Types, Symptoms and Advice
What is urinary incontinence?
Put simply, incontinence is when you can’t control the passing of urine (urinary incontinence) or faeces (bowel incontinence). It could be just a little leak now and then or it could be more of a problem, more often.
If you think you have either form of incontinence you must visit your GP. Everyone’s experience of incontinence is different and it’s important to find out exactly what’s going on in your particular case. You’ll discover there are many things your doctor can suggest that will help and it may turn out to be something very simple. Also you need to remember that incontinence is not an inevitable part of ageing so do speak to someone.
We’ve listed the most common types of incontinence here with some advice on what you can do to alleviate or even eliminate the symptoms, so you can get on with your life.
Types of urinary incontinence
If you let out a little bit of urine when you cough, sneeze, laugh or exercise it’s called stress incontinence. Even gentle exercise, such as walking or lifting shopping can cause leakage. Stress incontinence is most often caused by a weak bladder outlet or weak pelvic floor muscles. It’s a condition that’s more common in women because of the strain childbirth puts on the pelvic floor muscles. Being overweight can also put strain on these muscles and men may develop stress incontinence after a prostate operation.
Help for Stress Incontinence
As with all forms of incontinence, your first action should be to visit your GP. But with stress incontinence pelvic floor exercises are often suggested. If you find it difficult to do these, ask your GP or a continence physiotherapist, as there is equipment that may be used to help you learn which muscles to use. Sometimes very mild electrical stimulation is used to help exercise and strengthen the muscles.
There is also a medicine available for women with a moderate to severe stress incontinence problem. This works best when used with pelvic floor exercises. Ask your doctor for more details. Losing weight may also help control stress incontinence and, if you smoke, try to stop – coughing can make you leak more often. If leakage is very severe, or there is a prolapse, an operation may be suggested. You can choose to have this treatment or not, but for many people it works well.
This is the second most common form of incontinence after stress incontinence and is often caused by an overactive bladder. This is a condition where the muscles in the wall of your bladder contract too often creating a sudden, urgent need to pass urine. You may also need to pass urine more often than usual - known as frequency. If you’re frequently getting up during the night, you may have a condition called nocturia. This type of night-time incontinence can disturb your sleep, making you tired in the day and affecting your daily activities. The reasons for an overactive bladder are sometimes unclear but drinking too much alcohol or caffeine or not drinking enough water can irritate your bladder and cause symptoms of overactivity. Constipation could also be a cause, as can urinary tract infections, blockages in the bladder, neurological conditions or certain medications.
Help for urge incontinence
A technique called bladder retraining is usually suggested to help with urge incontinence and pelvic floor exercises may also help you to hold on. If these don’t work, your doctor may prescribe medicine that can help to calm an overactive bladder. Remember, it’s particularly important for you to speak to your GP about this type of incontinence, as there are so many things that could be causing it – some very simple to remedy.
Also called chronic urinary retention, overflow incontinence is often caused by a blockage or obstruction to the bladder. This could be an enlarged prostate in men, bladder stones or even constipation. With overflow incontinence, your bladder may fill up as usual, but as it is obstructed you can’t empty it completely, even when you try. At the same time, pressure from the urine that is still in your bladder builds up behind the obstruction, causing frequent leaks. This type of incontinence is most common in older men because of the link to an enlarged prostate gland.
Overflow incontinence may also be caused by the detrusor muscles in your bladder not fully contracting, which means that your bladder does not completely empty when you go to the toilet. As a result, the bladder becomes stretched. Your detrusor muscles may not fully contract if there is damage to your nerves, for example as a result of surgery to part of your bowel or a spinal cord injury or if you’re taking certain medications (ask your GP about this). Multiple sclerosis, stroke or Parkinson’s disease may also make the bladder less efficient at emptying.
Help for overflow incontinenceOnce the reason for the inability of your bladder to empty completely has been identified by your GP, a range of options can be discussed. While you’re being treated for the underlying cause you may still need some help with keeping your bladder empty to stop any infection. Your doctor or continence nurse can advise on the treatments available and they may include a temporary catheter or learning self-catheterisation. Discrete incontinence products can also help to absorb any leaks.
Help for urinary incontinence
Help for Stress Incontinence
A specialist nurse or continence physiotherapist may be asked to help you with some pelvic floor exercises. If you find it difficult to do these, there is equipment that may be used to help you learn which muscles to use. Sometimes mild electrical stimulationis used to help exercise and strengthen the muscles. There is a medicine available for women with a moderate to severe stress incontinence problem. This works best when used with pelvic floor exercises. Ask your doctor for more details. Losing weight may also help control stress incontinence and, if you smoke, try to stop – coughing may make you leak more often. If leakage is severe, or there is a prolapse an operation may be suggested. You can choose to have this treatment or not, but for many people it works well.
Help for urge incontinence
Bladder retraining is the best treatment to help with urge incontinence. Pelvic floor exercises may also help you to hold on. If these don’t work, your doctor may prescribe medicine that can help to calm an overactive bladder. Remember, it’s particularly important for you to speak to your GP if going to the toilet in the night is making you tired and stopping you doing the things you want to during the day as this could really impact on your quality of life and there may well be a solution.
Help for overflow incontinence
Once the reason for the inability of your bladder to empty completely has been identified, a range of options can be discussed. A common cause in men is an enlarged prostate gland. (More needed?)
