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Incontinence

The various types of urinary incontinence and bowel incontinence, and how they can be treated.

There are around 14 million people with a bladder control problem and 6.5 million people with a bowel control problem in the UK.

In many cases incontinence can be treated and often cured. Even when the problem does not clear up completely, there are many ways of reversing incontinence.

Urinary incontinence

The main types of urinary incontinence are:

Stress incontinence

Stress incontinence results in leakage when you exercise, laugh, cough or sneeze.

In women, it is caused by pelvic floor muscles that support the bladder outlet being stretched and weakened by childbirth.

After the menopause women stop producing the hormones which keep the vagina and bladder outlet healthy.

Men can suffer from stress incontinence following a prostate operation.

Treatment and control
The best treatment for stress incontinence is pelvic floor muscle exercises.

Sometimes mild electrical stimulation can exercise and strengthen the muscles.

A medicine is available for women with moderate to severe stress incontinence. It works best when used with pelvic floor muscle exercises.

If leakage is severe, surgery is an option.

Reaching and staying at your ideal weight may also help control stress incontinence.

Urge incontinence

Urge incontinence, also known as ‘overactive bladder’, is the need to urinate so urgently that you are often unable to reach the toilet in time.

It often means you need to urinate with greater frequency than is normal, including interruptions to your sleep.

Urge incontinence affects people as they get older because with age the bladder becomes weaker and the nervous system becomes less efficient at sending messages telling the bladder to ‘hold on’.

An overactive bladder can be caused by a stroke.

Treatment and control
Urge incontinence is best reversed by bladder retraining.

Pelvic floor muscle exercises may also help you 'hold on'.

Overflow incontinence

Overflow incontinence is when the bladder doesn’t empty properly.

Urine continues to fill the bladder and will often dribble or leak. You may have difficulty starting to urinate and feel that your bladder hasn’t emptied completely or is emptying more slowly than before.

The bladder may not empty completely because of an obstruction, most commonly an enlarged prostate gland.

Severe constipation can also block the bladder outlet.

Conditions such as diabetes, multiple sclerosis, stroke or Parkinson’s disease may make the bladder less efficient.

Treatment and control
Overflow incontinence is more difficult to treat, especially when caused by other illnesses.  However, obstructions such as the prostate gland can be removed and severe constipation treated.

One treatment for overflow incontinence is 'intermittent catheterisation' which enables the patient to empty the bladder completely by using a small plastic tube two or three times a day.

Occasionally a permanent tube (catheter) is the best treatment.

Other factors

Not drinking enough makes the urine concentrated and makes the bladder less efficient.

Carbonated drinks and alcoholic drinks may cause bladder problems.  Too much caffeine can also cause problems for some people.

Bowel incontinence

Inform your doctor as soon as you are aware of bowel incontinence, significant changes in bowel habits and any blood in your bowel movements.

How the bowel works

The bowel takes the nourishment from food and gets rid of the waste. This waste travels along the large bowel where it is formed into bowel motions (faeces).

When these arrives in the rectum they create a feeling that prompts you to evacuate the motions through the anus.

Normal bowel motions:

  • are soft and easy to pass;
  • may come several times a day, or only once every two to three days;
  • don’t need force to pass.

Causes of bowel incontinence

Although it seems unlikely, constipation is the most common cause of bowel leakage as it causes small pieces and liquid mucus to be passed without warning.

Diarrhoea causes bowel incontinence. It has many causes including:

  • the overuse of laxatives;
  • stomach infection;
  • food poisoning;
  • alcohol and substance abuse;
  • change of diet;
  • change of climate, in particular exposure to heat and sun;
  • irritable bowel syndrome;
  • bowel diseases.

Bowel incontinence can also be caused by muscle weakness (for example after childbirth) and nerve diseases.

In mainly older people, bowel incontinence is caused by dementia and stroke.

Other illnesses such as Parkinson’s Disease and Motor Neurone Disease can cause constipation.

Treatment of bowel incontinence

Unless it is caused by a disease or illness affecting the bowel, colon or rectum, bowel incontinence can be self-treated by addressing the causes of diarrhoea and constipation.

Diarrhoea can be treated depending on its severity. It is best to take medical advice to find its cause and then take the appropriate treatment.

Constipation can be cured by:

  • drinking at least three litres of liquid each day;
  • eating five portions of fruit or vegetables a day;
  • eating a high fibre diet;
  • cutting out junk food and processed food;
  • increased exercise;
  • reduced caffeine intake;
  • changing medicines if constipation is a side effect of a current medication.

Getting help

Many people are too embarrassed to seek help for their incontinence.

However, your GP will put you at ease. He or she will talk to you about  your incontinence and possibly examine you.

Your GP may be able to treat your incontinence or might refer you to a continence advisor or hospital specialist such as an urologist or geriatrician.

These may carry out bladder tests and provide suitable treatments.

The continence advisor is a specialist nurse who will help with bladder retraining and pelvic floor exercises, and organise the supply of pads and othere appropriate items.

You can refer yourself to a continence clinic.

Your doctor may arrange for a district nurse to visit you.

A specialist continence physiotherapist can teach pelvic floor exercises and improve your mobility.

An occupational therapist can also provide advise on suitable aids and equipment.

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