends on lifestyle conditions, health, age and weight. It is common amongst overweight individuals, those with certain health conditions, and women that have given birth.
Different Types of Incontinence:
|Stress||Inability to prevent leakage due to strain on the bladder during activities such as high intensity exercise, coughing, laughing, sneezing, lifting, climbing and bending.
Commonly affects women.
Pelvic floor exercises, surgery.
|Urge||Leaking that occurs after the onset of feeling a small urge to relieve oneself and cannot be controlled.
Common in both men and women.
Pelvic floor exercises, behavioural training, medications, modified diet, surgery.
|Mixed||A mixture of both stress and urge incontinence.||
Pelvic floor exercise, medications, surgery.
|Overflow||The inability to completely empty the bladder when urinating, thus resulting in involuntary leakage.
More common in men.
Therapy involving catheters, medication
|Functional||Problems associated with the physical inability to make it to a washroom at the onset of needing to relieve oneself. Often due to mobility associated with age.||
Working to find a solution for the cause.
While many people rarely discuss incontinence with friends and family, it is a condition that affects people from all walks of life, regardless of age or gender. Urinary incontinence is one of the more common forms of incontinence, and it affects millions of people every year.
What is Urinary Incontinence?
Urinary incontinence is characterised by the inability to control the passing of urine which can be caused by many things including losing control of the urinary sphincter. The urinary sphincter is responsible for holding back the urge to urinate until you reach a restroom. However, those who suffer with urinary incontinence are unable to prevent urinating when the urge arises. The condition can cause great anxiety and isolation in individuals, as many become afraid to go out in public for fear of wetting themselves.
According to the NHS’s website, about 3 to 6 million people in the UK have some degree of urinary incontinence. Urinary incontinence affects women more commonly than men. Approximately 1/3 of women over 30 years old will suffer from it, whereas only a small fraction of men will have the same problem. Nevertheless, those who experience the condition are often too embarrassed to bring up the topic with family and health professionals, and often feel alone in their distress.
What is Faecal Incontinence?
Faecal incontinence (also called Bowel Incontinence) is characterised by the unintentional soiling of oneself due to the inability to control bowel movements. The NHS website estimates that 1 in 10 people will be affected by faecal incontinence at some point in their life. Despite being more common in elderly people, it can affect people of any age. It has been found to affect women more commonly than men. Some will experience the problem on a daily basis, while others will only have the problem now and then. Those with the condition may not feel the urge to go, and therefore often discover they have had a bowel movement after it has already occurred.
Urge incontinence is a type of incontinence that is understood as the immediate and strong urge to urinate or defecate at the onset of feeling a small leakage of urine or faeces (or very soon after).
Overflow incontinence is also called chronic urinary retention. This prevents an individual from being able to empty their bladder completely, and therefore leads to recurrent leaking thereafter.
This form of incontinence is characterized by the problem of making it to the toilet in time when the need to go arises. People who suffer from functional incontinence sometimes have a pre-existing problem with incontinence, or they are just unable to reach the toilet fast enough to meet the need to relieve themselves.
Mixed incontinence is a combination of urge incontinence and stress incontinence, causing sufferers to have an accident based on the strong urge post-leak, or due to stress on the bladder/bowel.
Stress incontinence occurs when the bladder or bowel is stressed or under pressure. This form of incontinence usually occurs when the person laughs or coughs and puts strain on the bladder or bowel (NHS website). Pregnant women often experience this form of incontinence due to the pressure of the foetus in the uterus pressing against the bladder.
What Causes Incontinence?
Urinary Incontinence Causes
We know that the condition is common in males and females from middle age onward, but just what causes urinary incontinence?
- Complications from childbirth
- Certain medications (such as diuretics, antidepressants, HRT, sedatives etc.)
- Excessive drinking of caffeine or alcohol
- Inadequate fluid intake
- Surgical damage to the bladder (ex. hysterectomy, prostate removal)
- Excessive pressure on abdomen (pregnancy, obesity)
- Neurological conditions (such as multiple sclerosis or Parkinson’s Disease)
- Some connective tissue disorders (like Ehlers-Danlos syndrome)
- Conditions of the lower urinary tract (including UTIs or tumours)
- Nerve damage to the bowel or spinal cord
- Birth defect of the bladder
- Spinal cord injury
- Bladder Fistula
Source: NHS Website
Bowel Incontinence Causes
What Causes Bowel Incontinence?
- Nerve damage
- Muscle damage
- Chronic constipation
- Scarred or stiffened rectal walls (from surgery, inflammatory bowel disease, or radiation)
- Rectocele (rectum protrudes through the vagina)
- Rectal prolapse
Source: Mayo clinic
The Most Common Risk Factors of Incontinence
Aging is one of the main risk factors of incontinence. The condition is more prevalent around middle age, and especially after the age of 80 years old. The use of certain medications, the aftermath of surgery, weakening muscles, decreasing health, and overall muscle loss can cause the inability to control the bladder or bowel effectively.
