Incontinence is the accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence).
The most common form of incontinence is urinary incontinence. It is more common in women. There are five types of urinary incontinence that effect older people:
- Stress incontinence which is leakage during activities that increase pressure inside the abdomen and push down on the bladder. Stress incontinence is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport.
- Urge incontinence, where urine escapes from the bladder soon after the urge to pass urine develops
- Overflow incontinence occurs when the bladder does not empty properly and leakage occurs as a result
- Functional incontinence occurs when a person does not recognise the need to go to the toilet or does not recognise where the toilet is, which results in them not getting to the toilet in time or passing urine in inappropriate places
- Reflex incontinence occurs when a person loses control of their bladder without warning. This is normally due to neurological impairment
Signs & Symptoms:
Urinary incontinence can be caused by a wide variety of physical conditions, including:
- Childbirth can weaken the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence.
- Dysfunction of the bladder and/or the urinary sphincter. In a continent individual, as the bladder contracts, the outlet that releases urine into the urethra (bladder sphincter) opens and urine exits the body. In individuals with overflow incontinence, bladder contractions and dilation of the sphincter do not occur at the same time.
- Enlarged prostate. In men, an enlarged prostate gland can obstruct the bladder, causing overflow incontinence.
- Hysterectomy or other gynecological surgery. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence.
- Menopause. The absence of estrogen in the postmenopausal woman can cause the bladder to drop, or prolapse.
- Neurological conditions. The nervous system sends signals to the bladder telling it when to start and stop emptying. When the nervous system is impaired, incontinence may result. Neurological conditions such as multiple sclerosis, stroke, spinal cord injuries, or a brain tumor may cause the bladder to contract involuntarily, expelling urine without warning, or to cease contractions completely, causing urinary retention.
- Obesity. Individuals who are overweight have undue pressure placed on their bladder and surrounding muscles.
- Obstruction. A blockage at the bladder outlet may permit only small amounts of urine to pass, resulting in urine retention and subsequent overflow incontinence. Tumors, calculi, and scar tissue can all block the flow of urine. A urethral stricture, or narrow urethra caused by scarring or inflammation, may also result in urine retention.
Estrogen hormone replacement therapy can help improve pelvic muscle tone in postmenopausal women
Anticholinergics (i.e., propantheline, or Pro-Banthine) and antispasmodics (i.e., oxybutynin, or Ditropan) are sometimes prescribed to relax the bladder muscles
Other over-the-counter medications such as pseudoephedrine (i.e., Actifed, Benadryl, Dimetapp) may be prescribed to tighten the urethral sphincter.
- Training. Used to treat urge incontinence, bladder training involves placing a patient on a toileting schedule. The time interval between urination is then gradually increased until an acceptable time period between bathroom breaks is consistently achieved.
- Biofeedback. The use of sensors to monitor temperature and muscle contractions in the vagina to help incontinent patients learn to control their pelvic muscles.
- Collagen injections. Collagen injected in the tissue surrounding the urethra can provide urethral support for women suffering from stress incontinence.
- Inflatable urethral insert. A disposable incontinence balloon for women is inserted into the urethra and inflated to prevent urine leakage.
- Intermittent urinary catheterisation. The periodic insertion of a catheter into a patient's bladder to drain urine from the bladder into an attached bag or container.
- Pelvic floor exercises. Exercises to tone the pelvic muscle can help alleviate stress incontinence in both men and women. These exercises involve tightening the muscles of the pelvic floor, and are also known as Kegel or PC muscle exercises.
- Perineal stimulation. Perineal stimulation is used to treat stress incontinence. The treatment uses a probe to deliver a painless electrical current to the perineal area muscles. The current tones the muscle by contracting it.
- Permanent catheterisation. A permanent, or indwelling, catheter may be prescribed for chronic incontinence that doesn't respond to other treatments. A Foley catheter is usually used for urinary catheterization. One end is inserted through the urethra and into the bladder, and the external end is attached to a plastic reservoir bag that the patient may wear on the leg. A second alternative is a permanent catheter, called a suprapubic tube, surgically inserted into the bladder. The tube exits the body through the abdomen near the pubic bone, where it is attached to a drainage bag. As infection may result, this treatment should be reevaluated periodically, and the possibility of alternative treatment addressed.
- Surgery. Bladder neck suspension surgery is used to correct female urinary stress incontinence. Bladder enlargement surgery may be recommended to treat incontinent men and women with unusually small bladders.
- Urinary sphincter implant. An artificial urinary sphincter may be used to treat incontinence in men and women with urinary sphincter impairment.
- Vaginal inserts. Devices constructed of silicone or other pliable materials that can be inserted into a woman's vagina to support the urethra.