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Incontinence

Incontinence or Incontinent may refer to urinary (bladder) incontinence, the involuntary excretion of urine or bowel incontinence, the inability to control one's bowels. Both conditions are surprisingly common, however with the right treatment and lieftsyle measures both can be managed effectively.

Bladder or Urinary Incontinence

Urinary incontinence is some degree of uncontrolled leakage of urine. It can range from mild to severe.

For instance, some people find that a few drops escape when they sneeze or cough. Others may get a sudden urge to pee and have to dash for the toilet before an accident happens. And others may be more severely affected and have no control over their bladder function.

What are the different types of urinary incontinence?

  • Stress incontinence is the most common form of leakage. It usually affects women after childbirth or menopause, although men can get it too. It's characterised by a little bit of leaking when sneezing, laughing, coughing or during exercise or sex.

  • Anything that makes someone strain against the abdomen can cause pressure against the pelvic floor muscles which need to be tense to ensure the plumbing is kept closed. If these muscles are weak, they can't maintain that tension. When that tension is lifted, the urethra opens and just a little urine can leak out.

  • Overactive bladder (OAB) or urgency urinary incontinence (or urge incontinence) can happen for several reasons and to a range of people. It's an involuntary contraction (tightening) of the bladder which causes partial or complete emptying. The bladder doesn't have to be full for this to happen. People may feel the need to go to the toilet frequently, both during the day and at night, but only pass a trickle of urine.

  • People with OAB can be wet, which means they need to go frequently and they have some leakage; or dry, which means they don't have any leakage, just a need to go to the toilet a lot.

  • Mixed incontinence is when someone has symptoms of more than one type of incontinence, usually the stress and urge types. Often, though, one set of symptoms can be more bothersome than another. It's important to tell the doctor about all symptoms to ensure full treatment.

  • Overflow incontinence is when the bladder fills beyond its capacity. Typically, people have constant or frequent dribbling of urine and are never quite satisfied that their bladder has fully emptied. Sometimes it has similar symptoms to stress and urge incontinence. It can happen because the communication systems (the nerves) between the brain the bladder are damaged. Or it can happen because of a blockage (such as in the urethra), which causes an overfilling which in turn causes overflow and leakage.

  • Functional incontinence is when someone isn't holding in their urine because of a reason that has nothing to do with bladder function. For instance, people can't get to a toilet because of chronic illness or mobility issues. Sometimes people with functional incontinence also have other bladder control problems that need to be treated.

  • Reflex incontinence is when someone loses control over the mechanisms of bladder function. This can be caused by injury, such as a spinal injury, or as a consequence of surgery. It can also happen without any obvious cause. It's characterised by a constant dribble or a total loss of urine without the person knowing (and is sometimes called unconscious incontinence).

  • Dual incontinence is when someone has both bowel and urinary incontinence.

How common is urinary incontinence?

The NHS estimates that between 3 and 6 million people in the UK live with urinary incontinence.1

No one knows for sure how many people live with it. It's common for people not to seek healthcare advice out of embarrassment or resignation to the condition.

Women are more likely to suffer from stress urinary incontinence than men. That's because of the effects of childbirth and the menopause. Men, on the other hand, are more likely to have urinary retention. That's because many men develop prostate gland enlargement as they age

How is urinary incontinence treated?

  • Diet: Some people find that their diet and the types of fluids they drink have an effect on their toilet habits. Getting advice from a dietitian about what is most likely to affect bladder habits can be helpful.

  • Exercise: If a patient has stress incontinence, first strategies usually mean exercises. These will help identify and strengthen the pelvic floor muscles, which control the opening and closing of the urethra.

  • Biofeedback: Biofeedback is a technique used when exercising that measures muscle contractions as a patient does them. Mild electrical stimulation is sometimes used to complement and enhance these exercises.

  • Behavioural therapy: Behavioural therapy can help alleviate bladder capacity problems. There are techniques that can help increase capacity and hold on for longer.

  • Medicines: Medicines can help relieve some symptoms and increase muscle tone. They might be recommended to complement your other treatment options. They are not normally recommended as a first option for stress incontinence.