The fluctuation of hormonal activity that occurs during pregnancy coupled with the additional stress on the bladder of holding a foetus in the uterus can both lead to incontinence. Often this form of stress incontinence causes you to leak urine as a result of laughing, coughing, sneezing or bending, and during vigorous exercise like brisk walking or running. More than half of women who experience the condition experienced symptoms beginning after pregnancy. Faecal incontinence also affects nearly a quarter of women who’ve had children.
WEAK BLADDER MUSCLES
It becomes more prevalent for a person to experience stress incontinence and the inability to control their bladder or bowel movements when the bladder muscles become weak or damaged as a result of age, an injury, childbirth or delivery. Strengthening the muscles can help prevent and treat urinary incontinence to a certain degree.
How to Avoid Incontinence
Smoking can help promote incontinence because smoker’s cough puts increasing stress on the bladder and pelvic floor muscles, which in turn can lead to stress incontinence. Smoking also sometimes stimulates the bowel and increases the urge to have a bowel movement.
Practice Pelvic Floor Exercise
Pelvic floor exercises can help prevent and treat incontinence (especially urinary incontinence) by training and strengthening the muscles that are responsible for holding your urge to urinate until you reach a toilet. It can take up to three months of pelvic floor exercise before results are noticeable, but do not give up - these are some of the most beneficial exercises to treat this condition.
Refrain from Lifting
Lifting stresses your pelvic floor muscles, and this can negatively impact your ability to prevent leaks. Avoiding lifting (or only lifting lighter things) can help prevent incontinence, however, the practice of pelvic floor muscle exercises can ensure that you know how to tighten the muscles any time that you are required to lift.
Perform Specific Exercises
Some exercise can increase the possibility of incontinence and lead to greater frequency of accidents. For example, high impact exercises like running tend to put greater stress on your pelvic floor muscles, and they should be avoided or performed lower impact. Certain ab work (such as sit-ups) can also exacerbate the problem and add pressure to your bladder, increasing the likelihood of leaks. Lower impact strength training, certain water aerobics and Pilates are all ideal choices for exercises to help treat and prevent incontinence (especially stress incontinence).
Manage Your Weight
Maintaining a healthy weight is essential for preventing incontinence, as excess fat surrounding the organs can add to the pressure and strain on the pelvic floor muscles. Many people who lost their excess weight noticed a considerable improvement in their incontinence symptoms. Maintaining a healthy weight allows all your organs the room that they need to work at their best capacity, and keeps stress off your bladder or bowel.
Reduce Your Caffeine Intake
Caffeine is an irritant to the bladder and adds to the symptoms of incontinence. Cutting down your caffeine intake can effectively help avoid incontinence, and is part of most treatment plans. Switching to herbal teas and decaffeinated beverages would be a good suggestion for prevention, since coffee is the number one culprit.
Chronic constipation is one of the leading risk factors for both bowel and bladder incontinence. The effects of straining during a bowel movement can cause the pelvic floor muscles to weaken, and can also lead to urinary tract infections (UTIs) that further irritate the bladder. Increasing your fibre intake, drinking more fluids, and exercising regularly can all prevent constipation and help to avoid incontinence.
Avoid or Reduce Alcohol Consumption
Alcohol consumption is an irritant to your bladder, and a risk factor for incontinence. It is also a diuretic that leads to frequency of urination. It’s best to avoid or limit your consumption of alcohol to help prevent issues with incontinence down the road.
Get Adequate Fluid Intake
Health organisations advise drinking 6-8 glasses of fluids per day, and being careful not to dramatically exceed that amount. If your health care provider advises a different amount due to medications or other health concerns, it’s best to follow their specific recommendation.
Avoid Certain Foods
Foods that are high in salt or sugar and those that are acidic or spicy are irritants to the bladder, and they add to problematic symptoms and incontinence. Spicy foods sometimes stimulate bowel movements and further aggravate the bowel, and they are generally advised to be avoided.
Eat a Nutritious Diet
Eating a healthy diet of mild flavoured foods, and lots of highly nutritious, fibre-rich fruits and vegetables can help to keep incontinence at bay.
Source: NHS Website
How is Incontinence Diagnosed?
If you are experiencing symptoms of incontinence, you’ll want to discuss it with your health care professional so that they can understand the best treatment method.
It can be easy to believe that incontinence is embarrassing, and many are ashamed to discuss the issue with a doctor or trusted family member/friend in order to get help. Often people will think that they can prevent or treat the symptoms on their own with incontinence pads and products. However, a doctor will make sure to exhaust all of your treatment options and figure out whether a health condition, medication or prior surgery has caused your symptoms.