What is bowel incontinence?
Also known as faecal incontinence, bowel incontinence happens when you can’t control bowel movements, resulting in involuntary soiling. Some people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Bowel incontinence can happen on a daily basis for some people, for others it only happens from time to time. It’s important that you see your GP if you’re experiencing any of these symptoms as there are lots of ways they can help. It's thought one in 10 people will be affected by bowel incontinence at some point in their life and it can affect people of any age.
What causes bowel incontinence?
There are several causes of bowel incontinence. One of the most common causes is damage to one or both of the anal sphincter muscles. The external anal sphincter delays the bowel emptying until the urge to empty is felt. People with a weak or damaged external sphincter muscle typically experience an urgent need to go to the loo as the muscles can’t hold on for as long as they need to. If they can’t reach a toilet in time, they become incontinent.
Causes of anal sphincter damage can include tears to the anal sphincter during childbirth so women are more prone to this type of incontinence.
The internal anal sphincter can also become damaged and people with this problem usually complain of passive soiling where soft stool or small pellets leak out without the person realising it is happening. Other common causes of bowel incontinence are constipation, diarrhoea and some medicines. Disorders such as Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury and Alzheimer’s can also result in this type of incontinence.
How to help bowel incontinence
Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms. Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended. Medication and surgery are usually only considered if other treatments haven't worked.
Before you see you’re GP, It is useful to keep aBowel Diaryfor a week or so before your appointment to record things such as how many times you go to the toilet, any accidents you have and what you eat or drink. This will be useful for your Doctor as it may highlight an underlying cause of your symptoms.
If you don't want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence.
Personal care and odour control
If you have bladder or bowel problems, intimate hygiene is very important. Not just for your own daily comfort and confidence but for health reasons too. Involuntary leakage can rapidly lead to unpleasant skin irritations and make bladder infections easier to pick up.
Continence experts often recommend using a cotton cloth and a cleansing lotion which has a pH specifically adjusted for sensitive areas. Or you could try disposable wipes that won’t dry the skin. It’s best to avoid normal soap and baby wipes, as they make the skin dry. Baby wipes often contain alcohol, which can also irritate. After cleansing, it’s important to moisturise and use a barrier cream. This forms a protective layer to block out unwanted moisture.
Many people worry about the possible odour if they have episodes of incontinence, but there are things you can do to avoid this.
Fresh urine shouldn’t smell offensive. If it does, there may be an infection and it’s a good idea to speak to your GP or a nurse. Urine does start to smell when it is exposed to air for long periods so change wet clothes and sheets as soon as possible if you’ve had a leak. If you can’t wash then straight away, keep them in a bucket with a lid until washed to keep odour to a minimum. When you’re out and about good quality, well-fitting pads help to absorb some smell and incontinence wipes can be useful to take with you (a spare pair of pants is also a good idea).
If you’ve had a spill at home, beds, chairs or carpets can be quickly cleaned with a mild detergent or disinfectant - allow fresh air to circulate where you can. You can also use deodorising sprays to keep the room smelling fresh.
If you have bowel incontinence, you may be more worried about the potential for unpleasant smells. So change any soiled pads quickly and place them in an airtight container or sealed bag. If you use your bathroom bin for used pads, make sure you transfer them to the dustbin regularly.
Eating and drinking to help incontinence
When you first experience symptoms of bladder or bowel problems, it can be distressing but there are some immediate and quite minor lifestyle changes you could try that may help.
You might feel tempted to cut down on drinking liquids if you experience urinary incontinence. Don’t! Drink normally, unless you’re advised otherwise. Cutting down on liquids will usually make urinary incontinence worse, not better. Aim to drink at least six to eight cups of liquid each day. However, if you’re struggling with nocturia, the need to pass urine more than twice during the night, try restricting how much you drink in the few hours before bedtime.
If you notice that tea, coffee or fizzy drinks make your symptoms worse, try to replace these with other types of drinks if possible (tap water is an excellent choice) or try decaffeinated versions. Drinking too many alcoholic drinks or drinks with artificial sweeteners in them may also cause problems. Keep track of what you’re drinking and you’ll soon notice which ones affect you. Keeping a note of this can also help.
Certain foods can cause irritation if you suffer from an overactive bladder. Tomato based products, highly spiced foods, fruit and fruit juices, fizzy drinks and foods containing caffeine such as chocolate, tea and coffee can be in this group. Artificial sweeteners can also adversely affect the bladder. Being aware of what triggers your particular symptoms can help you manage then more effectively day to day.
If you have an overactive bladder it’s also recommended that you increase your intake of dietary fibre as constipation can make this condition worse. Fruit, vegetables, pulses and whole grains are the main source of fibre so try and get more in to your daily diet.
Healthy weight to help incontinence
Being overweight can be the cause of many problems, it can also increase your risk of developing urinary incontinence. Carrying excess weight puts extra strain on the pelvic floor muscles. These are the muscles that help you hold on until you get to the loo and if they’re weak, you’re more likely to have a leak or not get to the loo in time. The best way to maintain a healthy weight is through regular exercise and healthy eating and there’s lots of advice on how to do this on the NHS choices website. Before you start any new eating or new exercise it’s a good idea to have a check up with your GP or practice nurse to find out what’s best for you.