Incontinence

Incontinence

Incontinence can mean urinary incontinence or bowel incontinence. Both cause distress and embarrassment but are conditions that are common and can often be cured or better controlled.

Symptoms

Urinary incontinence:

  • Weeing when you cough, sneeze or laugh
  • Urgent need to urinate but not reaching the toilet in time.

Bowel incontinence:

  • No sensation when passing a stool (poo)
  • Urgent need to pass a stool (poo) but not making loo in time.
  • Defecating small amount while passing wind

What causes incontinence?

Urinary incontinence: bladder weakness (also called stress incontinence) means you leak urine when you sneeze, cough, carry something heavy or laugh. Urge incontinence (or an ‘overactive bladder’) is where you get a sudden urge to wee but don’t make the toilet in time.

Urine is stored in the bladder until we feel the need to wee. At this point our pelvic floor muscles - the muscles we use to control the flow of urine - relax to allow a valve in the bladder (the sphincter) to open to release the urine. At the same time, muscles in the wall of the bladder also contract to help push the urine out.

Sometimes the pelvic floor muscles become damaged or weakened (often as a result of childbirth, the menopause or following prostate surgery). If this is the case then urine can leak out whenever pressure is put on the bladder, such as when you cough or sneeze. This is what happens during stress incontinence.

With urge incontinence it’s the muscles in the bladder walls that fail us. They contract involuntarily overcoming resistance from the pelvic floor muscles and sphincter to force out a large amount of urine. It’s not entirely known why this happens although it may due to an infection or nerve damage following a stroke or spinal injury.

  • Bowel incontinence: can occur because the rectum is unable to store stools properly until it’s time for the loo, or because the sphincter muscles (the valve at the top and bottom of the rectum) don’t work properly. Bowel incontinence can also occur due to nerve damage whereby messages fail to pass properly between the brain and the rectum.
  • Severe constipation, can result in a large stool becoming stuck in the rectum where it causes the muscles to stretch and weaken. Recurrent diarrhoea can cause incontinence as the rectum finds it harder to hold watery stools. Sphincter damage can occur as a result of childbirth or injury and nerve damage may result from a stroke or other illness.
  • Cancer can sometimes cause incontinence due to tumours developing inside the bowel.

How is incontinence treated?

Urinary incontinence: Solutions may include lifestyle changes such as losing weight, reducing caffeine intake and exercising your pelvic floor muscles. Pelvic floor exercises involve squeezing these muscles several times a day to increase their strength. There are also devices you can use such as a vaginal cone to give the pelvic floor a greater workout. Exercising alone may be enough to resolve the problem.

  • Bladder training may also be recommended whereby you learn to increase the length of time before passing urine.
  • If these measures are not effective, medication can be offered or sometimes surgery.
  • Bowel incontinence: If the problem is associated with diarrhoea or constipation simple lifestyle changes may treat the problem. A high-fibre diet (or fibre supplements) may solve constipation and a low-fibre diet may combat diarrhoea.
  • If the condition is caused by muscles weakened through childbirth, a physiotherapist can teach you pelvic floor exercises to strengthen things up.
  • Bowel retraining may be offered to people whose incontinence is due to nerve damage. This can involve biofeedback using electric sensors that relay information from your rectum to a computer to give you details about movement and pressure in the bowels.
  • If the problem results from an impacted stool - an enema may help wash this out.
  • If other treatments have failed, surgery may be required, for example to repair a damaged sphincter. A colostomy (a procedure to cut the colon to enable stools to be collected in a colostomy bag) will be offered only if other surgical procedures are unsuccessful.
  • Continence products can make life easier. These include anal plugs (made from foam) to help prevent soiling, and disposable pads to soak up liquid stools.
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