There are many incontinence medications and products available to treat symptoms and help improve your quality of life. The diagnostic tools include keeping a log of your bladder and bowel movements for a specified number of days in order to understand the severity of your symptoms. A physician will also perform any number of the following tests and exams:
Testing for Incontinence
· A Complete Physical Exam
This exam will look at your complete health and the workings of your organs, urinary system, bowel and colon, all depending on the specific type of incontinence symptoms that you are experiencing. Females will need to have a vaginal exam in which the doctor will assess their pelvic floor muscle strength, and determine whether you leak after coughing. For males, the doctor will examine your prostate gland and determine whether it is enlarged, as this can cause urinary incontinence. A digital rectal exam or colonoscopy will be performed for anyone experiencing bowel incontinence in order to determine the health of the colon and bowel and check for any health conditions.
· Dipstick Testing
A dipstick test may be performed on your urine in case the incontinence is the result of a urinary tract infection.
· Residual Urine Test
This test checks for the amount of urine that is remaining in your bladder after you use the toilet to determine whether you have a condition called overflow incontinence. This test is normally performed via ultrasound of your bladder, or using a catheter.
· Urodynamic Tests
These tests assess if your bladder and urethra are functioning effectively, and it measures bladder and abdominal pressure, as well as the amount of urine you excrete when you use the toilet.
A cystoscopy is a test that utilises an endoscope to view the inside of the urinary system and bladder, seeking out anything abnormal that could be the cause of your incontinence.
How to Treat and Manage Incontinence
There are a variety of incontinence treatments, medications and products on the market that have been designed to help manage your symptoms and quality of life. Medicine, behavioural training, exercise and diet/lifestyle changes are the first line of treatment, prior to looking into more aggressive and surgical options. Here are some of the common suggestions for what can be done for incontinence.
Monitoring Fluid Intake
If you suffer from incontinence, it is advisable that you monitor your fluid intake throughout the day to give you a better understanding of how your body is dealing with fluids. Fluid is lost throughout the day via perspiration, saliva and the expiration of air, in addition to urine and faeces. Your clinician may advise that you keep a diary with everything that you drink when dealing with urinary incontinence. Remember that it is not only drinks that you should be keeping track of, as certain foodstuffs like watermelon, grapes and cucumber also contain large amount to water which eventually needs to be dispelled. Track your fluid intake and the output too if possible so you can gain a better understanding of your incontinence.
Exercises that help to strengthen the abdomen and pelvic floor (including Pilates, strength training and pelvic floor muscle training) are all beneficial ways to treat and manage incontinence. They help to tighten and hold in the muscles responsible for holding your urine or bowel movements until you can reach a toilet.
A diet high in nutritious foods, fibre and adequate fluid intake, is essential for maintaining good overall health and treating your incontinence symptoms. Avoiding irritating foods (like spicy and acidic foods, as well as those high in salt and sugar) is a major part of an effective treatment plan. Any foods that can irritate the bladder/bowel are also to be avoided.
Medications such as duloxetine and antimuscarinics can help manage symptoms if other treatment options fail, as well as an alternative medication called mirabregron.
Behavioural training includes exercises like timed urination and bladder training, and can also include pelvic floor muscle exercises. These help allow a greater ability to control the urge to use the toilet until you get to the bathroom. Behavioural training courses normally run for a period of six weeks or more and are generally effective treatments methods for incontinence.
Surgical options are usually one of the last options suggested, and only after behavioural training, medications, incontinence products and lifestyle adjustments are all exhausted. Here are some of the surgical options available:
This is one of the most common surgical options, especially for females with stress incontinence of the bladder. Tissue is reallocated to create a synthetic mesh that helps to add support to the urethra. This process can sometimes work for men who have some degrees of stress incontinence.
Inflatable Artificial Sphincter
This is device that can be surgically inserted to fit around a man’s upper urethral area to function in replacement of the sphincter muscle.
Injectable Bulking Agents
This surgical option makes the use of synthetic gels or polysaccharides that are inserted into urethral tissues in order to support and improve the ability to tighten and close the sphincter muscle. This is not a permanent option, since subsequent injections are normally required to maintain effectiveness.
A surgical technique that makes use of sutures to add support to the bladder and urethral tissues.
Incontinence products cannot treat or prevent incontinence, but they are useful options for managing and improving your symptoms. They are also a good option for use while determining which other treatments are right for you, or if your symptoms are mild or infrequent. Some of the following incontinence products may be helpful:
- Absorbent incontinence pads or underwear/clothing
- A catheter for draining urine
- Portable handheld urinals
- Incontinence devices that help prevent leakage during activity
HARTMANN Direct has a wide variety of products for managing incontinence and related symptoms. Click here to view their products.
Incontinence is a common condition that affects millions in the UK, but there is hope to help prevent and treat all the types of incontinence, and greatly maintain your health and quality of life. By maintaining a healthy lifestyle and incorporating exercise and healthy eating, you can ensure to keep incontinence at bay and enjoy your life at any age. Please seek the advice of a medical professional before attempting any of the treatments discussed.