  • Nerves: Electrical stimulation of the nerves that pass through the lower back can help control muscle reactions, reflexes and sensations. It is called sacral neuromodulation. It is also effective for dual incontinence.

  • Surgery: Surgical options are available to those who need them. For instance, those people who have tried other therapies that haven't worked or are poorly tolerated. Surgery can also fix or alleviate muscular damage or slippages in the structures or organs in the pelvic and bladder area.

  • Continence aids: There are many continence products available. Designs and materials as well as product choice and performance have improved in recent years. These products aid skin care, leakage management and other aspects of continence care.

Bowel Incontinence

Incontinence is leakage of some kind from the bowel, or uncontrollable gas or flatulence that isn't caused by a one-time incident or infection and is repeated or continuous over an extended period of time.

Some people have symptoms such as a little bit staining of their underwear from time to time. Some people pass a lot of gas without knowing.

Others find themselves urgently running for the toilet. Some people are careful to ensure that they know where the toilets are when they go out. This is called toilet mapping.

Some people need to wear continence aids, such as absorbent pads.

Why does it occur?

Women who have had children by vaginal birth, older people (up to 25% of those living in care2), and people who've had trauma, such as an accident or surgery or a stroke, can have bowel incontinence.

Conditions such as diabetes or Parkinson's disease can also cause bowel problems. And people who have an inflammatory bowel disease or irritable bowel syndrome can find themselves running for the toilet or having some leakage.

Bowel incontinence is not an inevitable consequence of having had children. It's not a normal part of ageing.

How common is it?

Studies suggest that in the UK "major faecal incontinence" affects 1.4% of the general population over 40 years old and constipation affects between 3% and 15% of the population.3

How can it be treated?

Each type of incontinence requires specific treatment approaches. A healthcare advisor will assess the condition and help patients to decide what treatment and management options to take.

  • Diet and exercise: Some people find that their diet has an effect on their toilet habits. Getting advice from a dietitian on what might affect the bowel can be helpful. If a patient has muscle weakness, exercises will be recommended to strengthen the pelvic floor muscles and anal sphincter muscles. It’s quite common for people to be unaware of the muscles of the pelvic floor. There are a variety of methods to help you raise your sensitivity to these muscles, such as mild electrical stimulation.

  • Biofeedback: Biofeedback is a technique used when exercising that measures your muscle contractions as you do them. Mild electrical stimulation is sometimes used to complement and enhance these exercises.

  • Behavioural therapy: Patients might also benefit from behavioural therapy, which can mean adapting to a particular regimen that help to attain predictability in bowel habits.

  • Medicines: Medicines can help relieve some symptoms and increase muscle tone. They might be recommended to complement other treatment options.

  • Nerves: Electrical stimulation of the nerves that pass through the lower back can help control muscle reactions, reflexes and sensations. It is called sacral neuromodulation. It is also effective for dual incontinence.

  • Surgery: Surgical options are available to those who need them. For instance, those people who have tried other therapies that haven't worked or are poorly tolerated. Surgery can also fix or alleviate muscular damage or slippages in the structures or organs in your pelvic and bladder area.

  • Continence aids: There are many continence products available. Designs and materials as well as product choice and performance have improved in recent years. These products aid skin care, leakage management and other aspects of continence care.

Incontinence Web Chat

Mr Andrew Clarke, Colorectal Surgeon, from Poole Harbour BMI Hospital joins us live online here on Thursday 10th December 2009 at 14.00 to discuss bladder and bowel problems and the potential treatments to cure this common issue.

References:

1. NHS Direct Online Health Encyclopaedia. Urinary Incontinence. http://www.nhsdirect.nhs.uk (Accessed 12.10.2006)

2. Royal College of Physicians. (23.11.2005) Inadequate and Incomplete – Continence Care in the UK. Press release http://www.rcplondon.ac.uk. (Accessed 10.10.2006)

3. Jarret, M.E.D. et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. British Journal of Surgery 2004; 91: 1559-1569. http://www3.interscience.wiley.com/cgi-bin/abstract/109630867/ABSTRACT?CRETRY=1&SRETRY=0. (Abstract available. Article accessed 21.12.2006)



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